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Biomedical subjects

J C Handelsman

Publications and source records attributed to J C Handelsman.

14 recordsLinked to original sources
PubMed1993

Experience with ambulatory preoperative bowel preparation at the Johns Hopkins Hospital.

A transition to ambulatory preoperative antibiotic bowel preparation was carried out. The protocol included a liquid diet for 40 hours preceding surgery and coordination of purging with buffered oral saline laxative, 45 mL containing 8 g sodium phosphate and 22 g sodium biphosphate (Fleet Phospho-Soda, C.B. Fleet Co, Lynchburg, Va) and bisacodyl preparation with an oral erythromycin base-neomycin routine. Enemas were omitted. Personnel in the preoperative evaluation center had the responsibility of instructing patients, distributing directions and drugs, and reviewing for compliance and possible problems during the preoperative period. All patients scheduled for any of a variety of gastrointestinal procedures, as well as some other complex operations, were included in this study. Follow-up data were obtained. Surgeons' comments regarding efficacy were highly favorable. In only five cases was there comment regarding liquid stool, and this was no impediment to surgery. This incidence was comparable with that of the inpatient experience, as was the spectrum of postoperative complications. Transfer of responsibility to the department proceeded with ease. Results were entirely comparable with those of the former inpatient experience.

Adult↗
PubMed1993

Crohn's disease as a contraindication to Kock pouch (continent ileostomy).

Crohn's disease is often described as a contraindication to the construction of a Kock pouch (KP), but a consensus opinion is less definite. One hundred consecutive patients with a KP were reviewed after a minimum follow-up time of 2 1/2 years. The 95 patients with inflammatory bowel disease were analyzed for serious complications. All eight patients in whom the diagnosis of Crohn's disease or inflammatory disease of indeterminate type was made suffered serious complications requiring resections of the pouch or continuing treatment. By contrast, of the 87 cases with ulcerative colitis, only 17 (20 percent) had complications, six of which were readily and simply corrected. Our findings suggest that Crohn's disease should continue to be regarded as a firm contraindication to the KP procedure. It should be actively sought out preoperatively, and it should be treated aggressively if it is discovered after surgery. If such a patient requires further surgery, the KP should be removed.

Adolescent↗
PubMed1991

Treatment of outflow tract problems associated with continent ileostomy (Kock pouch). Report of six cases.

The Kock pouch procedure has undergone a number of revisions since its conception, including creation of a valve and fascial stabilization. Nevertheless, complications which defeat the goal of continence are not unheard of. Naturally, when such complications arise, the patients are disadvantaged. Major examples include pouchitis and valve leakage. Lesser complications of strictures of the outflow tract, valve prolapse, and tissue loss in the outflow tract are also identified and are surgically remediable. Problems may be successfully addressed by minor corrections under local anesthesia or may mandate more extensive procedures. Examples are provided of such successful cases, which allow patients to derive the benefits of continent ileostomy.

Constriction, Pathologic↗
PubMed1986

Surgical treatment of Hirschsprung's disease in adults.

A series of eight adult patients with lifelong refractory constipation are presented. All were proved to have Hirschsprung's disease. In some of the patients, the diagnosis was initially determined in childhood. However, the other patients were not found to have this hereditary disorder of the motor function of the colon and rectum until adulthood. The lengths of the terminal aganglionic segments were quite variable, ranging from 2 to more than 25 centimeters. Rectal myectomy alone or in combination with anterior resection proved to be curative and obviated the need for extensive pelvic dissection which otherwise would be hazardous in male patients.

Adolescent↗
PubMed1983

Endorectal pull-through operation in adults after colectomy and excision of rectal mucosa.

Ileal endorectal pull-through can be performed in adults after abdominal colectomy and excision of rectal mucosa. The procedure requires a painstaking dissection of the mucous membrane of the rectum to ensure cure of the polyposis or ulcerative colitis for which it is carried out. Some cases of ulcerative colitis are inappropriate for this dissection, and Crohn's disease prohibits the use of this operation. Fifteen operations in adults are described herein. Certain technical maneuvers have been of help to us and these are described. We have favored a diverting ileostomy maintained for 3 months. A pouch, positioned in the rectum, has hastened the return toward normal control. Sphincter control and responses have been uniformly good. Dilatations and sphincter exercises are routinely employed. Strictures are not rare but are amenable to correction by digital stretching.

Adolescent↗
PubMed1983

Stabilization of ileostomy position with fascia.

An ileostomy that maintains its protrusion in a stable manner can be fashioned by the technique of Brooke. However, in a significant number of patients, recession or prolapse of the ileostomy occurs, tending to displace an appliance. A safe and effective technique is described whereby the ileostomy is stabilized without danger. A ribbon of fascia, obtained from the abdominal wall, is passed through the mesentery adjacent to the bowel between vessels, at its point of exit from the peritoneum. It is neither wrapped around the bowel nor sutured to it. The ends of the fascia are securely sutured to the peritoneum and transversalis fascia. This secures the position of the ileostomy without the danger of fistula from suturing the bowel wall. It may be used for recession or prolapse. It may be supplemented by passing additional fascia or suture elsewhere in the mesentery or into other available tissue.

Adult↗
PubMed1979

A method for primary reconstruction following radical excision of sacrococcygeal pilonidal disease.

A great variety of procedures have been proposed for the cure of Sacrococcygeal pilonidal disease. Initial enthusiasm has usually given way to disappointment when it is realized that the treatment is painful, the hospitalization is prolonged, the aftercare is tedious or the original condition appears to have recurred. A technique is described which permits the total extirpation of cyst and sinus tracts while allowing for a tensionless wound closure by advancement of a buttock flap. Hospitalization is brief and the postoperative course is comfortable. Fifty such operations have been performed since November 1968. In the first group of thirty patients operated upon between three and ten years ago, a single bonafide failure occurred. An additional twenty patients have been successfully treated for an overall failure rate of 2%.

Adolescent↗
PubMed1976

Permanent ileostomy without external appliance: Kock internal reservoir (pouch) operation.

Employing a surgical technique described by Dr. Nils Kock of Göteborg, Sweden one can create a continent ileostomy beyond an internal reservoir of ileum for patients who have had total proctocolectomy. This operation is designed to obviate the necessity for wearing an external appliance. Instead, the patient introduces a catheter through the ileostomy into the reservoir of ileum three or four times daily and evacuates it in a convenient manner. Our experience with seven patients, as well as a useful opertive variation of our own, is described. In six patients the procedure was carried out at the time of proctocolectomy. Currently six of the seven patients function without an appliance. Two of the seven had serious postoperative complications which were associated with the pouch. While a number of physical and emotional advantages are ascribed to the procedure, the specific hazards of the complex surgery, the extra time consumed daily in emptying the reservoir, and the necessity for further surgery if the pouch fails to function in a satisfactory manner must be balanced against them. Over the short term, the experience of our patients with this operation has been favorable. Larger series have been reported by Dr. Kock and by Dr. Beahrs at the Mayo Clinic. While 80% of their patients have had satisfactory eventual outcomes, a larger number of secondary operations and an ultimate 20% incidence of unsatisfactory results dictate the necessity for a guarded approach to this procedure.

Adult↗
PubMedDate not supplied

Ileostomy options. Asking the right questions.

The patient requiring ileostomy may have the opportunity to choose from four options. The Brooke ileostomy has afforded thousands of patients a secure, comfortable life. Appliances adhere well, and complications are few. The continent ileostomy or Kock pouch permits a patient to forego the wearing of an appliance. It is about 90 per cent successful but has a significant complication rate. Crohn's disease and physical frailties preclude its use. In "endorectal pull-through," the colon and rectal mucous membrane are removed to cure polyposis or ulcerative colitis. The ileum is led through the rectal muscular cylinder and anastomosed to the anus. The operation is tedious and not uniformly successful. A period of training must follow. It is unfit for people with Crohn's disease. Ileal anastomosis to a rectal segment is simpler but leaves disease behind. It may be used in Crohn's disease but may expose the patient to the hazard of recurrent disease or cancer. We must understand and ask the right questions if we are to give our patients the right answers.

Colitis, Ulcerative↗