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J H Pemberton

Publications and source records attributed to J H Pemberton.

155 records · Page 9Linked to original sources
PubMed1981

Achieving ileostomy continence with an indwelling stomal device.

To determine whether intermittent occlusion of a Brooke ileostomy could be tolerated and achieve continence without impairing intestinal function, we constructed such ileostomies in seven dogs. After initial assessment of ileal diameter, compliance, transit, and absorption, four dogs underwent progressively lengthening periods of ileostomy occlusion, with the use of an indwelling intraluminal device. Three dogs served as unobstructed control subjects. All dogs were restudied after 20 weeks. Both occluded and control animals remained healthy, regaining and maintaining their preoperative weights. Complete continence for gas and stool was achieved without distress during periods of occlusion up to 6 hours twice a day. After the device was removed, the ileum emptied promptly. Occluded dogs developed amore dilated, compliant distal ileum with slower transit than did the control dogs. However, ileal absorption of water, glucose, sodium, and chloride, ileal secretion of potassium, and enteric absorption of fat were not impaired by occlusion; these indices did not change during 20 weeks in occluded or control animals. We concluded that chronic intermittent ileostomy occlusion in dogs was well tolerated, achieved fecal continence, slowed ileal transit, and resulted in the formation of a functional ileal reservoir without impairing enteric absorption.

Animals↗
PubMed1980

Vagotomy and pyloroplasty in the treatment of duodenal ulceration. Long-term results.

In the years 1960 through 1966, vagotomy and pyloroplasty was performed for duodenal ulceration in 182 patients. Elective operation was performed in 84% of cases, and intractability of symptoms was the major indication. For emergency operations, bleeding was the main indication. Eight of 182 patients died in the postoperative period (operative mortality 4.4%--3.3% elective, 10.3% emergency). Follow-up of 1 to 17 years has been obtained in 154 of 182 patients (96% of these from 5 to 17 years). Ulcer recurred in 12.3% of cases (13.6% elective, 4.5% emergency); the average time to recurrence was 4.8 years. Fully 37% of recurrent ulcers were documented 6 years or more postoperatively. Morbidity was significant; diarrhea and "dumping" were the most noteworthy sequelae, and these occurred in 16.2% and 7.8% of cases, respectively. "Postgastrectomy sequelae" occurred in 61 of 154 patients. It is concluded from this study that vagotomy and phyloroplasty, as currently practiced and used in the elective surgical treatment of chronic duodenal ulceration, does not sufficiently protect against recurrence of ulcer.

Adolescent↗
PubMedDate not supplied

Results of pouch surgery after ileo-anal anastomosis: the implications of pouchitis.

The ileal pouch-anal operation is the procedure of choice for those suitable patients requiring surgery for chronic ulcerative colitis or familial adenomatous polyposis. The functional results are generally good but pouchitis remains a significant and poorly understood complication. This review encompasses factors relating to pouchitis, e.g., bacteriological, functional and histological changes, with emphasis on its biology and treatment, and the long-term implications.

Anal Canal↗
PubMedDate not supplied

Long-term functional results and quality of life after ileal pouch-anal anastomosis and cholecystectomy.

Among 971 patients with chronic ulcerative colitis who underwent ileal-pouch anal anastomosis during an 8-year period from January, 1982 to December 1989, 30 patients were randomly selected from each year (total = 240 patients) for an assessment of their long-term functional results and quality of life as of 1990. Patients undergoing cholecystectomy during each of the same years served as "controls" (20 patients/year, total = 160 patients). All 400 patients completed a written questionnaire that measured bowel habits, overall quality of life, general health, and performance in sports/recreation, travel, sex life, family relationship, occupational work, social activities, and household activities. Ileo-anal patients had more frequent stools (median, 6 stools/day) and more fecal spotting (68% of patients had episodes) than cholecystectomy patients (median, 1 stool/day, 13% had episodes, p < 0.05). In spite of the altered bowel habits, 90% of ileo-anal patients had an excellent overall quality of life, 76% enjoyed good health, and 91% had good performance scores in the areas examined. In fact, quality of life and performance were similar among ileo-anal patients and cholecystectomy patients. Moreover, quality of life and bowel habits remained steady in both groups of patients during the 8-year follow-up. In conclusion, functional results were satisfactory and quality of life was excellent after ileal pouch-anal anastomosis; neither deteriorated as patients aged over an 8-year period after operation.

Adult↗
PubMedDate not supplied

Physiologic determinants of nocturnal incontinence after ileal pouch-anal anastomosis.

The goals of the ileal pouch-anal anastomosis (IPAA) operation are the construction of a fecal reservoir and the preservation of anal function, without compromising continence. Some of the patients are incontinent at night. The aim of our study was to identify the mechanisms responsible for nocturnal incontinence. We analyzed patients undergoing IPAA for ulcerative colitis, who underwent anorectal tests between 1993 and 1995. All patients were subjected to pull-through manometry and pelvic floor function studies, and 33 patients underwent overnight ambulatory manometry. Among 44 patients (27 men and 17 women), 22 had complete continence, whereas 22 had nocturnal incontinence. Mean age was 40 +/- 1 years. There were no differences with regard to sex, age, stool consistency, and ability to differentiate gas from stool between groups; only stool frequency was lower in the continent group (median [range] 6 [3 to 10] vs. 8 [5 to 25] stools/24 hours; P = 0.011). Resting and squeezing anal canal pressure did not differ (P = 0.42 and P = 0.73, respectively). Resting, squeezing, and defecating anorectal angle, percentage of pouch evacuation, and perineal descent, all measured scintigraphically, did not differ between groups (all P >0.05). Ambulatory manometry showed that the mean anal canal pressure was higher in continent patients compared to incontinent patients, both during awake (88 +/- 11 vs. 62 +/- 8; P = 0.032) and sleep (81 +/- 14 vs. 49 +/- 9; P = 0.029) periods. The motility index was similar (awake, P = 0.88; sleep, P = 0.95), as was the number of episodes where the pouch pressure was greater than the anal canal pressure (P = 0.28). In otherwise continent patients after IPAA, the combination of high stool frequency and low basal anal canal pressure may be related to nocturnal incontinence. Moreover, standard anorectal physiology tests cannot identify these subtle differences.

Adult↗
PubMedDate not supplied

Does the presence of a pre-ileostomy closure asymptomatic pouch-anastomotic sinus tract affect the success of ileal pouch-anal anastomosis?

Ileal pouch-anal anastomosis (IPAA) is the procedure of choice for patients with ulcerative colitis and familial adenomatous polyposis. This two-stage procedure with a temporary diverting ileostomy avoids the catastrophic consequences of anastomotic leakage. We set out to determine the incidence and effect of asymptomatic pouch sinuses detected prior to ileostomy closure on the outcome of IPAA. A total 1600 IPAAs performed at the Mayo Clinic were reviewed. Forty-one (2.6%) asymptomatic sinuses were treated expectantly. There were 22 males and 19 females who had a median age of 32 years (range 14 to 58 years). The median time to ileostomy closure was 5.9 months (range 4 to 11 months). Five patients required further surgery following closure of ileostomy. The pouch function in these five patients was similar to that in the remainder of the group. Patients with a persistent sinus at the time of ileostomy closure had the same function as the main cohort. This group had a median of five (range 2 to 12) stools during the day and two (range 0 to 4) at night. The total number of stools per 24 hours was seven (range 2 to 14). Frequent incontinence occurred in 9.7% and 7.3% during the day and at night, respectively. Only 2.4% (1/41) were disappointed with the results of the operation and 80.4% (33/41) found their quality of life improved. Functional outcomes were comparable to those achieved with uncomplicated IPAA. Radiologically detected asymptomatic sinuses can be treated expectantly with a low rate of pouch loss and subsequent surgery. This is not considered a serious setback inasmuch as long-term function and quality of life are comparable to that achieved with IPAA without sinus tracts.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

Ileo-anal pouch function and dysfunction.

Ileal pouch-anal anastomosis (IPAA) has become well established as the ideal surgical option for the majority of patients with chronic ulcerative colitis. Improvements and simplifications in operative technique over recent years mean that such patients need no longer live with the fear of a permanent ileostomy with its associated physical, sexual and sometimes psychological problems. Most patients who have undergone IPAA achieve a good quality of life. There are, however, a number of questions with regard to the ileal pouch that remain unanswered. The purpose of this review is to summarize the advantages and disadvantages of the various designs of pouch which have been described, to discuss the function of the normal pouch and manifestations of dysfunctional pouches.

Colitis, Ulcerative↗
PubMedDate not supplied

[Ileoanal reservoir: new concepts and current results].

More than 1,800 ileoanal pouches have been performed at the Mayo Clinic since 1981 and results have been satisfactory in more than 90% of the patients. However, we continue to search for alternatives to improve postoperative results and avoid the complications that currently occur in a minority of patients. During the last two years new concepts and surgical techniques for the construction of the ileoanal reservoir have been described. Herein we present those innovations and compare them to our current institutional practice.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

Evaluation and treatment of constipation.

Constipation is a symptom that usually reflects the existence of associated diseases. The clinical history, physical examination, and barium enema or colonoscopy should permit the diagnosis of extracolonic and structural colonic causes of constipation. A comprehensive evaluation of colonic transit and pelvic floor function in patients with functional constipation should categorize the underlying pathophysiologic mechanism, and optimize the selection of candidates for surgical operations and their results.

Aged↗
PubMedDate not supplied

Update on ileal pouch-anal anastomosis.

BACKGROUND: The surgical management of chronic ulcerative colitis and familial adenomatous polyposis was revolutionized in 1978 by the introduction of the ileal pouch-anal anastomosis, following proctolectomy and avoiding the necessity of a permanent stoma. AIMS: To analyze the current status of ileal pouch-anal anastomosis. METHOD: Factors such as age, concurrent medical conditions, and most importantly anal sphincter function are to be considered. Many technical aspects are reviewed such pouch design, mucosectomy, alternatives to perform the anastomosis, the use of diverting ileostomy, reservoir function and morbidity. RESULTS: Patient selection is of paramount importance to achieve good results. Many modifications to pouch design have been made in an attempt to improve functional results. Shorter mucosectomy is performed with hand-sutured anastomosis and double stapled anastomosis are the surgical alternatives to restore intestinal continuity. The use of diverting ileostomy is recommended in most patients to prevent pelvic sepsis. Mortality following ileal pouch-anal anastomosis is extremely unusual, however, morbidity is moderate. Small bowel obstruction, pelvic sepsis, fistula formation and pouchitis are the most common complications. Sexual dysfunction represents a major concern for younger patients in need of this kind of surgical treatment. However, its occurrence is rare. CONCLUSIONS: The ileal anal-pouch anastomosis has become the surgical treatment of choice for patients suffering from chronic ulcerative colitis and familial adenomatous polyposis. Primary advantages offered by this technique are that the disease is removed completely and adequate reservoir is restored and transanal defecation and fecal continence are reestablished, avoiding the necessity of a permanent stoma.

Adenomatous Polyposis Coli↗