대한대장항문학회

Anal outlet obstruction(AOO), which was caused by various anal diseases, presented<br>symptoms like acute or chronic constipation, obstipation, painful defecation and bleeding.<br>We retrospectively reviewed these patients to identify underlying diseases, corresponding<br>surgical treatment and outcome. From July 1989 to December 1995, 132 patients were<br>operated for AOO at Asan Medical Center. Colonic inertia and other pelvic outlet<br>obstructions such as rectocele, rectal intussusception, or Paradoxical puborectalis<br>conraction were excluded from this study by history taking, physical examination, colon<br>transit time study, manometry, and defecography. Male to female ratio was 1 : 1.2 and<br>mean age was 45 and 44, respectively. Among 132 Patients, 57 cases(43%) had sin91e<br>disease and remained 75 cases had combined two or more diseases. Hemorrhoids(90<br>cases) was the most common associated disease and then were anal stricture(59 cases),<br>chronic anal fissure(29 cases), internal sphincter hypertonia(25 cases) and anal fistula(6<br>cases) in decreasing order. Either single or combined hemorrhoidectomy was performed<br>in 85 cases, lateral internal sphincterotomy in 65 cases, anoplasty in 35 cases, rubber<br>band ligation in 13 cases, manual anal dilatation in 10 cases. Postoperative complications<br>were 7 cases of wound infection and one case of gas incontinence, that were subsided<br>by conservative management. 119 patients(90%) showed complete improvement and<br>twelve patients were partially improved from AOO. Only one patient did not respond<br>surgical treatment due to anismus. As AOO is a comprehensive disease entity<br>of<br>frequent anal diseases, adequate surgery for respective patients mandatory to relieve<br>discomfort.<br>