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J M Mackeigan

Publications and source records attributed to J M Mackeigan.

5 recordsLinked to original sources
PubMed1998

Pudendal nerve latency. Does it predict outcome of anal sphincter repair?

PURPOSE: Electrophysiologic evaluation has been suggested as a means of identifying prognostic factors for patients with fecal incontinence who undergo anal sphincter repair. The purpose of this study was to evaluate the results of anal sphincter repair in patients with documented pudendal neuropathy and to determine the usefulness of electrophysiologic studies for prognostication of sphincteroplasty. METHODS: A retrospective review of a series of patients undergoing electrophysiologic studies and anterior anal sphincteroplasty was performed. Data collected included age, standardized incontinence scores (preoperative, immediately postoperative, and current follow-up), and results of pudendal nerve terminal motor latency and monopolar electromyography. Outcomes of sphincteroplasty were designated as excellent, good, fair, or poor based on incontinence scores. Prolonged pudendal nerve terminal motor latency was defined as longer than 2.2 ms and elevated as unilateral or bilateral. RESULTS: During the time period of the study (1991-1996), 15 patients had electrophysiologic studies and underwent sphincteroplasty. Twelve patients (80 percent) were available for follow-up and form the basis for this study. All patients were women, with a mean age of 45 +/- 18.6 (27-75) years and a mean follow-up of 49.7 +/- 18.6 (20.4-72.6) months. Mean duration of incontinence preoperatively was 13 +/- 16.1 (range, 1-58) years. The incontinence score was 15.8 +/- 3.5 preoperatively, 5.4 +/- 4.5 postoperatively, and 5 +/- 5.1 currently for all 12 patients. There was one patient with normal pudendal nerve terminal motor latency. In the four patients with bilateral prolonged pudendal nerve terminal motor latency, the incontinence scores were 15 +/- 4.2 preoperatively, 8.5 +/- 5.3 postoperatively, and 6 +/- 6.1 (statistically significant compared with preoperation) currently. Seven patients were found to have unilateral prolonged pudendal nerve terminal motor latency with incontinence scores of 16.3 +/- 3.5 preoperatively, 4.4 +/- 3.2 (statistically significant compared with preoperation) postoperatively, and 5.1 +/- 4.9 (statistically significant compared with preoperation) currently. Based on incontinence scores, results of the sphincteroplasty at the most current follow-up were as follows: no neuropathy, excellent in one patient; unilateral neuropathy, five with good/excellent results, two with fair/poor results; bilateral neuropathy, two with good/excellent results, two with fair/poor results (P > 0.05 bilateral vs. unilateral). By monopolar electromyographic examination, external and sphincter denervation was noted in 11 patients; their incontinence scores were 15.5 +/- 3.5 preoperatively, 5.9 +/- 4.3 (statistically significant compared with preoperation) postoperatively, and 5.5 +/- 5.0 (statistically significant compared with preoperation) currently. Monopolar electromyographic results in the puborectalis included four normal examinations and six that were unobtainable. In the two patients with puborectalis denervation, the incontinence scores were 19.5 +/- 0.7 preoperatively, 8.5 +/- 4.9 postoperatively, and 2.5 +/- 3.5 (statistically significant compared with preoperation) currently. CONCLUSIONS: Anterior anal sphincteroplasty in patients with unilateral or bilateral prolonged pudendal nerve terminal motor latency can provide significant improvement in continence with minimum morbidity. Therefore, correction of the anatomic sphincter defect should still be considered, even in patients with documented pudendal neuropathy.

Adult↗
PubMed1995

What is the learning curve for laparoscopic colectomy?

Learning curves have been described for a variety of laparoscopic procedures including cholecystectomy, tubal ligation, and diagnostic laparoscopy. Although multiple series of laparoscopic colectomies have appeared, there is little information regarding the learning curve associated with this advanced procedure. The purpose of this study is to present a single team's experience with laparoscopic colon resection to allow the description of our learning curve. The data collected included age, sex, operating room time, recovery of bowel function, days to clear liquid, hospital stay, conversion, complications, indication for operation, and site of resection. Sixty consecutive patients were analyzed and divided into three groups: First 20, Second 20, and Third 20. There were no significant differences between the three groups with respect to age, male versus female ratio, indications for surgery, or site of resection. However, the complexity of surgical procedures and the incidence of previous major abdominal surgery increased steadily with experience. The incidence of pulmonary complications was 30 per cent in the First 20 group and decreased to 5 per cent for the next two groups. The conversion rate was 20 per cent for the First 20 group, 45 per cent for the Second 20 group, and decreased to 10 per cent for the Third 20 group.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1993

Open colectomy versus laparoscopic colectomy: are there differences?

Laparoscopic colectomy has been increasingly reported as an option for the treatment of colonic pathology. However, there is very little information regarding perioperative morbidity and the cost effectiveness of this technique. The purpose of this study is to review our first year of experience with laparoscopic colon resection. Data collected includes: age, technique (open laparotomy, laparoscopic, laparoscopic/converted open), Karnofsky score, complications, specimen size/nodes, OR time, hospital stay, and cost. This is a consecutive series of 140 elective colonic resections including 102 open laparotomies (O) and 38 laparoscopic (L) cases. The indications for surgery have included adenocarcinoma col/rect (O = 59, L = 9), diverticular disease (O = 10, L = 10), adenomatous polyp (O = 3, L = 7), IBD (Crohn's, CUC) (O = 15, L = 4), rectal prolapse (O = 3, L = 4), and other (O = 12, L = 4). There were no significant differences with respect to age (O = 60.7 +/- 1.5; L = 54.8 +/- 3.8; C = 66.1 +/- 3.1), perioperative morbidity (O = 11%; L = 15%; C = 17%). The laparoscopic and laparoscopic converted cases required significantly more time compared to the open laparotomy group (O = 2.1 +/- 0.2 hours; L = 2.9 +/- 0.2; C = 3.4 +/- 0.2). There were significantly less intraoperative blood loss associated with laparoscopic procedures compared with either open or converted groups of patients (O = 687 +/- 54 cc; L = 157 +/- 19; C = 491 +/- 50).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1993

Endoscopic tattooing of the colon: clinical experience.

Nonpalpable lesions of the colon can be difficult to locate intraoperatively. We have demonstrated in an experimental study in dogs that the colon can be endoscopically "tattooed" by injecting dye through a flexible needle into the wall of the colon. At laparotomy, the resulting "tattoo" is then visible on the serosal surface of the bowel. This technique allows precise surgical localization of endoscopically identified lesions simply by visualizing the dye. Our initial clinical experience tattooing 15 colonic lesions in 12 patients is presented. In all patients, the endoscopically injected dye (1 per cent indocyanine green) was easily visualized on the serosal surface of the colon at surgery. The dye remained at the site of injection for at least 36 hours allowing tattooing to be performed the day before surgery. No significant complications were encountered with only one patient developing an inflammatory reaction at the site of injection. This experience demonstrates the clinical utility of endoscopic tattooing of the colon to permit accurate intraoperative localization of small or nonpalpable lesions.

Adult↗