A c c e p t e d A r t i c l e 0 ABSTRACT Purpose To evaluate the incidence of vasovagal reactions (VVRs) and the efficacy of a lidocaine injection to prevent its occurrence. MethodsPatients (n=117) diagnosed with hemorrhoids and scheduled to undergo a stapled hemorrhoidopexy (SH) were randomly divided according to the submucosal injection used on the rectum into: lidocaine (n=53, lidocaine injected just before full closure of the stapler) and control groups (n=58). Outcomes compared included baseline patient characteristics (ASA class, body mass index, diabetes mellitus, hypertension, previous VVR history), vital signs during the operation, the incidence of VVRs (hypotension, bradycardia, dizziness, diaphoresis, nausea/vomiting), and postoperative complications (pain, bleeding, urinary retention). Statistical analysis of patient data was performed using the paired t-test and the chi-square test. ResultsBaseline characteristics were similar between groups. The number of patients with lower abdominal pain after firing the stapler and the incidence of dizziness were lower for the lidocaine group than for the control group (9.4% vs 25.9%, p=0.017; 0% vs 8.6%, p=0.035, respectively). However, there were no significant between-group differences in the incidence of nausea and diaphoresis (0% vs 3.4%, p=0.172) and syncope (1.9% vs 3.4%, p=0.612). Fewer patients in the lidocaine group complained of postoperative pain (41.5% vs 58.6%, p=0.072) and these patients used analgesics less frequently than those in the control group (28.3% vs 36.2%, p=0.374). ConclusionPatients who received a submucosal lidocaine injection prior to SH experienced lesser lower abdominal pain and dizziness, than those who received standard treatment. A larger, more detailed prospective study is needed for further analysis. A c c e p t e d A r t i c l e 1

Anal gland/duct cyst (AGC) is rare and observed in only 0.05% of patients undergoing anal surgery. AGC is thought to be a retention cyst in the anal gland and arises when an obstruction of the anal duct causes fluid collection in the anal gland. We report a case of AGC in a 66-year-old woman without anal symptoms. Found by colonoscopy, the AGC was excised transanally. The histopathology of the specimen confirmed AGC. Colonoscopists should include AGC in the differential diagnosis of anal canal mass and rule out of malignancy. Excision is recommended for definitive diagnosis and treatment.

Hidradenoma papilliferum is a rare benign cystic tumor that originates from apocrine glands or anogenital mammary glands. Here, we describe 2 cases of hidradenoma papilliferum of the anus. Two female patients aged 39 and 35 presented with perianal masses with hemorrhoids. The patients underwent hemorrhoidectomy and excision of the lesion. Histopathology confirmed the masses as hidradenoma papilliferum. The postoperative course was uneventful for both patients, and there were no recurrences after 18 and 12 months of follow-up, respectively. Proctologists should consider hidradenoma papilliferum in their differential diagnosis of benign anal tumors. Surgical excision is necessary for diagnosis and treatment of hidradenoma papilliferum.