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Biomedical subjects

I C Lavery

Publications and source records attributed to I C Lavery.

At least 109 records · Page 6Linked to original sources
PubMed1985

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↗
PubMed1985

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↗
PubMed1985

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↗
PubMed1985

Evaluation of the Proximate-ILS circular stapler. A prospective study.

In a prospective open study of the Proximate ILS circular stapler, the results of 125 intestinal anastomoses in 119 patients were reviewed. Intraoperative leakage was observed in five instances, after intraluminal povidone instillation, necessitating suture-line reinforcement. In three instances, incomplete tissue rings (donuts) were found. Temporary fecal diversion was used in seven of 84 patients with anastomoses made to the rectum or anal canal. Roentgenographic assessment of 79 of these anastomoses using Gastrografin demonstrated a leak in three (3.8%). There was one clinical leak (0.9%) in the series. Three patients died (2.5%), none from anastomotic complications. Transient anastomotic strictures were found in three of 82 operative survivors where the anastomosis was within range of the proctoscope. There were no instances of significant hemorrhage from the anastomosis. No patient required anastomotic revision, and of the 51 survivors of cancer surgery where proctoscopy could evaluate the anastomosis, there was no evidence of local recurrence in the period of follow up (mean 16.3 months). The authors conclude: that the Proximate ILS is a safe, reliable and effective instrument for construction of intestinal anastomoses.

Aged↗
PubMed1985

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↗
PubMed1985

Intraoperative consultation for the intestine.

There may be intestinal involvement during any procedure within the abdominal or pelvic cavity. Anticipation of this involvement with preoperative bowel preparation and a basic plan to meet the circumstances will minimize potential problems both in planned and unplanned situations. This article addresses the most common situations seen in urologic practice and describes the techniques to deal with them.

Humans↗
PubMed1983

Crohn's disease in the elderly.

Surgical procedures for Crohn's disease of the small intestine, colon, or rectum were performed in 25 patients who were 65 years of age or older. In elderly patients with primarily small-bowel disease, good results were obtained uniformly by ileal resection and primary intestinal anastomosis. In 15 patients, Crohn's disease involved primarily the large intestine. Subtotal abdominal colectomy with end ileostomy restored health and permitted weight gain in six patients, although three required subsequent proctosigmoidectomy for recurrent rectal symptoms (average interval--18 months). Four patients underwent one-stage proctocolectomy, with one postoperative death and delayed healing of the perineal wound in the three survivors. Major complications frequently followed surgical procedures for suspected sigmoid diverticulitis in elderly patients with unrecognized Crohn's disease of the colon.

Adult↗
PubMed1983

Major hemorrhage and perforation due to a solitary cecal ulcer in a patient with end-stage renal failure.

A case of solitary cecal ulcer with major hemorrhage followed by perforation after treatment with intra-arterial vasopressin in a patient with end-stage renal failure is presented. Though vasopressin has been used with success in the treatment of colonic hemorrhage, caution should be applied in patients with a bleeding cecal ulcer as the vasoconstriction produced by vasopressin may cause perforation in an area whose blood supply is already compromised.

Cecal Diseases↗
PubMed1983

Ileorectal anastomosis for inflammatory bowel disease in children and adolescents.

As in any operation for IBD, colectomy and ileorectal anastomosis should be performed only after every effort has been made to control the disease medically. Only in uncontrolled disease should early proctectomy be advised on the grounds of lack of normal physical development and sexual immaturity. Ileorectal anastomosis should not be performed upon every patient requiring surgical treatment any more than proctocolectomy and ileostomy should be performed upon every patient. Unless there is severe persistent disease of the rectum or destruction of the anal sphincter, the rectum should be preserved because severe ulcerative proctitis may heal or improve postoperatively with further medical treatment. If further surgical treatment is necessary, conversion to an ileostomy can be undertaken, and there are now other alternatives, such as the continent ileostomy and the ileoanal anastomosis, with or without a pelvic pouch.

Adolescent↗
PubMed1982

Cancer in the excluded rectum following surgery for inflammatory bowel disease.

The procedure of choice in the emergency surgical management of ulcerative colitis and Crohn's colitis is often subtotal colectomy and ileostomy. Further surgery of the retained rectum may be delayed, sometimes for many years. The risk of malignant change in ulcerative colitis is well documented; the cancer risk seems to be much less in Crohn's disease. Five cases are reported where carcinoma developed in the out-of-circuit rectal stump after subtotal colectomy, three cases of ulcerative colitis, and two of Crohn's disease. The importance of regular surveillance or removal of an excluded rectum is emphasized.

Colectomy↗
PubMed1982

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↗
PubMed1982

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↗
PubMed1981

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↗
PubMed1981

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↗
PubMed1980

Home parenteral nutrition in management of patients with severe radiation enteritis.

Five patients who would have been unable to survive because of intestinal complications of radiation therapy were able to lead an otherwise normal life with the use of parenteral nutrition administered at home. One patient died of recurrent carcinoma of the cervix after 14 months. Another patient died as the result of a totally avoidable pharmaceutical error after 2 1/2 years. The remaining three are still disease free without morbidity relating to the parenteral nutrition.

Adult↗