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T Oresland

Publications and source records attributed to T Oresland.

At least 19 recordsLinked to original sources
PubMed1999

Fertility after ileal pouch-anal anastomosis in women with ulcerative colitis.

BACKGROUND: Women with ulcerative colitis are believed to have normal fertility but colectomy and ileal pouch-anal anastomosis (IPAA) may impair fertility. The aim was to compare fertility in patients with ulcerative colitis before and after IPAA with that in the national population. METHODS: Some 258 consecutive women who had undergone IPAA for ulcerative colitis were identified. Data were collected by questionnaire and from medical records. The observed number of births was compared with the number expected by indirect standardization by age and calendar year. Fertility from the age of 15 years to colectomy, from the onset of ulcerative colitis to colectomy, and from the 12 months after stoma closure to the time of data collection was investigated. RESULTS: A total of 237 women (92 per cent) responded. From the age of 15 years to colectomy there were 251 deliveries compared with an expected number of 286 (P < 0. 05). The number of births from the onset of ulcerative colitis to colectomy was 120, compared with an expected 131 (P > 0.3). From the 12 months after ileostomy closure until data collection there were 34 deliveries, compared with an expected 69 (P < 0.001). CONCLUSION: There is a considerable reduction in postoperative fertility after restorative surgery for ulcerative colitis.

Adult↗
PubMed1999

Preliminary results of a multicentre trial of the electrically stimulated gracilis neoanal sphincter.

BACKGROUND: The electrically stimulated gracilis neoanal sphincter was initially developed to treat refractory incontinence. Good early results were reported from the two centres that pioneered the technique. The aim of this study was to assess the operation in a prospective multicentre setting. METHODS: The procedure was performed on 64 patients from seven centres worldwide and was performed in stages. All patients were evaluated clinically and manometrically before and after operation. RESULTS: There was a high incidence of infective and hardware-related complications. At a median of 10 months following closure of the defunctioning stoma 56 per cent had experienced a good functional result. The major functional problems comprised evacuatory difficulties experienced by 25 per cent. CONCLUSION: The technique is effective in treating otherwise refractory incontinence. It is, however, a complex procedure and the morbidity rate may be high, particularly during the learning curve, factors that necessitate careful patient selection. Presented to the Association of Surgeons of Great Britain and Ireland in Bournemouth, UK, April 1997 and the European Council of Coloproctology in Edinburgh, UK, June 1997; and published in abstract form as Br J Surg 1997; 88(Suppl): 39 and Int J Colorectal Dis 1997; 12: 144

Adolescent↗
PubMed1998

Objective methods cannot predict anal incontinence after primary repair of extensive anal tears.

BACKGROUND: An increased awareness of anal incontinence after delivery tears has developed during the last years. The aim of this study was to compare complaints with the results of physiological methods in women with complete sphincter ruptures primarily repaired at delivery. METHODS: Twenty-seven women, 16 with total rupture of the external anal sphincter and 11 who also had a ruptured internal anal sphincter were studied. Interviews on pelvic floor function, investigation with recto-anal manometry, single fiber EMG and anal endosonography were performed at 11.9 (2.5) months after delivery. Fifteen women vaginally delivered without sphincter rupture served as controls. RESULTS: Pelvic floor dysfunction was admitted in 74%, in particular gas incontinence (59%). Maximum squeeze pressure was significantly reduced (p<0.01) compared to controls, while resting anal pressure was unaffected. Fiber density was increased in 81% of patients and 91% had detectable defects on endosonography. Neither the degree of rupture nor the presence of complaints significantly correlated to the objective methods. CONCLUSIONS: A majority of women with primarily repaired anal sphincter ruptures at delivery were incontinent. Sphincter defects and signs of neuropathy could not precisely predict symptoms.

Adult↗
PubMed1997

Small bowel length in inflammatory bowel disease.

UNLABELLED: Small intestinal length has a particular significance in patients with inflammatory bowel disease (IBD). A determination of intestinal length by a standardised and simple technique is of interest for surgical decision making in primary and recurrent disease and in the evaluation and management of postoperative malabsorption. The aim of the present investigation was to analyse intestinal length in patients with IBD and define a standard method for this measurement. MATERIAL AND METHODS: Two consecutive series of patients. Crohn's disease (n = 279) and ulcerative colitis (n = 315) and a control group (n = 77) underwent standardised intra-operative small intestinal length measurement. RESULTS: Small intestinal length correlated to weight and height and was less in women than in men (P < 0.001) in both IBD groups and the controls. The small bowel in patients with Crohn's disease was significantly shorter than in patients with ulcerative colitis and in controls, P < 0.001. Also in Ulcerative Colitis small bowel length was significantly less than in controls, P < 0.001. In CD patients there was no difference in bowel length with regards to the anatomical extent of the disease. Original small bowel-length in patients with CD and one or two bowel resections (n = 67) was not different from that in patients with three or more resections (n = 88). CONCLUSION: Small bowel length correlated to weight, height and sex. Patients with CD had a significantly shorter small intestine at first laparotomy, compared with U.C. patients and controls. In CD-patients there was no difference between the anatomical subgroups.

Case-Control Studies↗
PubMed1997

The trephine stoma: formation of a stoma without laparotomy.

A trephine stoma may be an attractive alternative for those patients who require a stoma but not a laparotomy. Twenty-seven consecutive patients were candidates for formation of a trephine stoma. A loop ileostomy was successfully constructed in seven patients and an end sigmoid colostomy in 15, while conversion to a formal laparotomy was necessary in five patients mainly because the sigmoid colon was immobile or there were extensive adhesions. The absence of a major abdominal wound made the postoperative course simple with little pain, a quick recovery, and early discharge from hospital.

Adult↗
PubMed1997

Does simple hysterectomy alter bowel function?

BACKGROUND AND AIMS: Hysterectomy is believed to be associated with disturbed defecation, mainly constipation. This study longitudinally describes bowel function in women submitted for hysterectomy. MATERIAL AND METHODS: Rectoanal manovolumetry, whole gut transit time and detailed interviews on bowel function and dyspareunia were performed preoperatively and at 3 and 11-18 months after hysterectomy in 42 women. Twenty healthy women matched for age and parity served as manovolumetry controls. RESULTS: No significant changes in anal sphincter pressures could be demonstrated, neither early nor late after hysterectomy. Transit time was unaffected. All but one of the patients claimed that they had been suffering from one or more of the following symptoms; abdominal pain, distension, constipation and dysparenuia. While postoperative interviews revealed a significant improvement with respect to abdominal pain and dyspareunia (P < 0.01) after 3 and 11-18 months, improvement of abdominal distension and constipation proved to be transient only. CONCLUSION: Simple abdominal hysterectomy appears not to interfere adversely with bowel function. On the contrary many patients were relieved from abdominal pain present before operation.

Adult↗
PubMed1996

Postoperative pain. Does subcutaneous lidocaine spray relieve it? Can pain be predicted?

Postoperative pain is often a big problem after gastrointestinal surgery. The aim of the present investigation was two-fold; To see whether supplying of lidocaine spray in the surgical wound influences postoperative pain and to evaluate the role of patients and caring factors on the perception of postoperative pain. Sixty consecutive patients undergoing major abdominal surgery were randomized into a control or a treatment group. Pain relief, apart from lidocaine, was given according to routine. The methods included interviews, pain registration, on a visual analogue scale and registration of administered analgesics. No effect could be attributed to lidocaine. Nurses' ability to predict pain was unreliable, patients predicted pain better. Younger patients suffered greater pain than elderly. Preoperative anxiety correlated to postoperative pain, whereas malignant diagnoses did not. Most of the studied patients had considerable postoperative pain. Routines for postoperative pain relief should be improved.

Administration, Topical↗
PubMed1996

Perinuclear antineutrophil cytoplasmic antibody in pouchitis after proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis.

BACKGROUND: It has been shown that perinuclear antineutrophil cytoplasmic antibody (P-ANCA) may be associated with pouchitis after proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). METHODS: P-ANCA was studied with the indirect immunofluorescence technique in 76 UC patients after IPAA. Twenty-eight patients had had pouchitis, whereas 48 patients did not. RESULTS: P-ANCA was found in 49 of 76 (64.5%) UC patients after IPAA. In patients who had had pouchitis attacks within 1 year of serum sampling (group 1) 12 of 12 (100%) patients had positive P-ANCA. In patients who had had pouchitis attacks 1 or several years before the serum sampling (group 2) 9 of 16 (56.3%) patients had positive P-ANCA. In patients who had not yet had a pouchitis attack (group 3) 28 of 48 (58.3%) were positive. The occurrence of P-ANCA in group 1 was significantly higher than in group 2 (p = 0.01) or group 3 (p = 0.005). No statistically significant difference was found between the occurrence of P-ANCA in group 2 and group 3. Furthermore, we found that the titres of P-ANCA in the pouchitis patients were associated with the observation time since the first pouchitis attack to the time of serum sampling (r = -0.43, p = 0.02) and a pouchitis relapse index (average pouchitis attacks per year, r = 0.47, p = 0.03). CONCLUSIONS: P-ANCA was found in UC patients after proctocolectomy with IPAA. Patients with recent (< or = 12 months) or ongoing pouchitis are all P-ANCA-positive. Pouchitis patients with higher P-ANCA titres are more prone to have frequent relapses.

Adult↗
PubMed1995

Intestinal intraluminal continuity is a prerequisite for the distal bowel motility response to feeding.

BACKGROUND: We wanted to elucidate further the regulation of the intestinal motility response to feeding. METHODS: After intraduodenal administration of an oleate solution, mimicking a meal, the distal bowel motility and the plasma levels of bile acids, cholecystokinin (CCK), and neurotensin were monitored in patients operated on with restorative proctocolectomy (n = 4) or low anterior resection of the rectum (n = 4). Investigations were performed both with and without a diverting loop ileostomy. RESULTS: Intraduodenal sodium oleate elicited a prompt and significant increase in distal bowel motility. The motility response failed to appear when the luminal flow was diverted by a loop ileostomy. An increase in plasma CCK preceded the motility increase, but CCK was increased also in patients with a loop ileostomy. Whereas plasma bile acid levels were significantly increased after 30-45 min (p < 0.05), both with and without a loop ileostomy, neurotensin levels were not affected. CONCLUSION: Intestinal continuity is a prerequisite for the distal bowel motility response, indicating that apart from other possible mechanisms, luminal factors are involved in the regulation of intestinal motility.

Adult↗
PubMed1994

Gynaecological and sexual function related to anatomical changes in the female pelvis after restorative proctocolectomy.

Restorative proctocolectomy with an ileal pouch-anal anastomosis preserves anal sphincters, the normal route of defaecation and the normal body image and it has been suggested that the procedure might be associated with less gynaecological and sexual problems than conventional proctocolectomy. To shed further light on this subject 60 female patients were invited to participate in a study comprising a detailed interview, examination by a gynaecologist and investigation with hysterosalpingography and vaginography. Twenty-one women with a mean follow-up of 38 months after surgery agreed to participate. Their gynaecological state was considered normal although one woman complained of vaginal discharge. Five women experienced occasional dyspareunia and 2 patients had to take special precautions to avoid bowel leaks at intercourse. While the position of the vagina and uterus in the pelvis appeared normal, hysterosalpingography disclosed bilateral occlusion of the fallopian tubes in 2 and unilateral occlusion in another 9 patients with tubes adhering to the bottom of the lesser pelvis in 10 of the patients. Only one out of 14 patients succeeded in trying to conceive during the follow-up period. Among the remaining 39 women not specially studied 5 out of 14 had conceived after the operation.

Adult↗
PubMed1994

Abdominal rectopexy for rectal prolapse. Influence of surgical technique on functional outcome.

PURPOSE: The aim of this study was to investigate the influence of surgical technique on functional and manovolumetric results in patients treated with Marlex mesh abdominal rectopexy. METHODS: The lateral ligaments were completely divided (the Wells procedure) in 16 patients and preserved (the Ripstein procedure) in 16 patients. Clinical and physiologic assessment were performed before and at 3, 6, and 12 months after operation. RESULTS: Improvement of continence was similar. Bowel regulation problems which were unchanged after the Ripstein procedure increased significantly after the Wells procedure (P < 0.01). Rectal volume became reduced in the group who received the Wells procedure (225 ml vs. 115 ml, P < 0.05 at one year), but remained unchanged after receiving the Ripstein procedure. The pressure thresholds required to elicit sensation of rectal filling and defecation urge were increased after the Wells procedure (15 cm of H2O vs. 25 cm of H2O, P < 0.05 and 25 cm of H2O vs. 45 cm of H2O, P < 0.05, respectively). In the Ripstein group there was only a slight increase of the threshold for urge (P < 0.05). CONCLUSION: The Wells procedure was followed by severe rectal dysfunction accompanied by increased constipation and evacuation problems. The Ripstein procedure, preserving the lateral ligaments, appears not to affect such symptoms adversely. On the other hand, improvement is not likely to occur.

Defecation↗
PubMed1994

Does the level of stapled ileoanal anastomosis influence physiologic and functional outcome?

PURPOSE: The aim of this investigation was to ascertain how the length of anal canal preserved above the dentate line in stapled end-to-end ileoanal anastomosis influenced late outcome. METHODS: Two groups, high cuff group and low cuff group of nine subjects with stapled anastomosis, matched for sex, age, pouch configuration, and mean follow-up, representing the highest (median, 2.5 cm) and lowest (median, 0.7 cm) anal cuff lengths in our series, were selected. Physiologic and functional parameters were appraised preoperatively, at the time of ileostomy closure, and at 1, 3, 6, and 12 months after reestablishment of intestinal continuity. RESULTS: At one year, the drop in mean anal canal resting pressure was 13 percent in the high cuff group (not significant) and 31 percent in the low cuff group (P < 0.05); mean maximum squeezing pressure did not differ significantly from preoperative values in both groups. The mean volume of the ileal pouch was higher in the low cuff group at all insufflation pressures. The rectoanal inhibition reflex reappeared in four high cuff group patients and in none of the low cuff group patients. Mean distention pressure (cm H2O) and volume (ml) eliciting urge sensation were 80 and 360 in the low cuff group compared with 40 and 240 in the high cuff group (P < or = 0.05). Daytime bowel movements and night incontinence were significantly better in the low cuff group. No statistical differences were observed for night stool frequency, daytime incontinence, pad use (day and night), discrimination between gas and feces, ability to defer evacuation, and difficulty in emptying the pouch. CONCLUSION: Patients with stapled anastomoses and a low rectal cuff length, despite presenting lower anal resting pressure and absence of rectoanal inhibition reflex, had a better functional outcome in terms of continence than those with a high cuff length.

Adult↗
PubMed1994

Loperamide improves anal sphincter function and continence after restorative proctocolectomy.

The physiological and clinical effects of loperamide treatment versus placebo were investigated in a randomized, double-blind, crossover study in patients operated with restorative proctocolectomy. Sixteen patients operated with endoanal mucosectomy and a handsewn ileal pouch-anal anastomosis and 14 patients operated with abdominal proctocolectomy and stapling of the pouch to the top of the anal canal were studied. While loperamide treatment increased resting anal pressure in both groups of patients by approximately 20% (P < 0.05), squeeze pressure was not affected. Loperamide did not affect pouch volume or contractility. Sensory thresholds and the recto/pouch-anal inhibitory reflex were not influenced by loperamide treatment. Clinical function was improved, with a reduced bowel frequency and an improved nighttime continence, with less soiling (P < 0.05) as well as need to wear a protective pad.

Adult↗
PubMed1994

Ileostomy output and bile acid excretion after intraduodenal administration of oleic acid.

BACKGROUND: Ileostomy output and small-intestinal transport are regulated by complex mechanisms, which the present study aimed to further elucidate. METHODS: The time-related ileostomy output and bile acid excretion after intraduodenal administration of a fat solution (oleic acid, 3.5 g) was studied in 29 ileostomy patients. Eighteen patients had the entire small bowel preserved (group I), whereas 11 had various lengths of the ileum resected or bypassed (group II). RESULTS: Intraduodenal fat administration resulted in a prompt and significant increase in ileostomy output in both groups. The accumulated 2-h output after fat administration amounted to 60% of the normal 24-h output in group I and 30% in group II. A marked increase in bile acid excretion preceded the flow response. The fat-induced response was abolished by administration of cholestyramine. CONCLUSIONS: Bile acids seem to have important regulatory effects with regard to secretion/absorption and transport of small-bowel contents, affecting ileostomy output, with clinical implications in many patients.

Bile Acids and Salts↗
PubMed1994

The leaking colorectal anastomosis; why does it happen and how do we prevent it?

The ingredients predisposing for an anastomotic leak can be attributed both to the patient and to the surgeon. Some causative elements can be remedied; others cannot be changed very much. In cancer surgery the quest for cure involves ligation of the inferior mesenteric artery in the treatment of left-sided tumours. This obviously creates a conflict with the goal of constructing a well circulated anastomosis. In the treatment of rectal cancers total mesorectal excision has in recent years been put forward as the crucial step in avoiding local recurrences. The use of drains is a matter of controversy. The rationale for using them is to avoid pelvic collections with subsequent infection. The anastomosis is the point of least resistance so this is where a pelvic abscess is liable to break through, thus creating a leak. The choice of anastomosis, single layer or double layer, has been extensively dealt with and is beyond the scope of this presentation. My opinion is that you should stick to the type of anastomosis you are familiar with and try to refine your technique as much as possible. Continuous surgical audit and improved surgical training are likely the most important measures to lower the complication rates in colorectal surgery.

Anastomosis, Surgical↗
PubMed1993

Possible role of the autonomic nervous system in sphincter impairment after restorative proctocolectomy.

Peroperative manometry was performed in 12 patients operated on with endoanal proctectomy and a hand-sewn pouch-anal anastomosis and in 12 in whom proctectomy was performed entirely from above, with the ileal pouch stapled to the top of the anal canal. Results from both groups showed that division of the superior rectal artery reduced the median (95 per cent confidence interval (c.i.)) resting anal pressure from 77.5 (69.9-83.3) mmHg to 64.5 (55.2-70.0) mmHg (P < 0.01). Complete rectal mobilization to the pelvic floor decreased resting pressure by an additional 22 per cent, to a median of 50.0 (95 per cent c.i. 40.1-53.5) mmHg (P < 0.01). After completion of anastomosis, irrespective of the operative technique used, a further decline in median pressure to 35.0 (95 per cent c.i. 26.0-47.7) mmHg could be demonstrated (P < 0.05). This study indicates that anal sphincter pressure is reduced to a similar extent after hand-sewn and stapled anastomoses. Injury to the autonomic nervous supply to the anal sphincter mechanism might be the major cause for this reduction.

Adult↗