摘要:

&NA;Peace is a time for planning and building. It is not merely the absence of war, the destroyer. Surgery has been seen as a war against disease, which must be cut out. Even during peace, trauma is a war of epidemic proportions. Medical professionals now believe prevention is better than cure, and in surgery, much attention is paid not merely to excision, but to repair, reconstruction, and transplantation. Only when there is global peace is it possible for international scientific societies to flourish. Peace provides the opportunity for clinical trials on a large scale and for the exchange of scientists, surgeons, and surgical trainees. The Society has established a Secretariat, a central bureau where requests about acquisition of new skills or details of research opportunities may be directed, advertised, and relayed.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Disruption of the terminal ileum and excision of the ileocecal junction during restorative proctocolectomy and formation of a pelvic ileal reservoir may lead to abnormalities of motility, transit, and absorption. We therefore preserved this portion of the gastrointestinal tract in 12 patients who underwent restorative proctocolectomy for ulcerative colitis. In each patient, the entire anal sphincter was preserved without mucosal stripping: the two sphincters were connected by a single loop of ileum without any reservoir. After median follow‐up of 12 months, the functional results were similar to those seen with conventional pelvic ileal reservoirs and superior to the results of mucosal protectomy and straight endoanal ileoanal anastomosis. This operation may be an alternative to standard restorative proctocolectomy for patients with ulcerative colitis.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The authors present a method of creation of a smooth‐muscle cuff at the site of the perineal colostomy in 36 patients who have undergone extirpation for malignant neoplasms of the low ampulla recti. Creation of the smooth‐muscle sphincter mechanism was performed during the process of removal of the rectum in 29 patients, whereas it was done two to eight years after extirpation of the rectum in seven patients. Inflammatory complications were observed in the perineal colostomy area during the early postoperative period in eight patients. These complications were accounted for by necrosis of the distal colon and transplanted muscle in two patients. There were no deaths. Satisfactory functional results were seen in 22 of 26 patients six months after surgery. Physiologic studies show that there is a functioning sphincter at the site of the perineal colostomy.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;During the period 1972 to 1987 inclusive, 313 multivisceral resections in advanced rectal cancer were performed, accounting for 10.3 percent of all radical surgical interventions for this disease. Of these resections 71 were for distant metastases and 242 for tumor infiltration to adherent organs. The postoperative mortality was 5.4 percent, which was not significantly different from that in the total group of patients with rectal cancer (4.9 percent) operated upon during the same period. After multivisceral resections, 49.5 percent of patients developed postoperative complications. In the total group of patients with rectal cancer, the postoperative morbidity was 30.3 percent. Long‐term results were assessed in 190 patients who had been operated upon more than five years ago. It has been established that 42.1 percent of patients lived more than five years after multivisceral resections. Hope is inspired by the fact that of 15 patients with hepatic metastases (26 percent) lived over five years following radical surgery. These data allow the conclusion that radical surgery for advanced rectal cancer is justifiable and advisable.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A new method for the surgical treatment of ulcerative colitis and polyposis coli is described. Instead of preparing a pelvic pouch, the natural rectal pouch stripped of the diseased mucosa was used experimentally in dogs. The undisturbed muscular cuff of the rectum (12 cm from the anal verge) was covered by healthy vascularized mucosa of small bowel in such a manner that the dog could use its rectum as usual before surgery. The results are encouraging. The rectal reservoir is spared, with its sensitivity, continence and motor activity covered by healthy mucosa. The dogs thrived.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Coloanal anastomosis after resection of the rectum is the ultimate procedure to preserve the patient's sphincter and avoid a permanent colostomy. Carcinoma of the midrectum, and sometimes of the lower third of the rectum, may not require excision of the pelvic floor and anus for cure. A coloanal anastomosis was achieved in 38 patients in whom the indications for surgery were carcinoma in 29, recurrent or extensive adenomas in four, radiation proctitis in two, rectal fistula following radical cystectomy in one, secondary low Hartmann reconstruction after a failed attempt in one, and stenosis of a very low colorectal anastomosis in one. Twenty‐six patients were men and 12 women, with a mean age of 62. Dukes' staging for carcinoma were A:9, B:7, C:11, and two had a palliative resection. The mean distance from the anus was 6.0 cm. All had a temporary defunctioning colostomy. There were no postoperative deaths and 17 (45 percent) had postoperative complications, major in 7 (18 percent), minor in 10 (26 percent). Mean follow‐up is now 40 months (range, 12 to 64 months). Among patients who underwent curative resection, three have had pelvic recurrences. Two of these patients died of widespread distant disease and one underwent abdominoperineal resection and is now free of disease. All others are alive with no evidence of disease. The colostomy was closed in all but six (16 percent). Two (palliative) died within the colostomy and the other four are awaiting closure. Anastomotic stricture was the most common long‐term problem, occurring in 16 and requiring more than one dilatation in eight. Six months after closing the colostomy, the mean daily number of bowel movements is 3.8. Twenty‐six (87 percent) are continent to solid stools, two are incontinent to solid stools, and 16 have to wear a pad to prevent soiling. All but one prefer their present status to having their colostomy. In selected cases of rectal carcinoma with little or no extramural spread, the authors estimate that resection and coloanal anastomosis is a good alternative with acceptable function and a low rate of recurrent disease, which is comparable to complete rectal excision but avoids a permanent colostomy. However, it should not be a substitute for standard abdominoperineal resection for extensive lower rectal carcinoma or for a colorectal anastomosis when the latter is technically feasible.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;In a series of 27 patients who required surgery for distal colonic lesions, primary bowel resection with immediate anastomosis after intraoperative antegrade colonic irrigation was performed. The technique of on‐table lavage was similar to that described by Dudley and Radcliffe in 1980; however, some new technical details are introduced to minimize fecal contamination. There were 17 men and 10 women (mean age, 68.5 years). Twenty patients were admitted for obstructing carcinoma of the left colon; 11 underwent immediate surgery, while the remaining 9 underwent delayed surgery after 12 hours of intravenous fluids and nasogastric suction. Of the remaining seven patients, five had perforated sigmoid diverticula and diffuse peritonitis and two had obstructing diverticular disease of the left colon with remarkable bowel distention. One hospital mortality occurred secondary to a ruptured aortic aneurysm. The radiologic anastomotic leakage rate was 14.8 percent. Clinical anastomotic dehiscence was not observed.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The aim of this prospective study is to investigate whether anal manometry is useful in orienting the surgical policy and improving the clinical and functional results following surgery for fistula‐inano. Anal manometry was performed preoperatively and postoperatively in 96 patients. The results of surgery, in terms of both fecal soiling and recurrence rate, were analyzed and compared with those of another group of 36 subjects. Some operative maneuvers, such as internal sphincterotomy, laying open of the fistula with division of striated muscle, or use of a seton, were carried out according to the preoperative sphincter pattern as shown by anal manometry in the first group. A standard procedure was followed in the control group. The recurrence rate was 3 percent in the anal manometry group and 13 percent in the control group (P<0.01); postoperative soiling occurred in 14 percent of patients in the anal manometry group compared with 31 percent of patients in the control group (P<0.001). The functional results in transsphincteric and suprasphincteric fistulas, which are usually considered at higher risk for postoperative incontinence, were better in the anal manometry group, due to greater use of the seton. No increase in recurrence rate was observed in these complex fistulas after anal manometry. Internal sphincterotomy led to a disordered continence, mainly when associated with division of striated muscle; a significant decrease in resting tone from 56±22 to 47±50 and voluntary contraction from 114±30 to 85±28 mm Hg (mean ± S) was found after surgery in patients with soiling. In conclusion, the routine use of anal manometry may be recommended in the management of patients with fistula‐in‐ano as it improves the clinical and functional outcome of surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;In 597 patients with adenocarcinoma or mucinous adenocarcinoma of the rectum, the prognosis after radical resection for cure was investigated. Staging according to the fourth edition of the UICC TNM classification showed a good correlation to prognosis. By multivariate analysis, various additional independent prognostic factors could be demonstrated. The individual additional prognostic factors are partly of significance in some pTNM defined stages and substages, but not in others. In order to obtain the most detailed knowledge of prognostic factors after radical resection for cure, multivariate analysis of prognostic factors in colorectal carcinoma must be performed not only in separate colonic and rectal groups, but also separately for each of the individual pTNM defined stages and substages.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID