ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:This study evaluated the feasibility and safety of laparoscopic bowel surgery performed by colorectal surgeons not previously experienced in laparoscopic biliary or appendiceal surgery.METHODS:Thirty‐two patients underwent ileocolic resection/anastomosis (n=12), loop ileostomy (n=7), colostomy (n=4), ileostomy takedown/ileorectal anastomosis (n=3), subtotal colectomy/ileorectal anastomosis (n=2), sigmoid resection (n=2), or other procedures (n=2). No curative cancer surgery was undertaken.RESULTS:Time to first bowel movement was one to eight (median, four) days. Length of stay ranged from 4 to 11 (median, 6) days. There were no major complications seen in follow‐up from 6 to 15 (median, 7) months after surgery.CONCLUSIONS:Large intestinal and distal ileal surgery using laparoscopic techniques, performed by surgeons with training only in laparoscopic intestinal surgery, is feasible and safe. Faster recovery and need for less postoperative analgesia in laparoscopic surgery compared with conventional surgery cannot be surmised from this study. A randomized study design is needed to evaluate many of the differences between conventional and laparoscopic intestinal surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to clarify the distribution of lymph node metastasis in colorectal cancer. We also examined the relationship between the primary tumor (T) and the regional node (N) categories of the TNM (primary tumor, regional nodes, metastasis) classification.METHOD:Lymph nodes of surgical specimens in 311 consecutive patients with colorectal cancer were studied using the modified clearing method.RESULTS:Lymph node metastasis was seen in 59.2 percent of the total cases. The upward metastasis rate was 30.7 percent. In the longitudinal spread, most of the lymph node metastasis was seen within 10 cm. On the oral side in rectal cancer, there was no metastasis beyond 4 cm. The lateral metastasis rate in rectal cancer was 8.8 percent and in the lower rectum, the rate of cancer within 6 cm from the anal verge or beyond pT3 was much higher.CONCLUSION:In the TNM classification, there was no significant difference between colon and rectal cancer except pT1 with rectal cancer. In the lower rectal cancer within 6 cm from the anal verge or beyond pT3, there is a high risk of lateral metastasis, and lateral lymph node dissection or radiation therapy should be performed.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to determine the value of preoperative anal manometry in predicting postoperative continence.METHODS:Anal manometry was performed in 73 consecutive patients before ileal pouch‐anal anastomosis (IPAA) surgery (m1), before loop ileostomy closure (m2), and at a follow‐up of one (m3) and two (m4) years. Mean and maximum resting and squeezing pressures were documented at each occasion. One year after surgery, pressures were correlated(r)with an incontinence score.RESULTS:A significant(P< 0.05) decrease in mean resting pressures was observed after IPAA (m1=66 mmHg; m2=42.8 mmHg), followed by a significant(P< 0.05) improvement of mean resting pressure after loop ileostomy closure (m3 = 538 mmHg; m4 = 54.7 mmHg). Mean squeezing pressures did not change(P> 0.05) at any time during the study (m1 =114 mmHg; m2 = 102.9 mmHg; m3 = 103.4 mmHg; m4 = 95.8 mmHg). There was no correlation between preoperative mean resting pressure and postoperative (mI) incontinence score.CONCLUSION:Anal manometry showed a characteristic trend in internal anal sphincter injury after IPAA followed by recovery after ileostomy closure. However, it failed to prove helpful in the prediction of clinical outcome. Thus, although this study supports the continued use of manometry in a research setting, it challenges the value of routine manometry in a clinical context.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:This study was designed to compare the efficacy and patient tolerance of standard orthograde bowel preparation using 4 liters of polyethylene glycol solution with only 2 liters of polyethylene glycol preceded by the stimulant laxative bisacodyl.METHODS:Three hundred eighty‐two consecutive patients undergoing outpatient colonoscopy under two surgeons over a six‐month period were randomized to receive one of the two preparations. Patients were asked to record the effects of the preparation and to give it a “discomfort rating” on a scale from 1 to 5. Surgeons were blinded to the preparation used and rated the quality of bowel cleansing on a scale of 1 to 5. One hundred ninety‐one patients were randomized to the 4‐liter preparation and 191 to the 2‐liter preparation.RESULTS:Ninety‐three percent of patients in the 2‐liter group