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  • 1
    Electronic Resource
    Electronic Resource
    Newly designed occluder pin for presacral hemorrhage (1992)
    Springer
    Diseases of the colon & rectum 35 (1992), S. 166-169 
    Details
    ISSN: 1530-0358
    Keywords: Presacral hemorrhage ; Occluder pin ; Hemostasis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Conventional hemostatic measures are often unsatisfactory in presacral venous bleeding occurring during surgical mobilization of the rectum. We designed a new type of hemorrhage occluder pin, with a ridged shaft, which may be rapidly placed into the sacrum to control hemorrhage. The aims of this study were 1) to assess the best pin shaft length by measuring the thickness of human sacral vertebral bodies, 2) to measure the forces needed to pull the newly designed pin out of the human sacrum compared with conventionally shaped titanium thumb-tacks, and 3) to assess clinically the efficacy of the new device. Four fresh cadaveric pelves were isolated and cut on a sagittal plane, and the thickness of each vertebral body was measured. Titanium pins, both with ridged and with smooth shafts, were used. Twelve-millimeter-shaft pins were used for S1 and S2, and 7-mm pins were used for S3, S4, and S5. Pins were inserted into each sacral vertebra, and the forces needed to extract them from the bone were measured by computerized dynamometry. Significantly more force was required to extract ridged vs. smooth pins, both with 12-mm and with 7-mm shafts. There was no significant difference between the forces needed to pull out 12-mm vs. 7-mm pins. The new pin was successfully used to stop presacral hemorrhage in three patients with no complications one, three, and six months after surgery. This newly designed hemorrhage occluder pin may represent an improved method of controlling presacral venous hemorrhage.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02050673
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  • 2
    Electronic Resource
    Electronic Resource
    Predicting the functional result of anastomoses to the anus: The paradox of preoperative anal resting pressure (1993)
    Springer
    Diseases of the colon & rectum 36 (1993), S. 895-900 
    Details
    ISSN: 1530-0358
    Keywords: Ileal pouch-anal anastomosis ; Coloanal anastomosis ; Anorectal manometry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This article examines the effect of ileal pouch-anal (n=134) and coloanal (n=16) anastomoses on resting anal canal pressures in 150 patients. METHODS: Patients underwent anal manometry before ileal pouch-anal anastomosis (IPAA) and coloanal anastomosis (CAA) and again six weeks after ileostomy closure following these procedures. A water-perfused catheter system with four radial ports was used for manometry, pressures being recorded during both station and continuous pull through. RESULTS: Patients with IPAA were younger than those with CAA (34 years vs. 50 years) and had a different ratio of hand-to-stapled anastomosis (1∶2.6 vs. 1.3∶1). All CAA patients had had rectal cancer while IPAA patients suffered mainly from ulcerative colitis (n=114) or familial polyposis (n=10). The mean preoperative resting pressure for all patients was 79 mmHg (75–87, 95 percent confidence limit) and the mean fall in this pressure after surgery was 25 mmHg (−21 to −29, 95 percent confidence limit). There was no difference in preoperative pressure or fall between handsewn and stapled anastomoses, or between IPAA and CAA. CONCLUSION: There was a significant relationship between preoperative pressure and change in pressure that held true for all subgroups (change=−0.7 × preoperative pressure + 31,r=0.69). Analysis of the functional results confirmed that patients with high preoperative pressure are at risk for severe falls after surgery and are not guaranteed a good result. Conversely, patients with low preoperative pressures may actually have an increase with surgery and are not always incontinent. Patients with low preoperative anal resting pressures should not be denied anastomosis to the anus if they are continent.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02050622
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  • 3
    Electronic Resource
    Electronic Resource
    Abstracts (1990)
    Springer
    Diseases of the colon & rectum 33 (1990), S. P2 
    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/BF02052161
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  • 4
    Electronic Resource
    Electronic Resource
    Podium presentations (1993)
    Springer
    Diseases of the colon & rectum 36 (1993), S. P1 
    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/BF02053958
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  • 5
    Electronic Resource
    Electronic Resource
    Incidence and natural history of dysplasia of the anal transitional zone after ileal pouch-anal anastomosis (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 1660-1665 
    Details
    ISSN: 1530-0358
    Keywords: Ileal Pouch ; Ulcerative colitis ; Cancer ; Precancerous conditions ; Anus ; Rectum ; Surgery ; Treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Preservation of the anal transitional zone during ileal pouch-anal anastomosis is still controversial because of the risk of dysplasia and the theoretical risk of associated cancer. Without long-term follow-up data, the natural history and optimal treatment of anal transitional zone dysplasia are unknown. The aim of this study was to determine the long-term risk of dysplasia in the anal transitional zone and to evaluate the outcome of a conservative management policy for anal transitional zone dysplasia. METHODS: Two hundred ten patients undergoing anal transitional zone-sparing ileal pouch-anal anastomosis for ulcerative or indeterminate colitis between 1987 and 1992 and who were studied with serial anal transitional zone biopsies for at least five years postoperatively were included. Median follow up was 77 (range, 60–124) months. RESULTS: Anal transitional zone dysplasia developed in seven patients 4 to 51 (median, 11) months postoperatively. There was no association with gender, age, preoperative disease duration or extent of colitis, but the risk of anal transitional zone dysplasia was significantly increased in patients with prior cancer or dysplasia in the colon or rectum. Dysplasia was high grade in one and low grade in six. Two patients each with low-grade dysplasia detected on three separate occasions underwent mucosectomy 29 and 38 months after detection of low-grade dysplasia, but no cancer was found. The five other patients with dysplasia on one or two occasions were treated expectantly and were apparently dysplasia-free for a median of 72 (range, 48–100) months. CONCLUSIONS: Anal transitional zone dysplasia after ileal pouch-anal anastomosis is infrequent, is most common in the first two to three years postoperatively and may apparently disappear on repeated biopsy. Anal transitional zone preservation did not lead to the development of cancer in the anal transitional zone after five to ten years of follow-up. Long-term surveillance is recommended to monitor dysplasia. If repeat biopsy confirms persistent dysplasia, anal transitional zone excision with neoileal pouch-anal anastomosis is recommended.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236846
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  • 6
    Electronic Resource
    Electronic Resource
    Laparoscopic colectomy: A critical appraisal (1993)
    Springer
    Diseases of the colon & rectum 36 (1993), S. 28-34 
    Details
    ISSN: 1530-0358
    Keywords: Laparoscopy ; Laparoscopic colectomy ; Colectomy ; Colon resection ; Colon and rectal surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A multicenter retrospective study was undertaken to assess the efficacy and safety of laparoscopy in colon and rectal surgery. To minimize potential bias in interpretation of the results, all data were registered with an independent observer, who did not participate in any of the surgical procedures. Sixty-six patients underwent a laparoscopic procedure. Operations performed included sigmoid colectomy (19), right hemicolectomy (15), low anterior resection (6), colectomy with ileal pouch-anal anastomosis (IPAA) (5), and abdominoperineal resection (APR) (3). The conversion rate from laparoscopic colectomy to celiotomy was 41 percent. Major morbidity and mortality were 24 percent and 0 percent, respectively. Length of stay, hospital costs, and lymph node harvest were compared between the sigmoid resection and right hemicolectomy subgroups. Data from traditional sigmoid colectomies and right hemicolectomies were obtained from the same institutions for comparison. Mean postoperative stay for laparoscopically completed sigmoid and right colectomies was significantly less than that for either the converted or the traditional groups (P 〈0.02). Total hospital cost for traditional right hemicolectomy was significantly less than that for the converted group (P 〈 0.05) but not the laparoscopic group. Laparoscopic sigmoid resection showed no significant total hospital cost difference among traditional, converted, and laparoscopic groups. Lymph node harvest in resections for carcinoma was comparable in all groups. These preliminary data suggest that laparoscopic colon and rectal surgery can be accomplished with acceptable morbidity and mortality when performed by trained surgeons. Length of stay is shorter, but there is no proven total hospital cost benefit. Appropriate registries will be necessary to adequately assess long-term outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02050298
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  • 7
    Electronic Resource
    Electronic Resource
    The results of surgical treatment of cancer of the colon at the Cleveland Clinic from 1965–1975: classification of the spread of colon cancer and long-term survival (1986)
    Springer
    International journal of colorectal disease 1 (1986), S. 33-39 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Between the years 1965–1975, 564 patients underwent surgical treatment for cancer of the colon. The primary tumour was removed in 502 patients (89%) in all cases with a “no touch isolation” technique. The 5-year survival rate corrected for age was 64% in 546 operative survivors, and 82% in 413 patients operated with intent to cure. Survival analyses are presented classifying the spread of the tumour by (1) the clinico-pathological method of Turnbull, (2) the TNM method, (3) the Astler-Coller method, (4) Dukes' method. The results suggest that (a) the Astler-Coller classification offers no advantage over that of Dukes' when predicting survival for patients after operation for cure, and (b) that separating those patients considered to have evidence of invasion of an adjacent organ at operation (Turnbull's classification) from those patients without evidence of contiguous growth, is only justified if invasion of cancer is confirmed by histological examination of the resected specimen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01648834
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  • 8
    Electronic Resource
    Electronic Resource
    Our approach to the management of congenital presacral tumors in adults (1993)
    Springer
    International journal of colorectal disease 8 (1993), S. 134-138 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study reviews the recent overall experience in one colorectal surgery department with congenital presacral tumors in adults. 24 patients greater than 21 years of age, who underwent curative resection between January 1980 and August 1992, were analyzed retrospectively. The growths were divided into two broad categories: developmental cysts and chordomas. The most common presenting symptom was pain (19/24). A preoperative evaluation regimen is outlined in the study and includes use of CT scanning, MRI imaging, and possibly the use of endoluminal ultrasound to document the relationship of presacral tumors to pelvic viscera. There were 20 developmental cysts and 4 chordomas treated in this series. 15 of 19 developmental cysts were excised by a posterior approach alone, 2 were excised by an anterior approach alone, and 3 were treated by a combined approach. Trans-sacral excision was carried out in 4 patients with developmental cysts. One chordoma was resected posteriorly and the other 3 through a combined anterior and posterior approach. Three recurrences were diagnosed after excision of developmental cysts at 8, 18, and 41 months postoperatively. Recurrence occurred in 3 of 4 chordoma patients after 25, 32, and 55 months. Reexcision was carried out in all patients. None of the developmental cyst cases developed a second recurrence but 2 of the 3 chordoma patients have recurred, but have undergone local irradiation, which has controlled their disease. A detailed surgical treatment plan is outlined in this article, emphasizing that total excision be the goal surgery, even if this requires a combined anterior and posterior approach. In cases of recurrence of both development cysts and chordoma, re-excision is a reasonable therapeutic option.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00341185
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  • 9
    Electronic Resource
    Electronic Resource
    The outcome of loop ileostomy closure in 293 cases (1987)
    Springer
    International journal of colorectal disease 2 (1987), S. 214-217 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Our experience with closure of loop ileostomies between the years 1975–1986 was reviewed. Ninety-three percent of stoma closures were done by simple transverse suture. The overall complication rate was 17%. Of the early postoperative complications (13%), the major complication was small bowel obstruction especially in patients where the stoma was protecting a pelvic ileal reservoir. Abdominal septic complications (postclosure) were rare (1%). These were generally caused by unrecognized enteric tears during the mobilization of the stoma rather than anastomotic leakage. A careful operative technique is required. The wound infection rate after healing by both secondary intention and primary skin closure was low (3%) and mainly superficial. Only one incisional hernia was observed in the late postoperative period. In three patients a posterior rectus sheath defect at the stoma site was found incidentally at laparotomy, without clinical evidence of an incisional hernia. Closure of a loop ileostomy is a safe operation with a low morbidity. In patients with a previous total colectomy there was a significant risk of small bowel obstruction after ileostomy closure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01649508
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  • 10
    Electronic Resource
    Electronic Resource
    The differential diagnosis and comorbidity of hidradenitis suppurativa and perianal Crohn's disease (1993)
    Springer
    International journal of colorectal disease 8 (1993), S. 117-119 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Au cours des 8 ans passés, 61 patients avec hidradénite supparative (HS) ont été traités à cette institution. 24 avaient aussi un diagnostic de maladie de Crohn (38%). Cette pathologie double est examinée en détail dans une revue rétrospective. Il y avait 11 hommes et 13 femmes d'un âge moyen de 39 (18–75 ans). La maladie de Crohn était iléale chez 1 patient, iléocolique chez 4 et affectait le colon seulement chez 19. Le diagnostic de malade de Crohn était antérieur à celui de HS en moyenne de 3,5 ans. A l'époque de la revue, 22 patients avaient une stomie, 23 avaient subi une laparotomie et 17 avaient perdu le rectum. L'hidradénite suppurative est survenue dans les zones périnéales ou périanales chez tous les patients mais occupait aussi d'autres lieux dans 20 cas. Une greffe cutanée a été faite chez 9 et des traitements locaux chez 19 patients. Des granulomes ont été trouvés dans la peau excisée chez 6 malades mais ces découvertes n'étaient pas associées avec un mauvais pronostic. Avec un recul moyen de 3,2 ans après la plus récente intervention chirurgicale pour hidroadénite (1 à 11 ans) 11 étaient asymptomatiques pour leur hidroadénite, 11 avaient des symptômes et 2 étaient perdus de vue. Ces faits montrent que HS peut coexister avec la maladie de Crohn rectocolique, compliquant le diagnostic et la traitement des patients ches lesquels elle survient. Un accroissement de l'appréciation de cette possibilité est recommandée.
    Notes: Abstract Over the last 8 years, 61 patients with hidradenitis suppurativa (HS) have been treated at this institution. Twenty-four have also had a diagnosis of Crohn's disease (38%). This dual pathology is examined in detail in this retrospective review. There were 11 males and 13 females with a mean age of 39 years (range 18 to 75 years). The Crohn's disease was ileal in 1 patient, ileocolic in 4, and affected the large bowel only in 19. The diagnosis of Crohn's disease predated that of HS by an average of 3.5 years. At the time of review, 22 patients had a stoma, 23 had undergone laparotomy and 17 had lost their rectum. Hidradenitis suppurativa occurred in the perineal or perianal area in all patients but involved other sites in 20 cases. Skin grafting had been done in 9 and local procedures in 19 patients. Granulomas were found in excised skin in 6 cases but this finding was not associated with a poor outcome. At a mean follow-up of 3.2 years from the most recent surgery for HS (range 1 to 11 years) 11 were asymptomatic for HS, 11 had symptoms and no follow up was available in 2. These data show that HS may coexist with Crohn's proctocolitis, complicating the diagnosis and management of patients in whom it occurs. An increased appreciation of the possibility is recommended.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00341181
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