Francis Seow-Choen

Fortis Surgical hospital · Seow-Choen Colorectal Centre

Pilonidal disease is a very common affliction that affects mainly young, hirsute, obese males during their young adult years of life. Previous etiological theories of this ailment centred on congenital causes. The current understanding is that pilonidal disease is an acquired affliction. Some patients, however, may have confounding hereditary tende...

Surgical hemorrhoidectomy is still an important part of the treatment of prolapsed and symptomatic hemorrhoids. While it is effective in most cases, troublesome and even serious side effects may following surgery which had not been performed expertly. In this chapter, we draw from our extensive experience to highlight some tips and tricks which we...

The areolate Oriental family Heteropterygidae Kirby, 1893 is critically reviewed and the results of the present study contradict the arrangement suggested by Zompro (2004), but in most aspects agree with a molecular study presented by Whiting et al (2003) and a phylogenetic study presented by Bradler (2009). The family is critically discussed and n...

The advent of total mesorectal excision (TME) together with minimally invasive techniques such as laparoscopic colorectal surgery and robotic surgery has improved surgical results. However, the incidence of bladder and sexual dysfunction remains high. This may be particularly distressing for the patient and troublesome to manage for the surgeon whe...

Background: The aim of this retrospective study was to assess our experience of 41 patients with anal fistulae treated with video-assisted anal fistula treatment (VAAFT). Methods: Forty-one consecutive patients with cryptoglandular anal fistulae were included. Patients with low intersphincteric anal fistulae or those with gross perineal abscess...

Aim: The study aimed to determine whether Coca-Cola (Coke) Zero is a safe and effective solvent for polyethylene glycol (PEG). Method: Between December 2013 and April 2014, 209 healthy adults (115 male, 95 female) scheduled for elective colonoscopy were randomised to use either Coke Zero (n=100) or drinking water (n=109) with PEG as bowel prepar...

Intravenous (IV) analgesia has particular advantages in the immediate postoperative period. For example, IV administration results in a faster onset of pain relief and results in more predictable pharmacokinetics than does administration by other routes. It also allows for convenient dosing before or during surgery, permitting the initiation of eff...

A 75-year-old male presented with difficult defecation and increasing urinary frequency over a few months. He had a significant history of previous partial gastrectomy for gastric carcinoma 20 years prior. Computed tomography of the abdomen and pelvis showed extensive lymphadenopathy, a gastric mass and rectal as well as bladder wall thickening wit...

Definitive surgical management of sigmoid volvulus is usually via a midline laparotomy or laparoscopy. We report our experience with a series of five consecutive cases over a 10-year period. All patients had definitive surgery via a left iliac fossa mini-incision after prior decompression. For four patients, it was the first episode of sigmoid volv...

A 60-year-old Indonesian woman presented with a 9-day history of increasing abdominal distension, pain and tiredness. Physical examination revealed significant pallor with a palpable mass in the abdomen. CT of the abdomen reported a 22 cm complex mass in the peritoneal cavity with free intra-abdominal fluid. Laboratory results showed anaemia with a...

An anal fissure is a linear ulcer in the squamous epithelium of the anal canal located just distal to the dentate line. The French surgeon, Joseph-Claude-Anthelme Recamier (1774–1852), has been widely credited for having first described this pathology in the 1820s and subsequently went on to describe the technique of anal dilatation for treating th...

Background: Anorectal reconstruction with the gracilis muscle following abdominoperineal resection (APR) is an option for patients who do not want a permanent abdominal stoma. Despite some promising results, significant heterogeneity still exists in the method and timing of surgery, as well as the use of electrical stimulation. Aim: We review the l...

This chapter defines the role of endoscopic evaluation in patients before reoperative surgery, providing complementary assessment of new imaging modalities, particularly in the assessment of recurrent cancer and in the definition of problems that may occur after anastomotic construction and neoreservoir use in inflammatory bowel disease. Assessment...

This chapter discusses the surgical considerations to be perused before an elderly person is subjected to surgery. Old age itself is not a criterion against the use of surgery for the management of colorectal cancer. Treatment goals have to be clear when the elderly are treated. Appropriate informed consent is important to ensure a satisfactory out...

To investigate the effect of reducing dietary fiber on patients with idiopathic constipation. Sixty-three cases of idiopathic constipation presenting between May 2008 and May 2010 were enrolled into the study after colonoscopy excluded an organic cause of the constipation. Patients with previous colon surgery or a medical cause of their constipatio...

The main purpose of the Italian Society of Colorectal Surgery (SICCR) is to enhance the science and standard of care of patients with colorectal diseases in our Country. The Annual Report (AR) from the Coloproctology Units (UCP) affiliated to the Society was introduced in 1993 in order to monitor their activity and includes four sections covering t...

A 30-year-old woman in the 30th week of her second pregnancy presented with intestinal obstruction that was confirmed by abdominal ultrasound examination. In the patient's first pregnancy 2 years previously, a dilatation and curettage had been performed 4 weeks after delivery, to remove the retained placenta. She had developed intestinal obstructio...

Surgery for cancer has made significant progression in recent years and these developments have been in tandem with various adjuvant treatments including chemotherapy and radiotherapy. The concurrent use of traditional Chinese medicine (TCM), a 5,000-year-old art, with surgery has not been popular among those who practice Western style medicine. Th...

A chronic anal fissure is a common perianal condition. This review aims to evaluate both existing and new therapies in the treatment of chronic fissures. Pharmacological therapies such as glyceryl trinitrate (GTN), Diltiazem ointment and Botulinum toxin provide a relatively non-invasive option, but with higher recurrence rates. Lateral sphincteroto...

The lower cost of the procedure associated with a good long term cosmetic effect in patients with large skin tags make open excision hemorrhoidectomy a viable option still.It is not uncommon however for surgical excision of hemorrhoids to be associated with postoperative pain together with perianal discharge, itchiness and irritation during the hea...

Deletion of 11q23-q24 is frequent in a diverse variety of malignancies, including breast and colorectal carcinoma, implicating the presence of a tumor suppressor gene at that chromosomal region. We examined a 6-Mb region on 11q23 by high-resolution deletion mapping, using both loss of heterozygosity analysis and customized microarray comparative ge...

With great advances made tour understanding of the lower gastrointestinal tract there often arise situations where surgeons realize that realities in everyday practice do not tie in with conventional wisdom. There are four main reasons why humans eat: for nutrition, for energy requirements, to satisfy our taste buds, for social or community reasons...

The primary treatment for rectal cancer is still surgery. Surgery however, may be either preceded or followed by chemotherapy and radiotherapy as and when needed. Good surgery on its own when applied appropriately is associated with a very low rate of local recurrence. Bad surgery however, is associated with a high risk of local and systemic recurr...

Anal fissures can cause morbidity in an otherwise healthy young patient. The process of evacuation results in stretching and descent of the anoderm and perineum especially posteriorly. Posterior perineal support may provide counter pressure at the posterior aspect of the pelvic floor, balancing the pressure exerted by the faeces on the anal wall, t...

Objective: Colonic hydrotherapy is widely used and many of its practitioners are medically qualified. Nonetheless, the basis of many of their practices requires physiological scrutiny. Method: The claims of colonic hydrotherapy are examined against known physiological facts. Results: Hydrotherapy is not entirely physiological. Conclusion: Co...

Although many patients with symptomatic hemorrhoids may be successfully managed without surgery, there are still a large number of patients who require surgical excision of hemorrhoids. It is not uncommon for surgical excision of hemorrhoids to be associated with postoperative pain together with perianal discharge, itchiness, and irritation. The nu...

Pearls and PitfallsHemorrhoidal tissue is a normal anatomical structure that is only of concern when symptomatic.Factors predisposing to hemorrhoids include: hereditary factors, straining during defecation, squatting during defecation, and pregnancy.Use of a high fiber diet is controversial and may aggravate symptoms.Other sinister colorectal condi...

The wound protector has been used widely to prevent port site metastases (PSM). Although port site metastases ties in with poor survival, it is not because of PSM itself, but rather because PSM is a sign of more widespread metastatic disease. Whilst being touted as a method of preventing PSM, it fails to address the bigger issue of preventing intra...

Surgery, chemotherapy and radiotherapy have been the mainstay of colorectal cancer treatment. There is however current intense research on traditional Chinese medicine (TCM) as novel or additional treatment methods for colorectal cancer. This article reviews the current use of TCM in colorectal cancer so as to increase the awareness of colorectal s...

