摘要:

&NA;From 1980 to 1986, 165 patients underwent ileal reservoir procedures at the Lahey Clinic Medical Center; 142 (86 percent) had J‐shaped pouches constructed, and 23 (14 percent) had S‐shaped pouches constructed. In this series, 42 complications specifically related to the pouch occurred in 36 patients. Stricture was most common, followed by separation of the ileoanal anastomosis, pelvic sepsis, complex fistula, and a leaking pouch. Through judicious application of remedial operations and either delay in closure of the ileostomy or establishment of proximal loop ileostomy, only seven patients required reestablishment of fecal diversion. The authors urge aggressive diagnostic and therapeutic efforts to save the pouch and maintain satisfactory function in most patients.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;The results of 81 endorectal flap advancements for simple rectovaginal fistulas are reported. Simple fistulas are defined as <2.5 cm in diameter, low or mid vaginal septum in location, and infectious or traumatic in origin. Essentially, the technique is advancement of a flap of mucosa, submucosa, and circular muscle over midline approximation of internal sphincter muscle. The mean patient age was 34 years old (range, 18 to 76 years). The causes were obstetrical injury (74 percent), perineal infection (10 percent), operative trauma (7 percent), and unknown (8 percent). Overall, the repair was successful in 83 percent of patients. Success correlated with the number of previous repairs,i.e., none: 88 percent success; one: 85 percent success; two: 55 percent success. There were 25 concomitant overlapping sphincteroplasty procedures. Only minor complications ensued, with no mortality. This repair is recommended for patients with no or one previous repair because of its lack of mortality, minimal morbidity, ease of concomitant sphincteroplasty, and avoidance of a colostomy. For patients with two or more earlier repairs, a muscle interposition should be considered.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;To determine if subtotal colectomy constitutes a valuable alternative in the treatment of patients with chronic constipation, a retrospective review of 52 consecutive patients who underwent subtotal colectomy between January 1980 and August 1985 was undertaken. Forty‐six patients underwent ileodistal sigmoidostomy while five patients underwent ileoproctostomy and five with concomitant rectal prolapse underwent simultaneous proctopexy. A mortality rate of 3.8 percent and morbidity rate of 60 percent were encountered. The most frequently occurring complication was small‐bowel obstruction, which occurred in 36 percent, and necessitated laparotomy in 66 percent. Additional procedures were necessary in five patients because of newly discovered rectal prolapse (two patients), rectocele (one patient), unrelieved constipation (one patient), and incapacitating incontinence (one patient). Follow‐up data available in 94 percent (mean, 46 months) disclosed that patients had an average of 2.8 bowel movements per day without the use of laxatives (89 percent) or enemas (80 percent). Overall, 79 percent were satisfied with the final outcome. It is concluded that subtotal colectomy constitutes a viable option in the treatment of chronic constipation. However, the significant morbidity and mortality associated with the procedure dictate the need for careful patient selection on the basis of appropriate physiologic testing.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Voiding dysfunction is a common sequel of abdominoperineal resection of the rectum. Twenty patients symptomatic after abdominoperineal resection, 14 with a preoperative normal urodynamic study and six with evidence of obstruction, were studied postoperatively. The importance of the following factors is analyzed: sex, stage, grade, size, distance of the tumor from the anal verge, metastatic lymph‐node involvement, and extent of lymphadenectomy. Male gender, tumors situated between 4 and 8 cm from the anal verge, and lymphadenectomy that includes more than ten nodes may be considered risk factors for neurologic damage and postoperative voiding dysfunction.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;With the theory that Ogilvie's syndrome is caused by sympathetic inhibition of contractility in the colon as a basis, 18 patients with acute colonic pseudo‐obstruction were enrolled in a treatment program assessing the safety and efficacy of sympathetic blockade, by epidural anesthesia, in those who failed conservative management. In some cases colonoscopy had been performed initially and, if unsuccessful, these patients were referred for treatment with epidural anesthesia. Seven patients recovered with conservative treatment alone. One patient refused further treatment and died of her underlying disease. Five of eight patients treated by epidural anesthesia responded. There were no recurrences following successful epidural anesthesia. Five of eight patients treated by colonoscopic decompression responded. No patients required surgical intervention. One patient suffered a subendocardial infarction during colonoscopy. There were no significant complications from epidural anesthesia. Epidural anesthesia is safe, effective, simple, and well tolerated in the management of Ogilvie's syndrome.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;The objective of this study was to demonstrate the existence of colorectal adenomas in India and compare the findings with those reported elsewhere. Seventeen (2.06 percent) adenomas were detected among the 824 colonoscopic examinations conducted from 1978 to 1987. Synchronous malignant tumors were present in 3 (17.6 percent) of the 17 patients. Thus, though adenomas exist in India, they are relatively uncommon to western countries.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;The easiest way to reduce the cost of hospital care for patients is to reduce the length of hospital stay. Multivariate analysis was used to identify potentially alterable factors affecting postoperative length of stay for 320 consecutive colorectal cancer patients undergoing elective surgery during a three‐year period. Prolonged postoperative stays were noted for patients over age 69. Significantly longer stays were seen for men than for women (13.9vs.11.9 days,P=.012). Operative procedure significantly influenced postoperative stay: left hemicolectomies, anterior resections with colostomy, abdominoperineal resections, and subtotal coloectomies were associated with significantly longer stays than right, transverse, sigmoid, and anterior resections without colostomy (P<.001). Complications increased the mean postoperative stay from 11.4 to 19.7 days (P<.001) and stay increased progressively with the number of blood transfusions received from 11.1 days for no blood to 21.6 days for more than four units (P<.001). Severity of disease, as reflected by Dukes' stage, tumor differentiation, and tumor size, was not related to postoperative stay. In the latter half of the study, postoperative stay declined, accompanied by a decline in the use of blood and a shift in the procedures performed for rectal carcinoma away from abdominoperineal resection toward anterior resection without colostomy. Diagnosis‐related group (DRG) relative weights for procedure, age, and complications are at variance with these findings.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Although familial polyposis coli (FPC) is often thought to be a discrete disease with uniform clinical presentation and few therapeutic options, review of 16 families encountered in the last five years has shown that marked variation in the clinical manifestations of the syndrome is the rule rather than the exception. Thirty one percent of propositi had negative family histories, 67 percent of observed cancers were in the rectum, three individuals from three families developed cancer under the age of 20. In another family the only cancer was in a 67‐year‐old patient. Polyp growth rate varied tremendously among individuals and over time within individuals, rectal polyps did not regress after subtotal colectomy, and three patients developed rectal cancer after subtotal colectomy (18 percent). Fifty percent of propositi had cancer on presentation, while only 18 percent of screened family members had cancer. The only extracolonic tumors seen were gastroduodenal polyps and retroperitoneal desmoids in three families. The mode of inheritance of FPC causes this variation and treatment is best tailored to the individual and his family rather than uniformly applied to all patients with FPC.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Perineal excision of rectal prolapse with simultaneous posterior levator ani repair was used to treat 41 elderly patients with rectal procidentia. The majority of the patients had significant associated risk factors. This procedure was performed with minimal morbidity and no mortality. A significant improvement in anal continence was seen in 78 percent of patients. The recurrence rate of rectal prolapse was 4.8 percent.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID