Biomedical subjects

R J C Steele

Publications and source records attributed to R J C Steele.

4 recordsLinked to original sources

PubMed2003

The interrupted serosubmucosal anastomosis - still the gold standard.

BACKGROUND: The single-layer appositional serosubmucosal anastomosis is a well established technique and appears to have a favourable record. Over a 15-year period the senior author of this paper has performed or directly supervised 553 anastomoses using this technique. This report describes the results of these operations, the results of stapled anastomoses carried out during the same period and discusses the utility of the handsewn technique. METHODS: From August 1986 to July 2001, 553 intestinal anastomoses in 550 patients were fashioned using single-layer, interrupted serosubmucosal 3/0 braided polyamide and 131 anastomoses in 131 patients were performed using a circular anastomosing stapler. RESULTS: One anastomotic leakage occurred in the group of patients whose anastomosis was handsewn (0.2%) and 11 leaks occurred in those who had a stapled anastomoses (8.4%). The mortality rate in each group was similar (2% and 2.3%, respectively). There were no deaths attributable to anastomotic dehiscence in either group. CONCLUSION: In this prospectively audited series of 553 handsewn anastomoses the leakage rate was 0.2%. These results compare favourably with other published series and continue to support a single layer of interrupted serosubmucosal sutures as the gold standard for anastomoses involving the large or small bowel.

Anastomosis, Surgical↗

PubMed2002

The colorectal adenoma-carcinoma sequence.

BACKGROUND: It is widely accepted that the adenoma-carcinoma sequence represents the process by which most, if not all, colorectal cancers arise. The evidence supporting this hypothesis has increased rapidly in recent years and the purpose of this article is to review this evidence critically and highlight its clinical significance. METHODS: Medline searches were used to identify recent key articles relating to the adenoma-carcinoma sequence. Further pertinent articles were obtained by manual scanning of the reference lists of identified papers. RESULTS: The evidence supporting the adenoma-carcinoma sequence can be classified as epidemiological, clinicopathological and genetic. The most recent and largest body of data relates to molecular genetic events and their cellular effects; however, many other approaches, such as cytogenetics, molecular cytogenetics and cytometry, have also yielded valuable information. CONCLUSION: Recent work continues to support the adenoma-carcinoma sequence, but there is a paucity of data on the interrelationship between different genetic mutations and on the relationship between molecular and other types of genetic abnormalities. The clinical utility of the observations described has yet to be fully realized and global genetic analysis of colorectal tumours may prove to be central in rational adenoma management.

Adenoma↗

PubMed2002

Management of colorectal cancer.

Colorectal cancer is the second most common cause of cancer death in the UK. Prompt investigation of suspicious symptoms is important, but there is increasing evidence that screening for the disease can produce significant reductions in mortality. High quality surgery is of paramount importance in achieving good outcomes, particularly in rectal cancer, but adjuvant radiotherapy and chemotherapy have important parts to play. The treatment of advanced disease is still essentially palliative, although surgery for limited hepatic metastases may be curative in a small proportion of patients.

Chemotherapy, Adjuvant↗

PubMed2002

Colonoscopy.

Colonoscopy is now the gold standard method for investigating most colonic symptoms. However, it is a demanding procedure that can be associated with low completion rates and significant complications, and it requires considerable skill to perform colonoscopy consistently well and safely. In this article, the key steps in performing colonoscopy are described with a view to providing the trainee with a logical sequence of manoeuvres on which to base a sound technique.

Colonoscopes↗