Factors affecting quality of life with a conventional ileostomy.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
F L Weakley
Publications and source records attributed to F L Weakley.
Desmoid tumors in familial polyposis coli.
Desmoid tumors are locally invasive, nonmetastasizing fibrous tumors most frequently seen in patients with familial polyposis coli (FPC). Of 325 patients with FPC treated at the Cleveland Clinic, 29 (8.9%) were found to have a total of 36 desmoid tumors. These tumors occur in young patients (mean age: 29.8 years), particularly women (ratio 3:1), and most appeared after previous colectomy (86%). The majority (72% of all desmoids, 90% of patients) were located within the abdomen, specifically within the mesentery of the small intestine. In most cases, attempts at surgical resection were followed by recurrence, and other previous treatments were similarly ineffective. Six of the 29 patients (21%) died from the desmoid and three died from other causes. The recent use of sulindac (Clinoril) has produced some early encouraging results in four patients with these tumors that have proven so difficult to treat in the past.
Abdominal Neoplasms↗
Anastomosis to the rectum. Operative experience.
Four hundred sixty-six consecutive procedures involving anastomosis to the rectum were performed between March 1969 and December 1982. Three hundred ninety-six (85 percent) were stapled anastomoses and 70 (15 percent) were hand-sutured anastomoses. The stapled anastomoses were constructed using the GIA or EEA instrument, some of the latter utilizing a pull-through technique. The hand-sutured anastomoses were constructed in the pelvic space, or externally as a staged pull-through procedure. A diverting stoma was constructed in all 14 staged pull-through procedures, in 47 of 56 (84 percent) conventional hand-sutured anastomoses, and in 38 of 396 (10 percent) stapled anastomoses. While the majority of very low anastomoses (0 to 5 cm from the dentate line) were stapled, 13 conventional hand-sutured anastomoses and all 14 of the staged pull-through procedures were constructed at this level. One patient (0.2 percent) died as the result of an anastomotic complication. Twelve patients (2.5 percent) had anastomotic complications requiring reoperation. The reoperation rate for stapled anastomoses was six of 396 (1.5 percent). For hand-sutured anastomoses, the reoperation rate was six of 70 (8.6 percent). The results show that, for anastomosis to the rectum, stapling instruments are at least as good as hand-suturing. Both stapling techniques and hand-suturing techniques provide the surgeon the capacity to construct safely very low anastomoses. A temporary, diverting stoma is required much less frequently with stapled than with hand-sutured anastomoses. The need for a permanent colostomy should be determined by the stage and level of disease, the systemic health of the patient, and the patient's anatomy, rather than by the selection of anastomotic technique.
Colostomy↗
Patient evaluation of the conventional ileostomy.
A survey of 322 ileostomates was undertaken to assess the impact of an ileostomy and determine problems that are encountered by patients. Most patients (72 percent) felt they led normal lives with the ileostomy and encountered fewer restrictions in life-style than with their disease. However, only 35 percent of patients felt their ileostomies functioned perfectly. Skin irritation (49 percent), offensive noise and odor (42 percent), detection of the appliance (17 percent), and difficulty in handling the appliance (29 percent) were some of the problems encountered. Psychologic problems were related to poor body image (22 percent) and sterility or impotence (12 percent). All of these problems, however, were less than had been anticipated. Various sources of information were available to the ileostomate. However, about 50 percent of patients felt they received inadequate preoperative information or counseling.
Adolescent↗
Management of the perineal wound after rectal excision for ulcerative colitis.
A retrospective review was conducted of 326 patients undergoing intersphincteric rectal excision for ulcerative colitis. Seventy-five patients (Group A) had rectal excision with closure of the pelvic peritoneum and packing of the pelvic space via an open perineal wound. One hundred sixty-nine patients (Group B) had excision without pelvic peritoneal closure, but with the levators and subcutaneous tissue closed and with transabdominal sump suction drainage of the pelvic space. Complete healing for Groups A and B occurred by three months in 42 and 79 percent, respectively, and by six months in 56 and 89 percent. Thirty-one percent of Group A and 9 percent of Group B were unhealed at one year, and/or required further surgery. When all 326 patients were considered, healing was achieved at three, six, and 12 months, for packed and for closed wounds, in 42 percent and 79 percent, 55 percent and 89 percent, 66 percent and 91 percent, respectively. All these differences are highly significant (P less than 0.0001). The incidence of small-bowel obstruction requiring surgery during follow-up was similar whether the pelvic peritoneum was closed (15.5 percent) or left open (15.7 percent). Other factors which adversely affected perineal wound healing were younger age, a short history of disease, a two-stage proctocolectomy especially for persistent severe rectal disease, and the presence of perianal disease.
Adolescent↗
The fate of the rectal stump after subtotal colectomy for ulcerative colitis.
In a retrospective review of 311 patients having subtotal colectomy for ulcerative colitis, information on the fate of the rectal stump was obtained in 288. Proctectomy was performed in 159 patients (55 percent); for persistent proctitis in 118 (41 percent), cancer prophylaxis in 37 (13 percent), and cancer in four (1.4 percent). One hundred twenty-two patients (42 percent) had ileorectal anastomoses. Eighty-four of these (69 percent) retained a functioning ileorectal anastomosis at the time of follow-up or death, one to 22 years later, and an additional six patients (5 percent) had a satisfactory ileorectal anastomosis for five to 14 years before proctectomy. Cancer developed in the rectal stump in nine patients (3.1 percent), underscoring the need for either proctectomy (total or mucosal) or long-term surveillance of the retained rectum. However, subtotal colectomy, by permitting ileorectal anastomosis or other sphincter-preserving surgery at a later date, does have a definite place in many patients requiring surgery for ulcerative colitis.
Adolescent↗
The relationship between fistulas in Crohn's disease and associated carcinoma. Report of four cases and review of the literature.
Patients with carcinoma involving chronic fistulizing Crohn's disease may have developed the malignancy due to chronic epithelial irritation at either end of the fistula tract. Alternatively, the carcinoma may be the cause of the fistula. Examples of each type of relationship are presented in the reports of four patients from our institution and supported by a review of the literature. The diagnoses of such carcinomas are often delayed due to lack of specificity of symptoms and signs. A high index of suspicion and regular surveillance of high-risk patients are recommended.
Abdominal Muscles↗
Complications and quality of life after ileorectal anastomosis for ulcerative colitis.
Ileorectal anastomosis is a safe operation with low mortality and morbidity and offers a good prospect for success in many patients with ulcerative colitis. The functional results are good in the majority of patients, and there is a high level of patient acceptance. There is a low cancer risk with regular surveillance, but there is a relative contraindication for ileorectal anastomosis in patients with colon cancer or dysplasia present at the time of colectomy. For many patients, especially children and adolescents in their formative years and for young adults, it avoids or delays an ileostomy and avoids the risk of postoperative sexual dysfunction, while at the same time still permits the elective use of some other continence-preserving operation at a later date.
Adolescent↗
A prospective, randomized, double-blind study of 10% mannitol mechanical bowel preparation combined with oral neomycin and short-term, perioperative, intravenous Flagyl as prophylaxis in elective colorectal resections.
The effect of 1-day mechanical bowel preparation with 10% mannitol combined with oral neomycin and short-term perioperative intravenous Flagyl (group I) was studied in a prospective, randomized, double-blind study and was compared with oral neomycin and an intravenous placebo (Group II). Thirty-one patients were evaluated in group I (Flagyl), and there was a 0% septic complication rate. Thirty-seven patients were in the neomycin placebo group (group II), which had a septic complication rate of 22%. The difference between the two groups was statistically significant. No complications were observed from either the 10% mannitol solution or the intravenous Flagyl at either clinical, hematologic, or biochemical assessment. The study indicates that 1-day mechanical bowel preparation with 10% mannitol combined with oral neomycin and short-term, perioperative, intravenous Flagyl is a safe, effective, and inexpensive method for significantly reducing the septic complications of elective colorectal surgical resections.
Adolescent↗
Cancer of the rectum: a review of surgical options.
Explore the source record for details and available documents.
Colostomy↗
Survival with carcinoma arising in mucosal ulcerative colitis.
Adenocarcinoma of the colon is a well-recognized complication of total chronic ulcerative colitis. The incidence increases with time, and the carcinoma arising in chronic ulcerative colitis has developed a bad clinical reputation in terms of aggressive behavior. The survival statistics of patients with cancer arising in chronic ulcerative colitis are compared with statistics for a group of noncolitic patients with equivalent clinicopathologic staging treated at the same institution. When grouped by extended Duke's classification and compared with carcinoma arising without ulcerative colitis, there was no statistical difference in survival rates. The overall results are worse because of a higher percentage of patients with incurable disease at the time of operation. With improved surveillance and methods of detecting premalignant changes, the necessity for prophylactic proctocolectomy should decline.
Adenocarcinoma↗
Stapling in intestinal surgery.
Although stapling technology was introduced to surgical procedures early in this century, its accelerated use has taken place since 1968. Several methods of restoring interrupted continuity of the large and small bowel are available to the surgeon. The method used is influenced by the level involved, especially as it relates to the availability of the two ends to be joined. The degree of cleansing of the bowel lumen also affects the method chosen, especially in colorectal anastomosis. The surgeon should avail himself of the appropriate training in the operation and use of stapling instruments because the principles of stapling technology differ from those of conventional suturing technics.
Colon↗
A prospective randomized study of prophylactic mannitol (10%)-neomycin-cefotaxime therapy in patients undergoing elective colonic and rectal surgery.
A prospective randomized trial was performed to assess the effectiveness of 10% mannitol, oral neomycin, and intravenous cefotaxime in preventing septic complications following elective colonic and rectal surgery in 99 patients. In each of the three regimens, 10% mannitol and oral neomycin were given preoperatively. In regimen 1 (34 patients) intravenous cefotaxime was given perioperatively. In regimen 2 (33 patients) cefotaxime was given perioperatively and for 24 hours postoperatively. Regimen 3 (32 patients) was the same as regimen 2 except that cefazolin sodium was substituted for cefotaxime. Septic complications developed in one patient each on regimens 1 and 3. There were no infections in the patients on regimen 2. This study demonstrates that bowel preparation with 10% mannitol and oral neomycin, coupled with a short perioperative course of cefotaxime or cefazolin sodium, is effective in controlling the septic complications of elective colorectal surgery, and the combinations are simple, safe, and cost effective.
Adult↗
Recurrence and reoperation for Crohn's disease: the role of disease location in prognosis.
Explore the source record for details and available documents.
Adolescent↗
The risk of cancer following colectomy and ileorectal anastomosis for extensive mucosal ulcerative colitis.
A retrospective study was performed on 89 patients who underwent total colectomy and ileorectal anastomosis for extensive mucosal ulcerative colitis between the years 1957 and 1977 in order to determine the risk of developing cancer of the rectum. The 30-day operative mortality rate was 0%. Of the 84 patients available for follow-up study, four patients, (4.8%) developed a carcinoma of the rectum. The risk of cancer per patient-year was zero in the first decade, 1/206 in the second decade, and 1/116 in the third decade. The cumulative risk of developing cancer was 0% at 10 years, 2.1% +/- 2.1% at 15 years, 5.0% +/- 3.5% at 20 years, and 12.9% +/- 8.3% after 25 years of disease. Patients with cancer or precancer in the colon at the time of colectomy appear to be at high risk for the later development of rectal cancer.
Adult↗
Radiation injury of the rectum: evaluation of surgical treatment.
One hundred four patients, 80 women and 24 men, with radiation injury of the rectum following treatment for gynecologic and urologic malignancy were studied. In 50 patients, the rectal injury was treated surgically; 54 patients were treated conservatively. The age and sex distributions were the same in each group. In 63 patients, symptoms developed one month to one year after radiotherapy. The longest latent interval was 17 years. Of the 50 surgical patients, 23 had associated small bowel injury. The indications for surgery for the rectal injury were 1) proctitis unresponsive to conservative measures in 14 patients, 2) rectal stricture or fistula or both in 32, and 3) rectosigmoid perforation in four. Forty-one patients had external diversions. Eleven had intestinal continuity restored; six of the 11 had required the stoma for proctitis unresponsive to medical measures. Nineteen patients did not undergo colostomy closure, although symptoms wer greatly improved. Diversion alone was insufficient treatment in the remaining 11 patients. Twenty-six patients died. The 12 deaths in the surgical group comprised four due to residual malignancy, four from postoperative complications, and four from unrelated causes. Of the 14 deaths in the nonsurgical group, 11 died of the primary malignancy and three of unrelated causes. Diversion is considered the safest form of treatment for rectovaginal fistulae, rectal strictures, and proctitis unresponsive to medical measures. Intestinal resection resulted in sharp rise in the morbidity and mortality rates.
Adult↗
Proximal recurrence and the fate of the rectum following excisional surgery for Crohn's disease of the large bowel.
One-hundred-twenty-seven patients with Crohn's disease of the large bowel underwent excisional surgery with the establishment of an ileostomy at the Cleveland Clinic between 1955 and 1973; the distribution of disease at this initial resection could be accurately determined. A mean follow-up period of 11 1/2 years has shown that the overall incidence of recurrence requiring resection was 27% and the cumulative risk of recurrence determined by actuarial methods was 44% (+/- 10.6%) at 19 years. Initial involvement of the terminal ileum in addition to the large bowel was associated with a significantly higher incidence of overall recurrence (p less than 0.05) and earlier postoperative recurrence (46% +/- 9% at 11 years), when compared with patients who had ileal sparing (23% +/- 5% at 11 years). This suggests that involvement of the terminal ileum in patients with Crohn's disease of the large bowel may be of prognostic importance. Of 101 patients who had a subtotal colectomy with rectal preservation, 58 subsequently underwent either rectal excision (46 patients), ileorectal anastomosis (six patients) or both of these operations (six patients); this high incidence of reoperation should not be confused with recurrence.
Adolescent↗
Acute gangrenous proctitis.
Explore the source record for details and available documents.
Acute Disease↗