Search PubMed⌕ Search

Biomedical subjects

R J Heald

Publications and source records attributed to R J Heald.

At least 91 records · Page 5Linked to original sources
PubMed1986

Stapled ileo-anal anastomosis: a technique to avoid mucosal proctectomy in the ileal pouch operation.

Ten patients have undergone abdominal proctocolectomy with the formation of an ileal reservoir anastomosed onto the anal canal using a stapling device. This technique avoids stripping of the rectal mucosa from the muscle tube (mucosal proctectomy) which is time consuming and often difficult. One patient is awaiting closure of her ileostomy. The remaining seven are continent and are passing between one and six motions a day.

Adult↗
PubMed1983

A survey of postoperative function after rectal anastomosis with circular stapling devices.

Seventy-five patients, who had previously undergone anterior resection or sigmoid colectomy using a circular stapling device, were interviewed and examined. Their postoperative bowel, sexual and bladder function was noted. 22 patients had anastomoses more than 10 cm from the anal verge (Group A); 32 between 5-10 cm (Group B); 21 below 5 cm (Group C). The lower anastomoses were associated with less perfect function but only 2 patients were incontinent. Some impairment of sexual function was noted in one-third of patients in Group B and one half of patients in Group C. Changes in bladder function were rare.

Abscess↗
PubMed1982

The mesorectum in rectal cancer surgery--the clue to pelvic recurrence?

Five cases are described where minute foci of adenocarcinoma have been demonstrated in the mesorectum several centimetres distal to the apparent lower edge of a rectal cancer. In 2 of these there was no other evidence of lymphatic spread of the tumour. In orthodox anterior resection much of this tissue remains in the pelvis, and its is suggested that these foci might lead to suture-line or pelvic recurrence. Total excision of the mesorectum has, therefore, been carried out as a part of over 100 consecutive anterior resections. Fifty of these, which were classified as 'curative' or 'conceivably curative' operations, have now been followed for over 2 years with no pelvic or staple-line recurrence.

Adenocarcinoma↗
PubMed1981

The low stapled anastomosis.

The complications of 100 stapled anastomoses onto the rectum or anus are reviewed. Anastomotic leakage in very low cases is the major problem; no leak occurred if the anastomosis was performed above 7 cm, but 3 leaks in 17 patients occurred if the anastomosis was performed between 5.5 and 7 cm, and 10 leaks occurred in 52 patients if the anastomoses was less than 5 cm from the anal margin. A covering colostomy is essential for these lower anastomoses, and for those not covered by a colostomy, an immediate colostomy with a distal loop washout is performed, if a leak develops. Attention to technique is mandatory, with a good blood supply, absence of tension and the elimination of the pelvic cavity being of great importance.

Adult↗
PubMed1980

Towards fewer colostomies--the impact of circular stapling devices on the surgery of rectal cancer in a district hospital.

Circular stapling devices can be used to extend the range of anterior resection of the rectum to encompass most of anterior resection of the rectum to encompass most rectal carcinomas. In one district general hospital the number of abdominoperineal resections performed in a 12-month period has been reduced from 27 to 4. A personal series is presented of 40 patients in whom the new technique allowed restorative resection to replace permanent colostomy. Special care is essential in the preparation of the colon for the low anastomosis.

Adult↗
PubMed1979

Results of proximal gastric vagotomy over 1-5 years in a district general hospital.

One hundred and seventy-three underwent proximal gastric vagotomy for duodenal ulceration over a 6-year period. One hundred and fifteen of these have been followed up for 1-5 years. The operative mortality was nil and the result was satisfactory in 91 per cent. The incidence of side effects was small, notably that of dumping being 2.4 per cent and of diarrhoea, 3.6 per cent. Incidence of postoperative heartburn was reduced from 13 per cent to 4 per cent by the introduction of hepatic interposition. The incidence of recurrent ulceration was 5.1 per cent after an average interval of 2 years and that of new gastric ulceration 2.6 per cent after an average of 4 years. There were no recurrent ulcers in those who had peroperative Burge tests, although secretory studies showed no difference between those tested and those not tested. Most recurrences occurred in the earliest cases operated on before Burge testing was introduced and when only 2 cm of the lower oesophagus were exposed.

Duodenal Ulcer↗