Desmoids are rare in the general population but occurs in between 10 to 20% of patients with familial adenomatous polyposis (FAP). This risk is about 852 times the risk for the population at large. Desmoids are benign neoplasms that are capable of infiltrating locally with a high risk of recurrence (25-65%) even after extirpating surgery. Desmoids...

Whilst fruits and vegetables are an essential part of our dietary intake, the role of fiber in the prevention of colorectal diseases remains controversial. The main feature of a high-fiber diet is its poor digestibility. Soluble fiber like pectins, guar and ispaghula produce viscous solutions in the gastrointestinal tract delaying small bowel absor...

Introduction Intradermal methylene blue has been used successfully in pruritus ani. The mechanism is likely the destruction of dermal nerve endings. We report a new method in achieving postoperative pain relief using intradermal methylene blue injection to the perianal region after lateral anal sphincterotomy. Methods Consecutive patients undergoin...

Sigmoid volvulus is a rare presentation of Hirschsprung's disease. A 38-year-old male presented with acute intestinal obstruction and a history of chronic constipation since childhood. Abdominal radiographs showed megarectum and megacolon with dissipated feces. Sigmoidoscopy revealed gangrenous bowel mucosa affecting the sigmoid colon. Emergency la...

RB1 gene expression has been reported to be upregulated in colorectal carcinomas (CRC) at both the mRNA and protein levels when compared to normal colonic mucosa. However, allelic loss at the genomic level has been detected in CRC with widely differing frequencies ranging from 11.5% to 50%. To determine whether there is indeed a correlation between...

A case of necrotising fasciitis with full-thickness loss of the entire abdominal wall is reported after an uncomplicated elective low anterior resection. Salvage was accomplished by early wide surgical extirpation and repeated re-explorations and debridements. The presence of ample omentum helped prevent evisceration and allowed granulation tissue...

Fibre is often recommended as the first-choice treatment but its effects can be uneven. The aim of the study was to compare the clinical efficacy and tolerability of fibre versus lactulose in outpatients with chronic constipation. In a prospective randomized crossover trial, patients were randomized to receive fibre or lactulose for four weeks. Bet...

Intestinal adhesion following abdominal surgery is a significant sequela to abdominal surgery. Intergel is a hyaluronate-based gel that reduces the incidence of postoperative adhesions when added to the peritoneal cavity before closure in gynecologic surgery. This is a randomized controlled trial evaluating the efficacy and safety of Intergel in co...

Total mesorectal excision for low rectal cancers has been shown to reduce local recurrence rate after curative operation to <5 percent. The lack of anatomic appreciation of the mesorectum is an important cause of inter-surgeon variability in the outcome of rectal cancer surgery. Surgical illustrations depicting the mesorectal anatomy, however, are...

Local recurrence and cure rates following abdominoperineal resections have been reported to be much worse than sphincter-preserving anterior resections. We compared the oncologic outcomes of patients treated by abdominoperineal resections with those following sphincter-preserving anterior resections. The medical records of patients who underwent ra...

Fashion more than science

Stapled hemorrhoidopexy may leave residual skin tags or external components following its use in large prolapsed piles. Excision of redundant mucosa above the dentate line and reconstitution to the staple line reduces these prolapsed elements. We describe a novel technique that removes residual skin tags and piles while remaining true to the spirit...

Desmoid tumour-related ureteral obstruction in familial adenomatous polyposis presents difficult management problems. Its role in altering prognosis for the worse in young patients has been neglected. Two patients are reported and 14 cases in the literature reviewed. Both our patients developed intra-abdominal desmoid tumours following proctocolect...

The inadvertent removal of smooth muscle during the use of stapled hemorrhoidectomy had raised concerns about its effects on postoperative anorectal function. We correlated the amount of smooth muscle removed with anorectal function in the early postoperative period. Patients were assessed preoperatively with an Eypasch quality-of-life questionnair...

Recent studies have implicated cyclin D1 G870A single-nucleotide polymorphism (SNP) in susceptibility to and early onset of colorectal cancers (CRC). We investigated the role of cyclin D1 G870A SNP in Singapore CRC patients without dominant family history by genotyping 254 patients and 101 controls. The risk of cancer for AA individuals was less th...

Assessment of healing after low colorectal, colo-anal or ileo-pouch anal anastomosis is routinely performed with a water-soluble contrast enema (WSCE) prior to the reversal of the defunctioning stoma. Interpretation of these radiographs is sometimes difficult and imprecise. As these anastomoses are within the reach of a simple digital rectal examin...

This is a prospective, randomized, controlled trial comparing the outcome of intraoperative colonic irrigation with that of manual decompression for acutely obstructing colorectal cancers distal to the splenic flexure. All patients admitted to our department from June 1999 to August 2002 with obstructing left-sided colorectal cancers were recruited...

Our aim was to review the results of total mesorectal excision (TME) in a specialised colorectal unit. Perioperative and follow-up data were prospectively collected in a computerised database. A review of all the records was made. The morbidity rate was about 14%, and was higher in patients with coloplasty due to a higher anastomotic leak rate. The...

To review the results of dynamic graciloplasty for total anorectal reconstruction after abdominoperineal resection (APR) for rectal cancer. Chart reviews were done on 17 patients who had dynamic graciloplasty following abdominoperineal resection and details of post-operative complications, bowel functions and recurrences were obtained. Seventeen pa...

The relative merits of either barium enema or colonoscopy for investigating lower gastrointestinal tract symptoms is still unclear. We studied the value of double contrast barium enema (DCBE) as the initial evaluation modality. We reviewed our 10-year experience of double contrast enemas as read by consultant radiologists. The study also aimed to i...

There is no optimum surgical method of repair for rectoceles; however, recent interest in the use of the circular hemorrhoidal stapler gun to treat rectoceles has stirred interest. We describe our early results using the circular hemorrhoidal stapler gun for repair of rectoceles. Seven patients (median age, 45 (range, 31-62) years; all females) hav...

Midline laparotomies offer excellent exposure but are associated with increased postoperative pain and longer recovery. A minilaparotomy resection of leftsided colorectal cancers was studied as an alternative approach. We performed a case-control retrospective review of 280 randomly selected patients (140 midline incisions; 140 left skin crease inc...

Cap polyposis is characterized by the presence of inflammatory polyps with a "cap" of granulation tissue. It may represent one end of a spectrum of conditions caused by chronic straining. This experience represents the second largest reported series of cap polyposis. The case notes of all patients with histologically proven cap polyposis were revie...

As the incidence of young colorectal cancer is rising, a review of the characteristics of such malignancy in those under 30 years of age is timely at this stage. Thirty-nine patients (21 M, 18 F) were operated upon over a 12-year period in a single centre. The mean age was 25 years and median follow-up was 20 months. Rectal bleeding, change in bowe...

We analysed the incidence, clinical presentation and outcome of small bowel malignancies treated in the department. From July 1993 to December 2001, 29 patients with small bowel malignancies were operated upon. The median age was 60 years (30-87 years), and there were 11 males and 18 females. The more frequently used diagnostic investigations inclu...

Stapled hemorrhoidectomy is gaining popularity worldwide. One problem that is often encountered is difficulty with insertion of the circular anal dilator because of very protuberant and fatty buttocks and a narrow interischial tuberosity distance. We describe a modification of this device for easier introduction in such patients.

This study was designed to compare diathermy excision and diathermy coagulation in the treatment of symptomatic prolapsed piles. Forty-five consecutive patients were randomly assigned to diathermy excision hemorrhoidectomy (Group A, n = 25) and diathermy coagulation (Group B, n = 20) under general anesthesia. The median duration of surgery was ten...

There are many methods of performing surgery for rectal prolapse, including abdominal nonlaparoscopic, abdominal laparoscopic, and perineal approaches. The laparoscopic approaches appeared to offer significant benefits in terms of cosmesis, return of bowel function, decrease in morbidity, length of hospital stay, and length of time to return of bow...

We investigated 48 normal patients and 25 diseased patients using our laser-induced autofluorescence spectra detection system during their regular colonoscopy. The colon and rectum mucosa autofluorescence were excited by 405 nm continue wavelength laser. We observed that cancer or diseased colorectal mucosa, their autofluorescence spectra are signi...

A temporary loop ileostomy is often created to minimize the impact of peritoneal sepsis from an anastomotic dehiscence after a coloanal or low colorectal anastomosis. Such a stoma is usually closed after 6 to 12 weeks when the intestinal edema is reduced and the peristomal adhesions are less dense. This period is three to four times longer than nec...