摘要:

PURPOSE:This study was designed to compare function of patients who had undergone reconstruction following proctocolectomy for ulcerative colitis using the J or W configuration ileoanal pouch.METHODS:Of 126 patients who underwent restorative proctocolectomy between January 1981 and March 1993, 101 had surgery for ulcerative colitis. Eighty‐seven of these patients were available for review by personal or postal interview. All operative procedures were performed by one surgeon. The group comprised 35 W‐pouches and 52 J‐pouches.RESULTS:More patients with a J‐pouch had a stool frequency of greater than 8 per 24 hours(P=0.044), and they were also more likely to use a perineal pad(P=0.019). No difference in the rates of nocturnal stool frequency, fecal incontinence, or use of constipating agents between the two pouch designs was found. Significantly more patients with a J‐pouch have had episodes of pouchitis(P=0.001). Of the total patient group 91.9 percent felt that restorative proctocolectomy had improved their quality of life.CONCLUSION:Minor differences in the function of the W configuration ileoanal pouch and the J configuration ileoanal pouch are demonstrated in this study.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:Since 1988, surgeons at five hospitals have been performing the Barnett continent intestinal reservoir (BCIR). The BCIR includes modifications to the original Kock pouch, designed to reduce the incidence of valve slippage and fistula formation. Principle modifications include an intestinal collar, an isoperistaltic valve, and a lateral pouch design.METHOD:This unique collaborative study includes 510 ulcerative colitis or familial polyposis patients, with a follow‐up time from one to five years postoperatively.RESULTS:Ninety‐two percent still have functioning reservoirs. Six and one‐half percent have had their pouches removed and replaced with conventional Brooke ileostomies. Reoperation rate for major pouch‐related complications (other than pouch removal) was 12.8 percent. These complications included slipped valve (6.3 percent), valve fistulas (4.5 percent), and pouch fistulas (6.3 percent). Several questions were administered to patients whose responses revealed a significant improvement in general quality of life, state of mind, and overall health.CONCLUSIONS:The BCIR represents a successful alternative to patients with a conventional Brooke ileostomy or those who are not candidates for the ileal pouch‐anal anastomosis.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to evaluate the results of treatment of partial fecal incontinence with perianal injection of autologous fat.METHODS:The study comprised 14 patients with partial fecal incontinence (9 women and 5 men). Ages ranged from 38 to 62 years. Fifty to 60 ml of fat were harvested from the abdominal wall and injected submucosally into the rectal neck at 3 and 9 o'clock positions. Mean follow‐up was 18.6 months.RESULTS:All patients were continent during the first two to three postinjection months. At the sixth month, patients were divided into three scores. Score 1 (complete continence) comprised three patients who are now continent for 9, 11, and 14 months postinjection, with normalization of their rectal neck pressure. Seven patients with Score 2 were incontinent to flatus and were reinjected; they are now continent (Score 1) for a mean of 13.8 months and have normal rectal neck pressure. Four patients had Score 3 (no improvement), of whom two became continent after the second injection and two after the third. They are now continent (Score 1) 6 to 16 months postinjection. Factors that contributed to failure comprised injection of unwashed fat or wrong positioning of the needle. There was no fat migration or embolism.CONCLUSION:Perianal fat injection is effective in treatment of partial fecal incontinence. The technique is simple, easy, cost‐effective, and performed on an outpatient basis.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:Hereditary nonpolyposis colorectal cancer (HNPCC) is an autosomal dominant cancer syndrome characterized by early onset of colorectal carcinomas (CRC). Recently, two HNPCC genes have been mapped and cloned, one in the short arm of chromosome 2 and another in the short arm of chromosome 3. There has been a major controversy about the frequency of HNPCC. The few estimates available have been based on series selected by age or series representing local area. The purpose of the present study was to design a nonselected, prospective, multicenter study, taking into account the family background and other risk factors of CRC.METHODS:The proportion of HNPCC of all (N=406) CRC cases was evaluated in a prospective multicenter study. Family history and other risk factors were investigated over a 12‐month period for all new CRC patients in ten hospitals. These cases constituted 23 percent of all CRCs diagnosed in Finland during the study period.RESULTS:Three (0.7 percent) cases of verified and seven (1.7 percent) cases of suspected HNPCC were identified, following the evaluation of all families with features indicative of susceptibility to cancer. The proportion of identifiable risk factors of CRC was 5.8‐7.5 percent (HNPCC, 0.7‐2.4 percent; previous CRC, 3.4 percent; ulcerative colitis, 1.0 percent; familial adenomatous polyposis coli, 0.7 percent). CONCLUSION. This prospective multicenter study revealed that the frequency of hereditary colorectal cancer is lower than in some previous studies, when diagnosis is based on extensive pedigree analysis. This result with recent findings of common ancestral founding mutation in Finnish HNPCC families indicates that there may be geographic differences in the occurrence of HNPCC. However, this does not change the fact that identification of HNPCC—perhaps one of the most common inherited diseases identified in humans—has become a question of vital importance now when diagnosis of the syndrome and largescale screening of gene carriers using specific tests are on the horizon.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

&NA;For the past decade peroral, orthograde, polyethylene glycol‐electrolyte lavage solutions (PEG‐ELS) have been the preferred bowel‐cleansing regimens before diagnostic and therapeutic procedures on the colon and rectum. The large volume and unpalatibility of these solutions may lead to troubling side effects and poor patient compliance.PURPOSE:This study was undertaken to determine which of various colon‐cleansing methods before colonoscopy would provide greater patient acceptance while maintaining similar or improved effectiveness and safety.METHODS:Three hundred twenty‐nine patients undergoing elective ambulatory colonoscopy were prospectively randomized to one of three bowel preparation regimens. Group 1 received 41 of PEG‐ELS (n=124). Group 2, in addition to PEG‐ELS, received oral metoclopramide (n=99). Group 3 received oral sodium phosphate (n=106). All groups were evenly matched according to age and sex.RESULTS:Ninety‐one percent of all patients completed the preparation received. Sixteen percent of patients suffered significant sleep loss with a bowel preparation. When comparing the three groups, there was no difference in the assessment of nausea, vomiting, abdominal cramps, anal irritation, or quality of the preparation. Compared with other preparations, oral sodium phosphate was better tolerated. More patients completed the preparation(P≤0.001). Fewer patients complained of abdominal fullness(P≤0.001). More patients were willing to repeat their preparation(P≤0.02). Also, sodium phosphate was found to be four times less expensive than either of the PEG‐ELS preparations.CONCLUSION:All regimens were found to be equally effective. Abdominal symptoms and bowel preparation were not influenced by the addition of metoclopramide. The oral sodium phosphate preparation was less expensive, better tolerated, and more likely to be completed than either of the other preparations.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:The purpose of this paper is to establish the number of cases necessary to master laparoscopic removal of the left or right colon.METHODS:Data were obtained by chart review and by individually completed questionnaires.RESULTS:A total of 144 laparoscopic‐assisted or intracorporeal right or left hemicolectomies were completed by four surgeons at separate institutions. Questionnaires were completed by each surgeon for each sequential hemicolectomy, and data concerning the type of surgery and total operating time were recorded. Times were plotted to diagram individual learning curves for each surgeon, and data grouping methods were used to determine the curve for each surgeon as well as for the combined data base. Learning was said to have been completed when the surgeon's operative time reached a low point and subsequently did not vary by more than 30 minutes. A total of 78 right colectomies and 66 left colectomies were completed by the group. Respectively, each surgeon appeared to learn the procedure after 16, 21, 11, and 6 cases. When the entire database was analyzed as a whole, it was shown that between 11 and 15 completed colectomies were needed for learning, after which operative times remained relatively stable.CONCLUSIONS:This analysis, using total operative time as an indication of learning, shows that approximately 11 to 15 completed laparoscopic colectomies are needed to comfortably learn this procedure.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:In a previous, prospective, randomized study of the use of nasogastric tubes in patients undergoing elective abdominal colorectal surgery, we found that patients who did not have nasogastric (NG) decompression postoperatively had a significantly higher rate of abdominal distention, nausea, and vomiting. Patients from that study have now been followed for a median duration of 5.3 years to evaluate whether this elevation in perioperative intra‐abdominal pressure would subsequently lead to an increased incidence of incisional hernia.RESULTS:Of the 251 patients who received NG decompression, 8 (3.2 percent) developed incisional hernias compared with 15 (6.6 percent) of 229 patients who were not decompressed(P=0.085).CONCLUSIONS:The increase in postoperative abdominal distention and vomiting that occurs in patients who do not receive NG decompression does not lead to a significantly increased incidence of incisional hernia. Furthermore, we continue to support avoidance of routine prophylactic post‐operative nasogastric decompression in uncomplicated, elective abdominal colorectal surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:Perineal involvement in Crohn's disease is a common and distressing condition, often refractory to medical or surgical treatments. Recent reports suggest the efficacy of hyperbaric oxygenation (HBO) in the healing of perineal lesions. We evaluated HBO in severe patients with perineal Crohn's disease.METHODS:Ten consecutive patients (8 women, 2 men; mean age, 30 years) were studied. There were four superficial fissures, four cavitating ulcers, six low or superficial fistulas, two high fistulas, and one irreversible anal stenosis. All patients had received one or more medical treatments without healing the perineal lesions, and all had had previous surgery for perineal lesions.RESULTS:Two patients discontinued HBO after a few sessions and did not complete treatment. Eight patients completed at least 30 HBO sessions and were evaluable. At the end of the procedure, six of eight patients treated were healed, three completely and three partially. All patients who healed completely received HBO as an additional treatment to local perineal surgery.CONCLUSION:HBO might be useful as a last resort treatment of chronic perineal Crohn's disease, resistant to other treatments or as a complement to surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to determine the effects of colostomy irrigation on the vital signs of patients with left colostomy.METHODS:Twenty‐two consecutive patients who underwent abdominoperineal resection for cancer of the lower rectum and had left lower quadrant end colostomy were included in this study. Subjective symptoms, blood pressure, and pulse rate during the first irrigation were investigated.RESULTS:Fluctuation of blood pressure during instillation was 8.0/8.5 mmHg (average) and 25.0/17.9 mmHg during evacuation. Fluctuation of pulse rate was 5.5 per minute (average) during instillation and 11.5 per minute during evacuation. The number of subjects who showed more than 20% fluctuation of systolic pressure was 12 (54.5 percent) and that of diastolic pressure was 14 (63.6 percent). One of 22 patients complained of illness during irrigation.CONCLUSION:Although colostomy irrigation showed no significant effects on vital signs in the majority of patients, it caused a significant reduction in both blood pressure and pulse rate in a small number of patients. Careful attention should be paid to vital signs considering the possibility of such effects, especially on the initial irrigation.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:This study investigated the value of intense follow‐up compared with no follow‐up after curative surgery of cancer in the colon or rectum.METHODS:One hundred seven patients were randomized to no follow‐up (control group; n=54) or intense follow‐up (follow‐up group; n=53) after surgery and early postoperative colonoscopy. Patients in the follow‐up group were followed at frequent intervals with clinical examination, rigid proctosigmoidoscopy, colonoscopy, computed tomography of the pelvis (in patients operated with abdominoperineal resection), pulmonary x‐ray, liver function tests, and determinations of carcinoembryonic antigen and fecal hemoglobin. Follow‐up ranged from 5.5 to 8.8 years after primary surgery.RESULTS:Tumor recurred in 18 patients (33 percent) in the control group and in 17 patients (32 percent) in the follow‐up group. Reresection with curative intent was performed in three patients in the control group and in five patients (four of whom were asymptomatic) in the follow‐up group. In the follow‐up group two asymptomatic patients with elevated carcinoembryonic antigen levels were disease‐free three and five and one‐half years after reresection and were the only patients apparently cured by reresection. No patient underwent surgery for metastatic disease in the liver or lungs. Symptomatic metachronous carcinoma was detected in one patient (control group) after three years. Five‐year survival rate was 67 percent in the control group and 75 percent in the follow‐up group(P >0.05); the corresponding cancer‐specific survival rates were 71 percent and 78 percent, respectively.CONCLUSION:Intense follow‐up after resection of colorectal cancer did not prolong survival in this study.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID