摘要:

PURPOSE:Rubber band ligation is a common office procedure for symptomatic hemorrhoids. The aim of the study was to assess our short‐term and long‐term results of combined sclerotherapy and rubber band ligation in the management of hemorrhoids and incomplete mucosal prolapse.METHODS:Data on 6,739 patients who had previous combined sclerotherapy and rubber band ligation by the senior authors (GLN and PRD) were retrieved from the database dating between January 1976 and June 2000. These patients either had hemorrhoids or incomplete mucosal prolapse. Furthermore, questionnaires were sent to a random sample of 2,400 patients. Telephone interviews were performed for 600 of the nonrespondents.RESULTS:Of 6,739 patients (3,683 males; mean age, 46.7 years) in the database, 4,686 (70 percent) received the procedure once, and 2,053 (30 percent) received the procedure more than once. There were 5,689 patients (84 percent) who had their procedures performed consecutively within a planned period, and only 1,050 patients (16 percent) had repeat procedures after a period of more than 12 months from their last treatments. Thus, the recurrence rate was 16 percent. The overall complication rate was 3.1 percent, with minor bleeding being the major complaint. With regard to the questionnaire, 44 percent responded. The mean follow‐up period was 6.5 (range, 1‐11) years. There were patients who had residual symptoms of bleeding (19 percent), itch (21 percent), and lump (20 percent). However, 58 percent of patients who replied were asymptomatic. With satisfaction scores ranging from +3 to −3 (+3 indicating complete satisfaction and −3 indicating complete dissatisfaction), 90 percent scored ≥1, 9 percent scored 0 or less, and 1 percent did not specify a score. Hemorrhoidectomy was required in 7.7 percent of the responders. Of 600 phone interviews with the nonrespondents, 152 responded to the questionnaires. Although there was less satisfaction from the phone respondents, which may have accounted for the initial nonresponse, no statistical difference was detected in residual symptoms.CONCLUSIONS:Combined triple sclerotherapy and rubber band ligation is an effective treatment for early hemorrhoids and incomplete mucosal prolapse, with low rates of recurrence, complications, and hemorrhoidectomy, and it can be repeated easily.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:The aim of the study was to investigate the effect of surgical trauma in terms of approach (laparoscopicvs.conventional surgery) and extent of bowel resection (ileocolic resectionvs.colectomy) on interleukin‐6 level, C‐reactive protein level, and expression of human leukocyte antigen‐DR on peripheral blood mononuclear cells. Second, the length of the incision was correlated with the inflammatory response.METHODS:Thirty‐four patients were analyzed as part of a randomized trial comparing laparoscopically assistedvs.open bowel resection for Crohn's disease, ulcerative colitis, and familial adenomatous polyposis. C‐reactive protein levels and expression of human leukocyte antigen‐DR on peripheral blood mononuclear cells were measured preoperatively and one day after surgery. Interleukin‐6 was measured preoperatively and on Days 1 and 7 postoperatively.RESULTS:Four of the 34 patients were excluded because of blood transfusion after surgery. One day postoperatively, the interleukin‐6 level peaked significantly within the laparoscopic and conventional group. There was no significant difference between the conventional and laparoscopic groups at Day 1 postoperatively. At Day 7 postoperatively, interleukin‐6 levels were similar in both groups and returned to baseline levels. There was a higher C‐reactive protein level in the conventional group one day after surgery than in the laparoscopic group, although the difference was not significant. Preoperative and postoperative human leukocyte antigen‐DR expression on monocytes and postoperative percentage of lymphocytes expressing human leukocyte antigen‐DR did not differ between the conventional and laparoscopic groups. No differences in immune response with respect to the measured parameters were noticed in patients with a large or small bowel resection segment or in patients with a small (≤8 cm) or large (>8 cm) incision.CONCLUSIONS:These data suggest that surgical trauma did not significantly affect the immune status of patients with respect to the measured parameters in terms of either the approach or the extent of bowel resection.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:This study was conducted to investigate the long‐term development of anal and urinary incontinence and to investigate the clinical value of electromyography and pudendal nerve terminal motor latency after obstetric anal sphincter rupture.METHODS:One hundred females with obstetric anal sphincter rupture were evaluated by an anal incontinence questionnaire at 5 and 18 months postpartum and by a urine incontinence questionnaire at 18 months postpartum. Pudendal nerve terminal motor latency and electromyography examinations were performed on 68 and 67 females, respectively, at 10 months postpartum.RESULTS:Fecal incontinence increased from 7 to 17 percent between 5 and 18 months (P= 0.04). At 18 months, the incidence of anal incontinence in females working outside the home (42/70 (60 percent)) was greater than that for females still at home with their child (12/30 (40 percent);P= 0.05). Anal incontinence at 18 months was significantly higher (P= 0.01) in subjects with pathologic electromyographic findings (76 percent) than in those with normal electromyography (45 percent; observed differences, 31 percent (95 percent confidence interval, 9 to 54 percent)). Thirty percent of the subjects had urinary stress incontinence. The risk of fecal urgency was greater in females with urinary urgency (difference, 44 percent; 95 percent confidence interval, 18 to 69 percent) and urinary stress incontinence (difference, 24 percent; 95 percent confidence interval, 3 to 44 percent) than in those without.CONCLUSION:Fecal incontinence symptoms worsen with increased follow‐up time, and the change in working status is the most likely explanation; therefore, early evaluation of bowel symptoms is misleading. Denervation injury of the anal sphincter is an independent risk factor for anal incontinence but has no association with urinary incontinence. Urinary urgency and stress incontinence symptoms are strongly associated with fecal urgency.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:Emergency resections for colonic obstruction are accompanied with increased risk of anastomotic dehiscence. Elevated local degradation of submucosal collagens by matrix metalloproteinases may predispose to anastomotic leakage. This study was designed to study the effect of colon obstruction and surgical trauma on matrix metalloproteinase activities and correlate these results to collagen concentration in the colon wall.METHODS:Colonic obstruction was induced in male, Sprague‐Dawley rats (n = 58) by applying a constricting silicone ring around the left colon 3 cm above the peritoneal reflection. After four days of obstruction, 2‐mm wide colonic segments were resected approximately 3 mm proximal and 3 mm distal to the stenosis for biochemical analyses. Colonic segments at corresponding locations were obtained from sham‐operated rats (n = 5) without obstruction but with silicone ring placed adjacent to colon and from normal, nontraumatized rats (n = 10). Matrix metalloproteinase activity was determined by liberation of fragmented collagens from homogenized colonic tissue incubatedex vivo. Matrix metalloproteinase‐2 specifically was analyzed by gelatin zymography.RESULTS:Endogenous collagenolysis by matrix metalloproteinases increased (P< 0.001) in colon as a consequence of obstruction (4.1‐fold) and trauma (1.7‐fold) compared with normal colon. In the proximity of the colon stenosis, total matrix metalloproteinase activity and matrix metalloproteinase‐2 were significantly (P< 0.05) higher above than below the obstruction. Total activity was 22.9 (13.1‐32.9) units/mg collagen proximal and 16.6 (12.7‐18.4) units/mg collagen distal to the stenosis. Collagen concentration correlated inversely (r= −0.76;P< 0.001) with total matrix metalloproteinase activity.CONCLUSION:Colonic obstruction and trauma up‐regulated matrix metalloproteinases and decreased collagen concentration in colonic wall.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:Clinical and physiological results of Delorme's procedure were assessed retrospectively in patients undergoing this procedure for rectal prolapse.METHODS:A consecutive series of 31 patients (7 males, 24 females; age, 14‐93, mean 70 years) with full‐thickness, rectal prolapse were treated by Delorme's procedure between 1994 and 2002. Median follow‐up was 39 (range, 6‐96) months.RESULTS:Good results were achieved in 27 patients (87 percent), prolapse recurrence was observed in 4 (13 percent), and mean recurrence time was 14 (range, 3‐25) months. There were no postoperative deaths. Minor complications occurred in four patients. The median changes in preoperative and postoperative physiologic patterns in 16 patients were as follows: resting pressure from 21.0 (range, 5‐48) to 23.5 (range, 12‐76) cm H2O (P= 0.030), squeeze pressure from 64.0 (range, 27‐248) to 108.0 (range, 32‐264) cm H2O (P= 0.041), volume at first sensation from 100 (range, 70‐180) to 70 (range, 40‐130) ml (P= 0.002), maximum tolerated volume from 260 (range, 120‐400) to 160 (range, 70‐400) ml (P= 0.001). Incontinence improved in 63 percent. No patient became constipated, and 38 percent of those constipated preoperatively improved. The preoperative incontinence score improved from 11.5 (range, 1‐20) to 6.0 (range, 0‐20) after operation (P< 0.0001).CONCLUSION:Delorme's procedure had a low morbidity, did not lead to constipation, improved anal continence, and had a reasonably low recurrence rate. Improved anal sphincter and rectal sensation were associated with a reduced incidence of defecatory problems after Delorme's procedure.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:Involvement of the urinary tract by colorectal cancer is sufficiently rare to be encountered by an individual surgeon on an infrequent basis. The aim of this review is to highlight technical and oncologic issues that should be considered when dealing with complex colorectal cancer that involves the urinary tract.METHODS:The relevant literature from 1975 to 2001 was identified using the MEDLINE database of the U.S. National Library of Medicine and reviewed. Because of the diversity of forms of presentation of urologic involvement, few randomized, controlled trials are available, with most evidence derived from retrospective studies.RESULTS:Three distinct clinical situations in which the urinary tract may be affected by colorectal cancer were identified: involvement by primary colorectal cancer, involvement by recurrent cancer, and unexpected intraoperative findings of urinary tract involvement. Management strategies to identify and treat locally advanced primary or recurrent colorectal cancer involving the urinary tract improve survival with acceptable morbidity and mortality. Careful preoperative assessment of all patients with colorectal cancer will reduce unexpected identification of urinary tract invasion at the time of surgery. In patients in whom cure is not possible, endourologic techniques combined with judicious surgical resection can provide high‐quality palliation. Optimal care of many of these conditions is facilitated by specialist urologic advice.CONCLUSIONS:The wide spectrum of possible urinary tract involvement by colorectal cancer requires individual patient‐specific and disease‐specific consideration. The literature offers important guidelines that aid decision making and improve management of these challenging problems.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

INTRODUCTION:Prostate cancer is the most common cancer of males in the United States. One treatment modality for localized prostate cancer is brachytherapy, the implantation of radioactive seeds directly into the prostate. Although this is an effective treatment option, significant complications can result. More commonly these complications involve the genitourinary tract, but radiation proctitis is a well‐recognized, less common complication. A specific complication of brachytherapy, the development of a rectal ulcer is not well recognized. The clinical course of this complication and results of treatment options are unknown.METHODS:Three cases of rectal ulceration as a consequence of prostatic brachyradiotherapy are presented, and the presumed course of disease and treatment options is discussed.RESULTS:Two patients were initially treated with local advancement flaps that both failed. These patients developed rectourethral fistulas. One patient was treated with diverting colostomy and suprapubic urinary diversion. The second underwent proctectomy and coloanal anastomosis. This also failed after multiple attempts to treat perianastomotic fistulas. The third patient was treated endoscopically for bleeding and has had no further interventions.CONCLUSION:In the small percentage of patients who develop rectal ulcerations from prostatic brachyradiotherapy, local medical or surgical treatments will often result in failure. They also may contribute to the eventual development of rectourethral fistulas, the likely natural progression of this disease. These fistulas should be treated with both urinary and fecal diversion. Earlier stages of ulceration may be treated with rectal resection and reconstruction, but selection criteria for these procedures have yet to be determined.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;We report a patient who presented with rectal rupture and transanal evisceration, a rare entity with only 52 cases previously described in the world literature. Our case is the first to implicate sheer stress on the anterior rectum caused by postoperative adhesions as the major etiologic contributing feature. Moreover, this case is the third reported with chronic constipation without rectal prolapse as an additional preexisting contributory condition. A summary of the medical literature including etiology, treatment, and outcomes is presented.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Bleeding anorectal varices may complicate portal hypertension. Their treatment has rested largely on the principles of the treatment of hemorrhoids. Treatment using a circular stapling device in a patient with alcoholic liver disease is described.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:Despite the variety of surgical techniques proposed for the treatment of pilonidal disease, recurrence after its operative management remains a common occurrence. Relatively few data exist that focus on an optimal surgical approach that should be followed in cases of recurrent pilonidal disease. The aim of this study was to describe the technical details, analyze the advantages, and present the early results of a modified Bascom asymmetric midgluteal cleft closure technique applied in patients with recurrent pilonidal disease in a military hospital setting.METHODS:Among the 72 male military service patients (median age, 21; range, 18‐26 years) who underwent surgery for pilonidal disease in the Military Hospital of Samos Island, Greece, there were 24 who presented with recurrent pilonidal disease eight months to four years after one to four operations each, which were performed before their enrollment in the Army (total of 43 operations). One or two midline pits were evident in 41.6 percent of the patients, whereas the rest had more complex disease. Three patients presented with acute purulent disease and required initial incision and drainage. The modified Bascom technique was applied, which involved an asymmetric ellipse‐like, gluteal fat‐preserving excision of the affected skin, the pilonidal sinus, and lateral tracts, a thick skin and fat tongue of tissue mobilization, and finally, complete lateralization of wound closure and flattening of midgluteal groove.RESULTS:All patients tolerated the procedure well, with minimal to moderate postoperative discomfort. Full return to military duty was possible in three weeks after surgery. There was one case of limited primary healing failure. No recurrences have developed in a short median follow‐up period of ten months.CONCLUSION:The suggested modified Bascom technique is an attractive, safe, easily performed operation with minimal morbidity and can be reliably used as a second‐line surgical option for recurrent pilonidal disease.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID