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K W Eu

Publications and source records attributed to K W Eu.

At least 19 recordsLinked to original sources
PubMed2006

PPH03 stapled hemorrhoidopexy: our experience.

BACKGROUND: Stapled hemorrhoidopexy is an established treatment for hemorrhoidal disease. We evaluated our experience with stapled hemorrhoidopexy using the new Procedure for Prolapse and Hemorrhoids (PPH03) Proximate HCS hemorrhoidal circular stapler (Ethicon Endo-Surgery). METHODS: We retrospectively reviewed clinical data for 238 patients who had undergone stapled hemorrhoidopexy in our department over a 2-month period. Patients were followed-up for a median of 3.5 weeks (range, 1-11 weeks) and were analyzed for complications and resolution of symptoms. RESULTS: The hemorrhoids treated were third- and fourth-degree, as well as second degree (after failure of other therapies). Mean duration of surgery was 12.7 minutes (range, 5-20 minutes) and the majority of patients was treated with an ambulatory procedure. Most patients were discharged within 6 hours after surgery. On follow-up, 3.7% of patients had minor complaints after surgery. Technically, the new PPH03 stapler device has a quickclose knob, which allows rapid opening and closing. The closed staple height of 0.75 mm increases staple line compression on tissue and key blood vessels, hence minimizing bleeding. Prior to this, stapled hemorrhoidopexy was done using the PPH01 device. CONCLUSIONS: Stapled hemorrhoidopexy using the new PPH03 stapler is a safe, short and effective procedure in the management of hemorrhoids. It can be done in the ambulatory setting and patients have few postoperative complications.

Adolescent↗
PubMed2006

Primary colorectal lymphomas.

OBJECTIVE: The incidence of primary colorectal lymphomas is rare, comprising 10-20% of gastrointestinal lymphomas and only 0.2-0.6% of large bowel malignancies. There is a male predominance, with a maximal reported incidence in the 50- to 70-year age group. Patients often present delayed with nonspecific symptoms and consequently have advanced disease at the time of diagnosis. Inflammatory bowel disease and immunosuppression have been reported as risk factors, although a direct causal link has yet to be established. Treatment often involves a multimodality approach, combining surgery and chemotherapy, with the use of radiotherapy in selected cases. We present our experience in the management of primary colorectal lymphomas over a 10-year period (1989-1999). PATIENTS AND METHODS: We reviewed all cases of primary colorectal lymphoma seen at our institution from 1989 to 1999. Patients were included based on standard diagnostic criteria for primary intestinal lymphoma established by Dawson in 1961. The following clinical information was obtained: age, sex, presentation, site of tumour, operation performed, histology, length of stay, intraoperative complications, adjuvant therapy and duration of follow-up. The type of lymphoma was classified according to the WHO classification system. For staging, a modification of the Ann Arbor system for gastrointestinal lymphoma, proposed by Musshoff, was used. RESULTS: During the 10-year period from 1989 to 1999, 14 cases of primary colorectal lymphomas were identified. This comprised 0.44% of all colorectal malignancies (14 of 3199 cases) seen in our department during this period. There were 13 men and one woman. Their mean age at presentation was 61 years. The common presentations included a combination of abdominal pain (71.4%), anorexia and loss of weight (42.9%) and an abdominal mass (28.6%). The two most common sites of involvement were the caecum (57.1%) and the rectum/sigmoid colon (21.4%). The lesions manifested in a variety of ways, ranging from solitary fungating masses to multiple colonic polyps. All but one patient underwent attempted curative surgical resection. All cases were non-Hodgkin's B-cell lymphomas, with a majority being diffuse large B-cell lymphomas (57.1%). The diagnoses were established through laparotomy in all cases. All cases presented with evidence of spread to regional lymph nodes or beyond. Eleven patients (78.6%) received postoperative chemotherapy, with a regimen that included cyclophosphamide, vincristine, doxorubicin and prednisone. The remaining three were too ill or refused. There were no mortalities within 30 days of surgery. The patients were followed up for a median of 20 months (range 2-84) and more than half are alive and continue to be on follow-up with no evidence of recurrence. CONCLUSION: Primary colorectal lymphoma is a rare condition. It predominantly affects males between the sixth and seventh decade of life and most commonly occurs in the caecum. It often presents with abdominal pain and loss of weight and due to the nonspecific nature of these symptoms, patients frequently present late with advanced loco-regional disease. The histology is usually B cell and of intermediate grade. Therapy usually involves resection of the affected colon and regional lymphovascular structures, followed by adjuvant chemotherapy, with a reported 5-year survival of 27-55%.

Aged↗
PubMed2006

Mapping of hereditary mixed polyposis syndrome (HMPS) to chromosome 10q23 by genomewide high-density single nucleotide polymorphism (SNP) scan and identification of BMPR1A loss of function.

BACKGROUND: Hereditary mixed polyposis syndrome (HMPS) is characterised by colonic polyps of mixed histological types that are autosomal dominantly inherited and eventually lead to colorectal cancer (CRC). Study of the molecular basis of HMPS will enhance our knowledge of the genetic basis of the mixed polyposis-carcinoma sequence in both hereditary and sporadic CRC. METHODS/RESULTS: We performed a genomewide linkage search on 15 members of a three-generation HMPS family using the GeneChip Human Mapping 10K Array and identified a 7 cM putative linkage interval on chromosome 10q23. Subsequently, 32 members from two HMPS families were typed with nine microsatellite markers spanning the region and the linkage was confirmed with a maximum multi-point logarithm of the odds (LOD) score of 4.6 (p<0.001). The 10q23.1-10q23.31 haplotypes segregate with the disease in both families. We screened for mutations in four candidate genes within the linkage region and identified an 11 bp deletion in the bone morphogenesis protein receptor 1A (BMPR1A) gene in one family. CONCLUSIONS: Our results indicate that BMPR1A mutation accounts for HMPS. The data suggest that inactivating BMPR1A can initiate colorectal tumourigenesis via the mixed polyposis-carcinoma sequence.

Adenomatous Polyposis Coli↗
PubMed2005

Meta-analysis of randomized clinical trials comparing drainage alone vs primary sphincter-cutting procedures for anorectal abscess-fistula.

BACKGROUND AND AIM: Concurrent definitive treatment of underlying fistulas from infected anal glands at the time when the anorectal abscesses are drained is controversial as this is associated with a higher incidence of faecal incontinence, failure and recurrence. This meta-analysis was conducted to determine the merits of drainage alone vs primary sphincter-cutting procedures (which includes fistulotomy and fistulectomy) for anorectal abscess-fistula. METHODS: Medline, Embase and Cochrane Central Register of Controlled Trials database searches identified all randomized controlled trials using the keywords: anorectal abscess, anal sepsis, drainage, fistulotomy, fistulectomy or surgery from 1966 to 2004. The outcome variables analysed were recurrence, faecal continence and wound-healing times. RESULTS: Five trials were considered suitable for the meta-analysis, with a total of 405 patients. Sphincter-cutting procedures for anorectal abscesses resulted in 83% reduction in recurrence rate [relative risk (RR) 0.17, 95% confidence interval (CI) 0.09-0.32, p<0.001]. However, there was a tendency to a higher risk of faecal incontinence to flatus and soiling when primary sphincter-cutting procedure was performed (RR 2.46, 95% CI 0.75-8.06, p=0.140). CONCLUSION: There is no conclusive evidence if simple drainage or sphincter-cutting procedure is better in the treatment of anorectal abscess-fistula.

Anal Canal↗
PubMed2005

A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study.

PURPOSE: Defunctioning ileostomy or colostomy is still routinely performed after low anterior resection in the belief that diverting the fecal stream will prevent anastomotic dehiscence. However, an ileostomy is not without morbidity for the patient. This study aims to determine if a diverting stoma is really necessary after a low anastomosis. METHODS: All low or ultralow anterior resections done in this department were performed by consultant-grade surgeons in a standardized manner. The patients were all monitored closely after surgery for clinical signs of an anastomotic leak. There were 1078 patients who underwent elective low or ultralow anterior resections in a ten-year period between 1994 and 2004. Twelve of them were irradiated before surgery; they were excluded from the study. During a seven-month period from February 2004 through August 2004, 324 patients who underwent such procedures were not defunctioned. These were compared with 742 patients who were previously defunctioned with a proximal stoma. The results were analyzed using the Pearson chi-squared test. RESULTS: Thirteen (4 percent) patients who were not defunctioned developed a clinical anastomotic leak, whereas the leak rate for those who were defunctioned was 3.8 percent. There was no statistical difference demonstrated. Ninety-five percent of patients who developed a leak required surgical intervention; the remaining 5 percent could be dealt with by radiologic drainage. The overall mortality rate for anastomotic leak in this department is 7.3 percent. CONCLUSION: A diverting stoma does not reduce postoperative anastomotic leak rate. Rather, it reduces the otherwise catastrophic effects of an anastomotic leak such as fecal peritonitis and septicemia. An ileostomy carries certain morbidity and also adds to the cost of the entire operation. Therefore, it should not be performed routinely. Instead, it should be performed selectively in patients with poorly prepared bowels, coupled with a distal limb washout, and in patients with significant comorbidities who can ill afford the complications of a leak.

Adult↗
PubMed2005

Successful resuscitation after carbon dioxide embolism during laparoscopic-assisted abdomino-perineal resection.

We report a 67-year-old woman who underwent laparoscopic-assisted abdomino-perineal resection for rectal carcinoma. She sustained hypotension of 40/20 mmHg associated with bradycardia (heart rate 30 to 45 beats per minute) and an end-tidal carbon dioxide level of zero when she was raised to a head-up position at the end of surgery to facilitate pelvic irrigation. Pulmonary air embolism was confirmed by aspiration of 15 millilitres of foamy blood from her central venous line. Resuscitation was successful and she recovered completely with no neurological deficits.

Aged↗
PubMed2004

Minilaparotomy left iliac fossa skin crease incision vs. midline incision for left-sided colorectal cancer.

BACKGROUND: Midline laparotomies offer excellent exposure but are associated with increased postoperative pain and longer recovery. A minilaparotomy resection of leftsided colorectal cancers was studied as an alternative approach. PATIENTS AND METHODS: We performed a case-control retrospective review of 280 randomly selected patients (140 midline incisions; 140 left skin crease incisions) who underwent elective, curative resection of left-sided colorectal cancers. RESULTS: Patients in both groups were of comparable age and sex. The left skin crease incision was shorter (median length, 13.5 cm) than the midline incision (median length, 20.0 cm). Median operation time was less in the left skin crease group (75 min) than in the midline incision group (105 min). Similar types of operations were performed, including left hemicolectomies, sigmoid colectomies, anterior resections and ultra-low anterior resections. Adequacy of resection was confirmed by histological analysis, with no involvement of margins. The median numbers of lymph nodes removed were comparable: 10 for the skin crease incision group and 12 for the midline incision group. Postoperative parameters for the skin crease incision group showed that feeding, ambulation, narcotic use and hospital stay were significantly better than the parameters in the midline group. Complications of intestinal obstruction were also reduced in the skin crease incision group. CONCLUSIONS: The limited left skin crease incision provides adequate margins of clearance in colorectal cancers when compared to the midline incision, but has advantages of shorter operation time, earlier feeding and ambulation, and earlier discharge from hospital.

Adult↗
PubMed2004

Which colorectal cancers are missed by double contrast barium enema?

BACKGROUND: The relative merits of either barium enema or colonoscopy for investigating lower gastrointestinal tract symptoms is still unclear. We studied the value of double contrast barium enema (DCBE) as the initial evaluation modality. We reviewed our 10-year experience of double contrast enemas as read by consultant radiologists. The study also aimed to identify which lesions are usually missed. PATIENTS AND METHODS: We reviewed clinical data for all patients who underwent DCBE within the 6 months prior to surgical resection of colorectal cancer between April 1989 and April 1999. Patient demographics and tumour characteristics were analysed for their effects on the likelihood of the lesions being missed at DCBE. RESULTS: There were 706 patients included in the study, 54.2% were male and the mean age was 63.7 years (SEM=0.5 years). The site along the colon and rectum of tumours missed by DCBE corresponded with the frequency of tumour occurrence at each site. The overall rate of missed lesions was 4.1% (29 of 706 patients); these patients were found on subsequent endoscopy to harbour cancer. Tumours less than 3 cm in length and with lesser extent of circumferential involvement were more likely missed at DCBE (p=0.05 and p=0.01, respectively). Age, sex, and tumour grade and stage were not significant predictors of the likelihood of missed lesions. Of the 29 patients with missed lesions, 77.2% had a serum concentration of carcinoembryonic antigen (CEA) above the normal range (3.5 microg/l). The mean follow-up was 65.3 months (SEM=1.8 months). The overall survival for this series was 60.1%. The inaccuracy of the initial DCBE was not found to cause statistically significant differences in the stage of the tumour at diagnosis nor the overall survival of the patients in our series. CONCLUSIONS: Smaller cancers without circumferential involvement may be missed when DCBE is performed to evaluate lower gastrointestinal symptoms. Further evaluation by colonoscopy must be recommended when symptoms persist, especially in the context of a raised CEA level.

Adult↗
PubMed2004

Colorectal cancer in the young: a 12-year review of patients 30 years or less.

OBJECTIVES: As the incidence of young colorectal cancer is rising, a review of the characteristics of such malignancy in those under 30 years of age is timely at this stage. PATIENTS AND METHODS: Thirty-nine patients (21 M, 18 F) were operated upon over a 12-year period in a single centre. The mean age was 25 years and median follow-up was 20 months. RESULTS: Rectal bleeding, change in bowel habit and abdominal pain were the commonest symptoms. Six patients had a positive family history, while four others were diagnosed as index cases of familial adenomatous polyposis. Rectal tumours made up 43% of all colorectal cancers diagnosed. Seventy percent of patients presented at an advanced stage, but curative resection was attempted for 29 patients. Eight underwent palliative resections, 1 had an ileostomy while another underwent a bypass procedure. Eleven patients have died, 14 had no evidence of recurrent disease while 3 were still alive with recurrent disease. CONCLUSION: Age does not affect survival, and early endoscopy is recommended for all with persistent symptoms. Early diagnosis, radical resection and adjuvant therapy still form the cornerstone in management of colorectal cancer in this age group.

Abdominal Pain↗
PubMed2004

Small bowel malignancies: a review of 29 patients at a single centre.

OBJECTIVE: We analysed the incidence, clinical presentation and outcome of small bowel malignancies treated in the department. PATIENTS AND METHODS: From July 1993 to December 2001, 29 patients with small bowel malignancies were operated upon. The median age was 60 years (30-87 years), and there were 11 males and 18 females. The more frequently used diagnostic investigations included barium contrast studies, and CT scanning. RESULTS: The most frequent complaint was abdominal pain, though other symptoms like abdominal mass, weight loss and change in bowel habit may also be present. Intestinal obstruction necessitated emergency operation in some cases. One case was treated as Crohn's stricture and two others, as irritable bowel syndrome for nearly 6 months before referral was made for surgery. Fifteen cases were secondaries to the small bowel, and fourteen were primary small bowel malignancies. The secondaries were metastases from colorectal cancers (8), gynaecological cancers (5), breast (1) and transitional cell carcinomas (1). Of the 14 primary small bowel malignancies, there were 8 lymphomas, 4 adenocarcinomas and 2 neuroendocrine tumours. Eleven of these patients were alive at mean follow-up of 25 months (1-97 months) and 2 were lost to follow-up. Only one of the secondary small bowel malignancies was alive at the time of review. CONCLUSION: Small bowel malignancy is a rate entity with pre-operative diagnosis remaining difficult. Early surgical intervention with a high index of suspicion is required to improve survival.

Adenocarcinoma↗
PubMed2003

Prospective randomized study of bacteraemia in diathermy and stapled haemorrhoidectomy.

BACKGROUND: The incidence and consequences of bacteraemia associated with diathermy and stapled haemorrhoidectomy have not been studied previously. METHODS: Two hundred and five healthy patients randomized to stapled haemorrhoidectomy or diathermy haemorrhoidectomy had perioperative blood cultures taken. The clinical sequelae of bacteraemia and complications of surgery were assessed prospectively. RESULTS: Six patients were excluded for protocol violations. Eleven (11 per cent) of 101 patients with stapled and five (5 per cent) of 98 who had diathermy haemorrhoidectomy had positive blood cultures for organisms after haemorrhoidectomy, predominantly anaerobes commonly found within the bacterial flora of the anorectum (P = 0.19). Transient postoperative pyrexia in several patients did not correlate with detected bacteraemia and settled spontaneously without treatment. There were no serious complications from either operative technique, and no clinical consequences from proven bacteraemia. CONCLUSION: Transient bacteraemia may complicate surgical haemorrhoidectomy but has no serious clinical consequences for healthy adults.

Adult↗
PubMed2003

Gastrointestinal stromal tumor of the anus.

We report a rare case of gastrointestinal tumor of the anus with an unusual presentation as a perianal lipoma. A 65-year-old man presented with a 2-month history of a painless perianal lump clinically resembling a perianal lipoma. Endoanal ultrasonography revealed a 3 x 3 cm2 mass in the intersphincteric plane. Following initial excision of the lesion, histological analysis revealed a stromal lesion comprising fascicles of spindle cells with a mitotic count of 4 per 50 x high power field. Immunohistochemical analysis displayed positive reactivity for CD34 with focal staining for CD117; S100, smooth muscle actin and desmin were not expressed. No evidence of local or distant metastatic disease was found on computed tomography of the abdomen and pelvis. The patient subsequently underwent abdominoperineal resection. The resected specimen contained a mural nodule measuring 0.7 cm, located 5 cm from the distal margin and 2 mm from the radial margin. Histological analysis confirmed a stromal tumor composed of spindle cells with mitoses up to 2 per 10 x high power field. The patient's recovery was uneventful and he was free of recurrence at the 1-year follow-up. Gastrointestinal stromal tumors of the anal canal are an extremely rare occurrence, and may mimic benign perianal lesions. Tumor size and mitotic count are the most important factors in prognosticating outcome. Oncologic resection and protracted follow-up must factor in their predilection for late recurrence and metastatic spread. The role of adjuvant therapy with STI571 here remains to be clearly defined.

Aged↗
PubMed2003

A novel indicator for surveillance colonoscopy following colorectal cancer resection.

INTRODUCTION: Current surveillance for recurrent intraluminal or metachronous colorectal cancer following resection is largely undertaken by colonoscopic examination of the remaining colon. The burden on colonoscopic services is high and the procedure is expensive. Immunological faecal occult blood testing (FOBT) is a sensitive and specific test for detecting colorectal cancer, and may fine tune the need for timely surveillance colonoscopy. METHODS: Consecutive patients due for surveillance colonoscopy following colonic resection for cancer were prospectively studied. Each patient had a single faecal sample obtained at per rectal examination on a gloved examining finger. This was subjected to immunological FOBT in the clinic, and patients were categorized as FOBT positive or negative, according to the result. Colonoscopy as well as ultrasound or CT of the liver were performed within eight weeks of FOBT. RESULTS: Six hundred and eleven patients had both FOBT and colonoscopy. Fifty-nine (13.6%) were categorized as FOBT-positive. Of these, nine had biopsy-proven recurrent or metachronous cancer, 12 patients had one, or more adenomatous polyps, one patient had radiation proctitis and two patients had pan-colonic mucositis following chemotherapy. In the remaining 552 FOBT-negative patients, no cancers were found. Thirty-eight patients had polyps that were removed. The sensitivity and specificity for detecting cancer by immunological FOBT was 100% sensitivity for detecting adenomatous polyps was 24% but specificity was 93%. CONCLUSION: The immunological faecal occult blood test provides sensitive detection of metachronous and recurrent cancer in postoperative surveillance. Routine application may be used to reduce the frequency of colonoscopic surveillance, as a negative FOBT may be taken as a sign that colonoscopy may be deferred safely.

Adult↗
PubMed2003

Bowel surgery for epithelial ovarian cancer--an early case series.

OBJECTIVES: The aims of this study were to review our local experience with bowel surgery for epithelial ovarian cancer at the Gynaecological Cancer Centre, KK Women's and Children's Hospital, and to document the outcome of such surgery as well as their complication rates. MATERIALS AND METHODS: The retrospective medical records of 38 patients with epithelial ovarian cancer who underwent surgery including bowel surgery from January 1997 to May 2002 at the Gynaecological Cancer Centre, KK Women's and Children's Hospital, Singapore, were reviewed. RESULTS: Indications for surgery were predominantly debulking of disease. Fifty-eight per cent of patients had primary debulking surgery, 34% had debulking of recurrence and 3% had interval debulking. Only 5% of patients had bowel obstruction as the only indication for surgery. Rectosigmoid resection was the most common bowel operation overall, being performed in 76.3% of patients. The stoma rate for rectosigmoid resection was 61%. The remaining procedures included 7 colectomies, 1 intestinal bypass procedure and 1 intestinal diversion procedure. Optimal debulking (defined as < 1 cm of residual disease) was achieved in the majority (71%). The median operating time was 4 hours. The median blood loss was 1300 mL. The major complication rate was 10.5%. Major complications encountered were as follows: 1 patient (2.6%) had an anastomotic leak, 2 patients (5.3%) had intra-abdominal abscess and 1 patient (2.6%) developed intestinal fistula. Three patients (7.8%) required a re-operation within 30 days. There were 3 deaths (7.8%) within 30 days of surgery. CONCLUSION: Bowel surgery is commonly indicated for epithelial ovarian cancer to facilitate optimal debulking. Such surgery is feasible with acceptable complication rates in our local centre.

Adult↗
PubMed2002

Comparison between midline incision and limited right skin crease incision for right-sided colonic cancers.

We compared the postoperative recovery parameters between patients undergoing curative surgery for right-sided colonic carcinoma using a limited skin crease incision and a traditional midline incision. A retrospective study was carried out analyzing clinical records and histopathological reports for all patients operated in one colorectal surgical unit for cancer of the right colon over a 2-year period. Palliative procedures were excluded. We analyzed demographic details, operative data (length of incision and time of operation), recovery parameters (time to parenteral analgesia, time to first oral fluid intake, time to first solid meal, time to discharge) and oncological parameters (lymph node harvest and resection margins). A total of 123 patients were analyzed, 61 with a midline incision and 62 with a skin crease incision. Demographic and tumour data (number of lymph nodes resected and resection margins) as well as postoperative complications were similar between the two groups. Wound length was significantly longer in the midline incision group (median, 20 cm vs. 10 cm; p<0.0005), as was the duration of surgery (median, 60 min vs. 45 min; p0.0005). With regard to postoperative recovery, the skin crease incision group had a significantly quicker return of bowel function ( p<0.0005), shorter time to oral fluid ( p<0.001) and solid food ( p<0.0005) intake, and shorter hospital stay ( p<0.0005) than the midline incision group. There was no statistically significant difference between the two groups concerning postoperative narcotic requirements. In conclusion, the limited skin crease approach for right colon cancer resection is technically feasible and safe. It can achieve the same standards of tumour resection and clearance as the vertical midline approach while reducing postoperative recovery.

Adenocarcinoma↗
PubMed2002

Prospective, randomized trial comparing sigmoid vs. descending colonic J-pouch after total rectal excision.

PURPOSE: The aim of this study was to compare the bowel function of sigmoid vs. descending colonic J-pouches after ultralow anterior resection for rectal cancer. METHODS: A prospective, randomized trial was conducted from March 1998 to September 1999. Ninety-two consecutive patients undergoing ultralow anterior resection for cancers arising from 3 to 10 cm from the anal verge were recruited. Forty-eight patients were males; the mean ages (standard error of the mean) for patients with sigmoid and descending colon pouches, respectively, were 65.2 (3.1) years and 62.3 (3.1) years. A total of 46 patients were randomly assigned to each group. Two patients from each group were excluded; abdominoperineal resection was performed for two patients in the sigmoid pouch group and one patient in the descending pouch group. One patient in the descending pouch group had a transanal resection of a benign polyp. Dukes staging and use of postoperative chemoradiotherapy were statistically similar in both groups. All patients underwent a standardized ultralow anterior resection. A defunctioning loop ileostomy was used routinely. Anorectal physiology and bowel function questionnaires were performed at six weeks after ileostomy closure and again at 6 and 12 months after surgery. RESULTS: Median follow-up was 12 (range, 7 to 25) and 12 (range, 6 to 25) months, respectively, for sigmoid and descending pouch groups. Median tumor and anastomotic heights, time to ileostomy closure, operative time, and postoperative stay were statistically similar in both groups. There were no significant differences in stool frequency, incontinence, urgency, use of pads and antidiarrheals, sensation of incomplete evacuation, and anorectal physiology results between groups (P > 0.05). CONCLUSION: Pouches made from sigmoid or descending colon give similar bowel function after ultralow anterior resection for rectal cancers.

Adenocarcinoma↗