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  • 1
    Electronic Resource
    Electronic Resource
    Role of the seton in the management of anorectal fistulas (1993)
    Springer
    Diseases of the colon & rectum 36 (1993), S. 573-579 
    Details
    ISSN: 1530-0358
    Keywords: Seton ; Fistula ; Fistulotomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: To identify the incidence of major fecal incontinence and recurrence after staged fistulotomy using a seton. METHODS: A five-year retrospective chart review of 116 patients (70 males and 46 females) ranging in age from 18 to 81 years (mean, 42 years), in whom setons were placed as part of a surgical procedure for anorectal fistulas, was carried out. Follow-up ranged from 2 to 61 months (mean, 23 months). RESULTS: Setons were employed to identify and promote fibrosis around a complex anorectal fistula as part of a staged fistulotomy in 65 patients (56 percent). Other indications for seton placement included 24 women with anteriorly situated high transsphincteric fistulas (21 percent) and three patients with massive anorectal sepsis (floating, freestanding anus) (2.5 percent). In addition, setons were used to preclude premature skin closure and promote controlled long-term fistula drainage in 21 patients with severe anorectal Crohn's disease (18 percent) and in three patients with AIDS (2.5 percent). Major fecal incontinence (requiring the use of a perineal pad) occurred in five patients (5 percent), and recurrent fistulas were noted in three (3 percent). CONCLUSIONS: Staged fistulotomy using a seton is a safe and effective method of treating high or complicated anorectal fistulas.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02049864
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  • 2
    Electronic Resource
    Electronic Resource
    Stoma complications (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 1575-1580 
    Details
    ISSN: 1530-0358
    Keywords: Enteric stomas ; Enterostoma ; Colostomy ; Ileostomy ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: A retrospective analysis of enteric stomas performed at Cook County Hospital was undertaken to evaluate stoma complications per stoma type and configuration and operating service. In addition, we attempted to identify factors predictive of increased enteric stoma complications. METHODS: From 1976 to 1995, data cards on 1,616 patients with stomas were compiled by Cook County Hospital enteric stomal therapists. Data card information included age, gender, weight, early and late stoma complications, emergency status, operating service, type and configuration of the stoma, and whether the patient was seen preoperatively by an enteric stomal therapist. Data were then analyzed using a logistic regression model to identify those variables that influenced the rate of complications. RESULTS: There were 553 (34 percent) patients with complications. Among the total complications, 448 (28 percent) occurred early (〈1 month postoperative), and 105 (6 percent) occurred late (〉1 month). The most common early complications were skin irritation (12 percent), pain associated with poor stoma location (7 percent), and partial necrosis (5 percent). The most common late complications were skin irritation (6 percent), prolapse (2 percent), and stenosis (2 percent). The enteric stoma with the most complications was the loop ileostomy (75 percent). The enteric stoma with the least complications was the end transverse colostomy (6 percent). The general surgery service had the most complications (47 percent), followed by gynecology (44 percent), surgical oncology (37 percent), colorectal (32 percent), pediatric surgery (29 percent), and trauma (25 percent). Age, operating service, enteric stoma type and configuration, and preoperative enteric stomal therapist marking were found to be variables that influenced stoma complications. CONCLUSIONS: Complications from enteric stoma construction are common. Preoperative enteric stoma site marking, especially in older patients, and avoiding the ileostomy, particularly in the loop configuration, can help minimize complications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236210
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  • 3
    Electronic Resource
    Electronic Resource
    Invited editorial (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 949-950 
    Details
    ISSN: 1530-0358
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237356
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  • 4
    Electronic Resource
    Electronic Resource
    A safe technique for resection of perforated sigmoid diverticulitis (1990)
    Springer
    Diseases of the colon & rectum 33 (1990), S. 905-906 
    Details
    ISSN: 1530-0358
    Keywords: Diverticulitis ; Surgical technique
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A technique for safe “proximal to distal” dissection of the acutely inflamed sigmoid colon is described.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02051933
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  • 5
    Electronic Resource
    Electronic Resource
    A comparison of simultaneous longitudinal and radial recordings of anal canal pressures (1990)
    Springer
    Diseases of the colon & rectum 33 (1990), S. 201-206 
    Details
    ISSN: 1530-0358
    Keywords: Anal manometry ; Continence ; Internal sphincter ; External sphincter
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A new anal manometry perfusion catheter is described that offers the capability of simultaneous linear longitudinal pressure measurements. The authors studied 20 control subjects with this catheter and with a four-quadrant perfusion catheter. An asymmetry of basal, squeeze, and relaxation pressures was found. The highest basal pressures were in the middle of the anal canal, regardless of quadrant orientation. Using the radial perfusion catheter, the squeeze pressure profile was consistent with a double-loop external sphincter mechanism. Using the linear perfusion catheter, the internal sphincter relaxation pressures show a greater negative deflection at the proximal portions of the sphincter, which was not achieved at points distally in the same quadrant. This implies that during reflex relaxation, pressure is maintained in the distal anal canal so that patients remain continent during sensory sampling of rectal contents. The authors believe this is the first time this same-quadrant longitudinal asymmetry of relaxation has been shown with a single rectal balloon stimulus.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02134179
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  • 6
    Electronic Resource
    Electronic Resource
    Pull-through procedures performed months to years after permanent proctectomy (1995)
    Springer
    Diseases of the colon & rectum 38 (1995), S. 294-296 
    Details
    ISSN: 1530-0358
    Keywords: Rectal reconstruction ; Pull-through ; Ileal pouch-anal anastomosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Patients who have undergone proctectomy without concomitant rectal reconstruction or coloanal anastomosis were not normally considered candidates for re-establishment of anal continuity until a case report published in 1985. With the addition of nine patients, reported herein is a series of ten patients who have undergone delayed pull-through procedures months to years after permanent proctectomy. PATIENTS: Ten patients (including the single case reported in 1985) have undergone delayed pullthrough procedures up to 24 years after permanent proctectomy and ostomy formation. Delayed ileal pouch-anal anastomoses were performed in nine patients, and delayed coloanal anastomosis was performed in one patient. There were four males and six females, each of whom had evidence of external sphincter contraction on physical examination. Average age was 33 (range, 24–51) years at the time of reconstruction. Average duration of follow-up is 32 (range, 1–96) months. RESULTS: One patient is awaiting ileostomy closure. Five of nine patients use constipating agents. Two patients are constipated and use enemas to aid in evacuation. None are wearing protective undergarments. One patient had his ileostomy reconstructed eight years after delayed pull-through for uncontrollable diarrhea associated with chemotherapy for multiple myeloma and recently died. Postoperative complications included wound infection (3), enterocutaneous anastomotic stricture requiring anoplasty (2), small bowel obstruction (1), pneumonia (1), presacral abscess (1), and pouchitis (1). CONCLUSIONS: Delayed pull-through procedures performed months to years after permanent proctectomy can be performed in selected patients, with results comparable to rectal reconstruction done at the time of proctectomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02055606
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  • 7
    Electronic Resource
    Electronic Resource
    Management of recurrent rectal prolapse (1997)
    Springer
    Diseases of the colon & rectum 40 (1997), S. 832-834 
    Details
    ISSN: 1530-0358
    Keywords: Rectal prolapse ; Recurrence ; Procidentia ; Surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Many operations have been described for the management of rectal prolapse. Despite an overall recurrence rate of greater than 15 percent, few reviews address how to deal with this problem. This report summarizes our experience with recurrent rectal prolapse and includes suggestions for reoperative management of failed repairs from both abdominal and perineal approaches. PATIENTS AND METHODS: Fourteen patients (3 male) ranging in age from 22 to 92 (mean, 68) years underwent operative correction of recurrent rectal prolapse. Average time from initial operation to recurrence was 14 (range, 6–60) months. Initial operations (before recurrence) were as follows: perineal proctectomy and levatorplasty (10), anal encirclement (2), Delorme's procedure (1), and anterior resection (1). Operative procedures performed for recurrence were as follows: perineal proctectomy and levatorplasty (7), sacral rectopexy (abdominal approach; 3), anterior resection with rectopexy (2), Delorme's procedure (1), and anal encirclement (1). Average length of follow-up was 50 (range, 9–115) months. RESULTS: No further episodes of complete rectal prolapse were observed during this period. Preoperatively, three patients were noted to be incontinent to the extent that necessitated the use of perineal pads. The reoperative procedures failed to restore fecal continence in any of these three individuals. One patient died in the postoperative period after anal encirclement from an unrelated cause. CONCLUSION: Surgical management of recurrent rectal prolapse can be expected to alleviate the prolapse, but not necessarily fecal incontinence. Perineal proctectomies can be safely repeated. Resectional procedures may result in an ischemic segment between two anastomoses, unless the surgeon can resect a previous anastomosis in the repeat procedure. Nonresectional procedures such as the Delorme's procedure should be strongly considered in the management of recurrent rectal prolapse if a resectional procedure was performed initially and failed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02055442
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  • 8
    Electronic Resource
    Electronic Resource
    Technical manual for manufacturing autologous fibrin tissue adhesive (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 1334-1338 
    Details
    ISSN: 1530-0358
    Keywords: Fistula ; Autologous fibrin glue
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The aim of this article is to provide a concise and simple technical manual for manufacturing autologous fibrin tissue adhesive derived from the precipitation of fibrinogen using a combination of ethanol and freezing for surgery. METHODS: All materials and equipment needed to manufacture ethanol-based autologous fibrin tissue adhesive are listed. In addition, step-by-step instructions are provided to allow for easy and rapid fibrin adhesive production. RESULTS: Ethanol-based autologous fibrin tissue adhesive can be manufactured in under 60 minutes. Furthermore, at our institution the startup cost for manufacturing ethanol-based autologous fibrin tissue adhesive was under $2,500.00. CONCLUSION: Ethanol-based autologous fibrin tissue adhesive is a safe, reliable, and easily manufactured autologous fibrin tissue adhesive that can be made by a trained technician in any blood bank, pharmacy, or surgical laboratory.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02234225
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  • 9
    Electronic Resource
    Electronic Resource
    Bilateral gluteus maximus transposition for anal incontinence (1991)
    Springer
    Diseases of the colon & rectum 34 (1991), S. 478-481 
    Details
    ISSN: 1530-0358
    Keywords: Fecal incontinence ; Gluteus maximus ; Anal encirclement ; Muscle transfer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Seven patients (five men and two women) ranging in age from 26 to 65 years (¯x=44) underwent bilateral gluteus maximus transposition for complete anal incontinence. The indications for operation were sphincter destruction secondary to multiple fistulotomies (n=4), bilateral pudendal nerve damage (n=2), and high imperforate anus (n=1). The procedure is performed without the use of a diverting colostomy. The inferior portion of the origin of each gluteus maximus is detached from the sacrum and coccyx, bifurcated, and tunneled subcutaneously to encircle the anus. The ends are then sutured together to form two opposing slings of voluntary muscle. Postoperatively, six patients regained continence to solid stool, two to liquid stool as well, and only one patient in this group was able to control flatus. Although resting pressures remained unchanged, voluntary squeeze pressures were restored by this operation. In addition, rectal sensation was markedly improved, which helps make this a worthwhile procedure for properly selected patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02049933
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  • 10
    Electronic Resource
    Electronic Resource
    Island flap anoplasty for the treatment of anal stricture and mucosal ectropion (1990)
    Springer
    Diseases of the colon & rectum 33 (1990), S. 581-583 
    Details
    ISSN: 1530-0358
    Keywords: Anal stenosis ; Stricture ; Ectropion ; Anoplasty ; Whitehead deformity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Twenty patients with benign anal strictures and five patients with mucosal ectropion were treated with island flap anoplasty. U-shaped or diamond-shaped islands of perianal skin were created, without undermining, and advanced into the anal canal to remedy the stricture or site of ectropion. Over a postoperative follow-up period that averaged 19 months, 16 patients judged their clinical results as excellent and 7 as good. There were two failures. In all patients the skin flaps survived, even in the elderly patients. Island flap anoplasty is a simple, effective alternative to other forms of anoplasty such as Y-V advancement or S-plasty.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02052210
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