drank all of the solution as opposed to only 66 percent of patients in the 4‐liter group. Patients in the 4‐liter group gave the preparation significantly lower comfort scores than those in the 2‐liter group (Fisher's exact test;P= 0.0001). The quality of bowel cleansing was not significantly different between the groups(P= 0.88). A total of 6.8 percent of the 2‐liter group and 9.4 percent of the 4‐liter group were considered by the surgeon to have had a poor preparation (rating 4 or 5). The quality of the preparation was found to correlate with the patients' age and compliance with the preparation regimen, and was found not to correlate with presenting symptoms, pathology, or a previous colonic resection.CONCLUSION:Bowel preparation with bisacodyl and 2 liters of polyethylene glycol is more acceptable to patients than a 4‐liter regimen and is equally effective in cleansing the colon.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:This study investigates the normal ultrasono graphic morphology of pelvic floor striated muscle and evaluates whether there are differences between males and females and between healthy subjects and patients with idiopathic fecal incontinence.METHODS:Manometric and ultrasonographic studies of the anal canal were performed in 30 healthy volunteers and in 26 patients with idiopathic fecal incontinence. Verification of ultrasonographic findings was obtained by studying anatomic preparations.RESULTS:Ultrasonography reliably identified the internal and external anal sphincter and frequently visualized neighboring structures. In addition, it detected muscular structures that have not clearly been described previously. However, differences in external sphincter function between males and females and between healthy subjects and incontinent patients were not reflected by alterations in muscle thickness.CONCLUSIONS:Endosonography of the anal canal clearly delineates muscular structures and may even visualize structures that have been previously incompletely defined. However, it remains to be shown that differences in certain muscular functions have a morphologic correlate that can be detected by endosonography.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:The optimal time for reversal of Hartmann's procedure is controversial. Significant operative difficulty and morbidity have been reported for Hartmann's reversal. The purpose of this study was to examine 11 years' experience with Hartmann's reversal, with particular attention to rate of reversibility, operative difficulty, and timing of reversal.METHODS:Case records of all patients undergoing either Hartmann's procedure or Hartmann's reversal at St. Vincent's Hospital between 1981 and 1991 were examined. Patients having Hartmann's reversal were divided into an early group (before 15 weeks) and a late group (after 15 weeks). These groups were compared in terms of morbidity and mortality, bed stay, and operative difficulty.RESULTS:Hartmann's procedure was performed on 111 patients, mostly for advanced cancer and complicated diverticular disease. Of 96 patients who survived, 50 (52 percent) underwent reversal. Of those with diverticular disease, 40 of 48 (83 percent) underwent reversal. Mortality for Hartmann reversal was 2 percent; anastomotic leak rate 4 percent; and overall complication rate 26 percent. Early reversal was performed in 13 patients and late reversal in 37 patients. There was no difference between these groups in mortality, morbidity, or anastomotic leakage. However, bed stay was longer in the early group and graded operative difficulty greater. In particular, cases in which adhesion density was most severe and in which accidental enterotomy occurred were more common in the early group(P= 0.02, Miettinen's modification of Fisher's exact test).CONCLUSIONS:Hartmann's reversal can be performed with an acceptable morbidity and mortality in most survivors of complicated diverticular disease. Operative difficulty appears to be less after a delay of 15 weeks.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to devise a measuring method for an anterior rectocele on standardized defecographies and magnetic resonance images (MRI) to quantify anterior rectocele and to test whether this could substantiate clinical decision making for operative treatment for anterior rectocele.METHODS:Quantitative analysis by the measuring method as proposed was compared with qualitative scores on defecographies and MRI from the same patients. Thirty‐eight patients with symptoms compatible with an anterior rectocele were subjected to physical examination in the left decubitis position and supine position and to defecography. Findings on defecography were compared with findings on physical examination. Thirteen patients were examined before and after surgical correction of the anterior rectocele for a total of 51 qualitative and quantitative examinations. The group of operated patients was analyzed for treatment results. Nineteen controls were included.RESULTS:Sixtysix radiographs of 33 defecographies were qualified in three grading classes and quantified with the proposed method by two observers. The mean measured value of the anterior rectocele in the three subjective grading classes is significantly different(P< 0.001). Anterior rectoceles qualified as severe had a measured value of 20 mm or more in 96 percent of the radiographs. Lower gradings were never >20 mm. On MRI severe anterior rectoceles were not scored and measured values did not correlate with qualitative scores. When findings on physical examination were compared with defecographic measurement, the coefficient of correlation(r)between the radiologic assessment and clinical examination in the left decubitis position isr= 0.87, for the examination in the supine position,r= 0.77. All 15 cases scored as severe anterior rectocele in the left decubitis position had a measured anterior rectocele of ≥20 mm. In the 13 cases that received surgery, there was a significant reduction of the anterior rectocele(P< 0.001) and clinical improvement. Patients with small or moderate anterior rectocele on physical examination with a size ≥20 mm on defecography were cured by surgical correction. None of the controls had an anterior rectocele on physical examination or an anterior rectocele ≥20 mm on defecography.CONCLUSIONS:An anterior rectocele with a size of 20 mm or more corresponds with a qualitative score of “severe” on Radiographic defecography. Physical examination for anterior rectocele in the left decubitis position corresponds best with quantitative Radiographic assessment and anterior rectocele with a size ≥20 mm on defecography is pathologic. Patients with complaints compatible with anterior rectocele can be assessed in objective and quantitative terms by radiography and can be successfully surgically treated, even if at physical examination the anterior rectocele is not classified as large, provided that dynamic defecography shows an anterior rectocele of ≥20 mm. The potential of dynamic MRI with regard to anterior rectoceles presently seems absent.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to describe the natural history and management of surgically unresectable intra‐abdominal desmoid tumors in two patients with Gardner's syndrome from two unrelated families, where each had failed on conventional therapy.METHODS:Two patients with Gardner's syndrome were placed on a chemotherapy regimen which included doxorubicin (90 mg/m2) and dacarbazine (900 mg/m2) in divided doses over four days of continuous infusion. Their progress on chemotherapy was assessed by abdominal computerized tomography and laparoscopy.RESULTS:The computerized abdominal tomography scans proved difficult to interpret because of adhesions and matted small bowel resulting from the patients original colectomies. These findings made it difficult to differentiate postoperative changes from residual desmoid tumor. Second‐look laparotomy in such patients was contraindicated as this may predispose to further desmoid production. Laparoscopy disclosed a complete response to this chemotherapy. Nevertheless, we had an iatrogenic small bowel perforation in one of these patients. Each patient showed a complete response to chemotherapy.CONCLUSION:Surgical resection remains the first‐line treatment of intra‐abdominal desmoid tumors. However, doxorubicin/ dacarbazine chemotherapy on a clinical trial basis may be indicated in patients whose intra‐abdominal desmoid is unresectable, or who have failed to respond to treatment with hormones (tamoxifen, Toremifene), steroids (prednisone), and nonsteroidal anti‐inflammatory agents (Clinoril®; Merck & Co., Inc., West Point, PA).

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

&NA;Laparoscopic surgery seems set to make a significant impact on the practice of colorectal surgery. However, to date, the majority of surgeons have used a technique of laparoscopic assistance whereby initial laparoscopic mobilization of the bowel is followed by extracorporeal mesenteric and bowel division and subsequent restoration of bowel continuity. This report describes a technique of totally laparoscopic left‐sided colonic resection, transanal specimen delivery, and intracorporeal colorectal anastomosis. The technique employed is described in detail and the indications and controversies surrounding such an approach are discussed.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID