ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;Levator syndrome is a symptom complex of severe pain and pressure in the anorectal area. Electrogalvanic stimulation (EGS) has been proposed as a treatment for this condition. Several reports have described EGS as up to 90 percent “effective” in treating levator syndrome, but the length of follow‐up was uncertain or short‐term in these studies. The purpose of this study was to examine the long‐term benefits of EGS in levator syndrome patients treated at one institution. All patients undergoing EGS for levator syndrome between 1985 and 1991 were studied. Initial complaints, physical examination, number of treatments, procedure tolerance, and long‐term benefit were determined through personal interviews and chart reviews. There were 52 patients (63 percent females and 37 percent males) with a median age of 54 years (range, 24‐84 years). All patients presented with anorectal pain. Tenderness was localized by examination to the left in 43 percent, to the right in 23 percent, and bilateral in 8.6 percent and was not localized in 2.6 percent. Fifty percent received fewer than four one‐hour treatments, 33 percent received four to six treatments, and 17 percent received more than six treatments. Seventy‐seven percent felt that the treatment was painless. Follow‐up results were as follow: number, 52; percent follow‐up, 88; mean follow‐up, 28 months (range, 0‐71 months); symptoms relieved, 19 percent; partial relief, 24 percent; no relief, 57 percent. Of four patients with a wrong diagnosis, three were ultimately diagnosed with recurrent pelvic cancer and one had an anal fissure. At our institution, EGS was a tolerable treatment, but a substantial number of patients received no benefit. An organic etiology of anorectal pain must always be excluded.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;The management of anorectal disease remains a major component in the practice of the general surgeon. To assess the adequacy of general surgery residencies in addressing this educational need, data were obtained from the Residency Review Committee (RRC) for surgery on the anorectal experience of all graduating residents in accredited United States programs for a recent five‐year period (1987‐1991). The mean number of anorectal procedures in which a resident participated throughout the residency was 30.0. This is then further subdivided by type of procedure. It is concluded that general surgery residency programs tend to provide an inadequate training experience in anorectal surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;One hundred fifty‐two of 399 Crohn's patients (38 percent) diagnosed over 20 years, who lived within a geographically defined area at the time of diagnosis, underwent at least one operation. One hundred seventy‐one resections were performed in 160 operations during a mean follow‐up of 60 months. Forty‐eight percent of patients had undergone their first resection within 10 years of diagnosis, and 39 percent of these had undergone a second resection within 10 years of the first. There was no difference between smokers and nonsmokers in the timing of their surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;Recently, promising results with different modifications of an anal continence plug were reported in a pilot study. We have performed a clinical assessment of the plug preferred by the majority of patients in this study in an ambulatory group of patients incontinent to liquid and solid stool. Nine of 14 patients (64 percent; 95 percent confidence interval: 35‐87 percent) were continent when they used the plug. In 43 percent (18‐71 percent), the plug occasionally slipped out, and 71 percent (42‐92 percent) experienced discomfort to a varying degree, which caused 11 patients to withdraw from the study before the end of the planned study period. No correlation was found between the results of anorectal physiology studies and the benefit or inconvenience of using the plug. The overall conclusion is that the majority of patients would use the plug under special circumstances because it eliminates the fear of fecal leakage but that local discomfort, possibly due to the material, would prevent its daily use.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;Delayed hemorrhage following surgical hemorrhoidectomy is a well‐recognized complication. Emergency treatment may include suture ligation, anal packing, or other means of tamponade. At the Lehigh Valley Hospital, 27 patients were seen with the complication of delayed hemorrhage over an eight‐year period from 1983 to 1990, for an incidence of 0.8 percent. Twenty‐five patients (93 percent) underwent surgery primarily for hemorrhoidal disease; one patient had hemorrhoids removed in addition to a sphincterotomy for anal fissure, and the remaining patient had hemorrhoidectomy with fistulotomy. The mean interval from the operation to hemorrhage was six days. Treatment modalities included bedside anal packing in 20 patients (74 percent), observation alone in five patients (18 percent), and suture ligation in the operating room in two patients. Anal packing was successful in controlling postoperative hemorrhage in 20/20 patients, but late complications requiring reoperation developed in 15 percent.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;The use of laparoscopic surgical techniques is now being applied to a variety of operations traditionally performed in an open fashion. Twenty patients underwent laparoscopic‐guided large and small bowel surgery at our institution from March 1991 to April 1992. The indications for surgery included polyps, obstruction, bleeding, and perforation, and pathologic diagnoses included benign polyps, lipomas, inflammatory bowel disease, perforation of a jejunal diverticulum, colonic arteriovenous malformations, and adenocarcinoma. Mobilization of the colon, ligation of the mesentery, and closure of the mesenteric defect were performed using the laparoscopic equipment. One trocar site was enlarged to 3 cm to deliver the bowel through the abdominal wall. All anastomoses were hand‐sewn. Postoperative hospitalization ranged from 2 to 31 days (median, five days). No mortality was noted, and morbidity was 20 percent. We conclude that laparoscopic‐guided bowel surgery is technically feasible and should translate into shorter hospitalization and less patient discomfort.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;Laparoscopic surgical techniques have recently been applied to various types of colon resection. Early reports have focused on the technical feasibility of these procedures, and it has not yet been clearly shown that such procedures benefit the patient. We reviewed our experience with 28 attempted minimally invasive colectomies (MICs) performed over a nine‐month period. Laparoscopic or laparoscopic‐assisted resections were successfully completed in 24 of these patients. We compared the results of surgery in these 24 patients with a group of 33 patients undergoing similar procedures at the same institution by the same surgeon in the nine months preceding the laparoscopic experience. The two groups of patients were similar with respect to age, weight, and the types of procedures performed. However, the postoperative length of stay for patients undergoing MIC (4.8 days) was significantly shorter than for those undergoing open colectomies (8.2 days). Patients undergoing MIC also regained bowel function significantly earlier than those undergoing open colectomy. The operative times for the minimally invasive procedures were significantly longer than for those undergoing open colectomy. No surgically related deaths were encountered, and morbidity was 13 percent. None of the four patients converted from laparoscopic to open colectomy suffered complications as a result of the attempted laparoscopic procedure. We conclude that MIC can be safely performed and does appear to reduce the duration of postoperative ileus and decrease the length of postoperative hospitalization.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;The clinical course of 44 patients undergoing elective proximal fecal diversion for Crohn's disease of the colon is reported. Sustained disease remission was obtained in 31 patients (70 percent). Diversion was associated with a significant reduction in steroid requirements(P<0.01) and a significant improvement in hemoglobin(P<0.001), erythrocyte sedimentation rate(P<0.001), and albumin(P<0.05). Sixteen patients (36.4 percent) have required a proctocolectomy, 19 patients (43.2 percent) remain defunctioned, and four patients (9 percent) have died. Five patients have had intestinal continuity restored, which has remained intact in four patients for a mean follow‐up of 99 (range 21‐153) months. Fecal diversion for Crohn's disease of the colon produces a high incidence of sustained disease remission, but for the majority of patients the prospect of future restoration of intestinal continuity is limited.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID