Biomedical subjects

V W Fazio

Publications and source records attributed to V W Fazio.

At least 19 recordsLinked to original sources

PubMed1996

Long-term analysis of the use of transanal rectal advancement flaps for complicated anorectal/vaginal fistulas.

UNLABELLED: Transanal rectal advancement flap (TRAF) is a surgical option in the management of rectovaginal and other complicated fistulas involving the anorectum. Most reported series have a short follow-up. PURPOSE: This study was undertaken to determine the long-term success, safety, applicability, and factors affecting recurrence in patients managed with TRAF, including patients with Crohn's disease. METHODS/MATERIALS: Retrospective analysis of all patients undergoing endorectal advancement flaps at a single institution between 1988 and 1993 was performed. One hundred one patients were identified (70 percent female; 30 percent male). Included were 52 patients with rectovaginal, 46 with anal perineal, and 3 with rectourethral fistulas. Causes were obstetric injury in 13 patients, Crohn's disease in 47, cryptoglandular in 19, mucosal ulcerative colitis in 7, and surgical trauma or undefined causes in 15 patients. RESULTS: No mortality occurred. Median follow-up was 31 (range, 1-79 months). Immediate failure (within one week of the repair) was seen in 6 percent of patients. Statistically (P<0.001) higher recurrence rates were observed in patients who had undergone previous repairs. Mean hospital stay was four days. Overall recurrence was seen in 29 patients (29 percent). Seventy-five percent of all recurrences occurred within the first 15 months; however, recurrence was noted for up to 55 months after repair. Etiology of fistula, use of constipating medications, antibiotic use, and most importantly associated Crohn's disease did not statistically affect recurrence rates. Failure rate was only influenced by previous number of repairs. CONCLUSION: TRAF is a safe technique for managing complicated anorectal and rectovaginal fistulas, including patients with Crohn's disease. Long-term follow-up is essential to accurately report recurrence rates.

Adolescent↗

PubMed1996

Laparoscopic techniques for fecal diversion.

UNLABELLED: Although the role of laparoscopic techniques in performing major colorectal resections is unclear, laparoscopy may be well suited for fecal diversion procedures because no resection and minimal tissue dissection is required. PURPOSE: This report reviews our initial experience with laparoscopic stoma procedures to assess safety and efficacy. METHODS: Using a simple two-cannula technique, 24 such procedures (16 loop ileostomies, 6 end sigmoid colostomies, 1 transverse, and 1 sigmoid loop colostomy) were attempted. Indications for diversion were rectovaginal fistula (7), perianal sepsis (7), incontinence (4), advanced rectal or colon carcinoma (4), and complicated pelvic infection (2). There were 15 females and 9 males with a median age of 44 (range, 25-88) years. RESULTS: Median operative time was 60 (range, 20-120) minutes, and median blood loss was 50 (range, 0-150) ml. There were no intraoperative complications. One case was converted to a laparotomy because of dense adhesions. Median time to passage of both flatus and stool was one (range, 1-3) day for ileostomy patients, two (range, 2-4) for flatus, and 3 (range, 2-6) days for stool after colostomy. Median time to discharge was 6 (range, 2-28) days and was often delayed by the primary disease process or ostomy teaching. One major postoperative complication, a pulmonary embolism, occurred eight days after operation in a patient with near obstructing, widely metastatic colon carcinoma. This patient later died of pulmonary failure. All stomas have functioned well, with no revisions required. CONCLUSIONS: Laparoscopic fecal diversion procedures can be performed safely, simply, and effectively. Apparent advantages over standard techniques are avoidance of a laparotomy, while maintaining the ability to precisely identify and orient the pertinent bowel segment and rapid return of bowel function.

Adult↗

PubMed1996

Preliminary experience with laparoscopic intestinal surgery for Crohn's disease.

BACKGROUND: Laparoscopic techniques are being applied to the surgical management of various intestinal conditions, but few reports describe their use with Crohn's disease. PATIENTS AND METHODS: Over a 2-year period, 31 selected patients with Crohn's disease underwent laparoscopic intestinal surgery: 18 women and 13 men, with a median age of 39 years (range 22 to 79). Indications for operation included: primary terminal ileitis (13); recurrent ileitis (2); Crohn's colitis (3); rectovaginal fistula (6); and severe perianal disease (7). Resections were laparoscopically assisted with division of mesentery and anastomosis performed extracorporeally. Diversion procedures were performed using a two-cannula technique. RESULTS: Twenty-five of 31 procedures were completed laparoscopically: loop ileostomy or colostomy (12); ileocecectomy (10); segmental colon resection (2); and total abdominal colectomy with ileorectal anastomosis (1). Six cases were converted to conventional surgery secondary to extensive adhesions from prior surgery (2) or severe inflammation (4). No case was converted because of intraoperative complication. Median operative time for diversion procedures was 53 minutes (range 20 to 90) and for resections 195 minutes (range 90 to 380). Median blood loss was 100 mL (range 10 to 500), and there were no intraoperative complications. Only 1 postoperative complication occurred: a myocardial infarction. Median times to passage of flatus and bowel movement were both 3 days (range 1 to 6). Median time to discharge was 6 days (2 to 21) for diversion patients, and 6 days (3 to 7) for resected patients. CONCLUSIONS: Laparoscopic intestinal surgery, both for resection and diversion, is feasible and safe for the management of selected patients with Crohn's disease. To determine if real advantages exist for laparoscopy in the surgical treatment of Crohn's disease, further study is needed.

Adult↗

PubMed1996

How safe is strictureplasty in the management of Crohn's disease?

BACKGROUND: Strictureplasty is a well-accepted technique in the management of selected patients with Crohn's disease. To determine the safety and optimal clinical setting for performing strictureplasty, perioperative complications and long-term outcomes need to be analyzed. PATIENTS AND MATERIALS: We retrospectively reviewed the charts of 162 patients (87 men, 75 women) with Crohn's disease who underwent strictureplasty between June 1984 and July 1994. Medical and surgical history, including medications and laboratory data, intraoperative findings, perioperative complications, and long-term follow-up data were recorded. RESULTS: These patients underwent 698 strictureplasties (Heineke-Mikulicz procedures, 617; Finney procedures, 81). Median hospital stay was 8 days. Perioperative septic complications were noted in 8 patients (5%); however, reoperation for sepsis was needed only in 5 patients. Five percent of patients developed prolonged ileus after strictureplasty. Symptomatic improvement after strictureplasty was achieved in 98% of patients. Restricture or new stricture or perforative disease was seen in 5% and 17% of patients, respectively, during a 42-month median follow-up period. CONCLUSIONS: Our findings show that strictureplasty is a good surgical option for stenosing small-bowel Crohn's disease, particularly in patients with multiple obstruction and in those vulnerable to short-bowel syndrome. Perioperative complications are few, and long-term results are gratifying.

Crohn Disease↗

PubMed1995

Postoperative intestinal motility following conventional and laparoscopic intestinal surgery.

OBJECTIVES: To evaluate the influence of conventional vs laparoscopic right-sided colectomy on postoperative motility of the stomach, small bowel, and large bowel, and to study the effects on postoperative intestinal motility of anesthesia only and of laparotomy vs laparoscopy only. DESIGN: Prospective randomized study in a canine model. SETTING: Animal research laboratory. ANIMALS: Twelve mongrel dogs weighting 23.4 to 29.6 kg. INTERVENTIONS: (1) Laparotomy or laparoscopy and (2) 1 week after complete recovery from the first procedure, right-sided colectomy with ileocolic anastomosis using conventional or laparoscopic techniques. End points of the study were (1) the postoperative time until the electrical response activity of the stomach, small intestine, and large intestine returned to a normal interdigestive pattern and (2) the time until first postoperative bowel movement occurred. RESULTS: Median time until return to normal interdigestive pattern of myoelectrical activity after laparoscopic colectomy was about 40% less than after conventional colectomy (P < .05). Time until first bowel movement was 27% reduced (P < .05). CONCLUSIONS: Recovery from postoperative ileus following laparoscopic surgery is more rapid than after conventional surgery in the canine model. Confirmatory human studies should be performed.

Animals↗

PubMed1995

Surgery for the teenager with familial adenomatous polyposis: ileo-rectal anastomosis or restorative proctocolectomy?

Increasing numbers of polyposis registries have led to more young patients being diagnosed with familial adenomatous polyposis (FAP). To provide guidelines for selecting the appropriate surgical procedure in teenagers (10-19 years), we compared the results of colectomy and ileo-rectal anastomosis (IRA, n = 17 patients) to the results of restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA, n = 7 patients). Charts were reviewed to obtain data on the operative technique, blood loss and transfusions, hospital stay (including the time for ileostomy closure), and early (within 30 days of surgery) and late complications. Functional results (bowel movements per 24 h, use of antidiarrheal drugs, seepage, and fecal incontinence) and quality of life were evaluated prospectively with a questionnaire and physical examination. The median follow-up time was 49 months (range, 6 to 95 months) after IRA, and 36 months after IPAA (range, 4 to 87 months). Although restorative proctocolectomy and IPAA, is a longer (5.75 vs 3.1 hours), more bloody (500 vs 300 mL blood loss), and more complex operation with a longer hospital stay (12 vs 7 days) than IRA (P = 0.008, P = 0.006, P = 0.02, respectively), no significant difference (P > 0.05) was found between groups concerning the complication rate or quality of life. For teenagers with FAP and rectal carpeting, large rectal adenomas, curable cancer in the upper two-thirds of the rectum, or who are unavailable for follow-up, we recommend a restorative proctocolectomy and IPAA. For the other patients, the decision whether to perform IRA or restorative proctocolectomy with IPAA depends on the patient's desire and the surgeon's skill.

Adenomatous Polyposis Coli↗

PubMed1995

Paradoxical puborectalis contraction in patients after pelvic pouch construction.

UNLABELLED: Normal defecation is associated with relaxation of sphincters during the evacuation process. However, obstructive defecation is sometimes seen clinically manifested by abnormal contraction of the puborectalis during defecation rather than relaxing. This condition has not previously been described after pelvic pouch construction. PURPOSE: This study was done to evaluate patients for defecation difficulties caused by paradoxical puborectalis contraction after pelvic pouch procedures. METHODS: Prospectively, patients with defecation difficulties were questioned. They then underwent electromyography if they met particular criteria. Biofeedback was offered to all patients demonstrating paradox on electromyography. Follow-up was by clinic visits and interviews. RESULTS: After pelvic pouch construction, 13 patients were found to have paradoxical puborectalis contraction. Twelve of 13 patients elected to have biofeedback therapy. Eleven of these 12 were available for follow-up an average of eight (1-15) months after biofeedback. Nine improved, and two had no change in their defecation difficulty. Of the initial 13, 10 had an event, either pouchitis or abdominal trauma, directly before their defecation problems. CONCLUSION: Paradoxical puborectalis contraction can occur in patients after pelvic pouch surgery. It should be suspected in patients with defecation difficulties in the absence of an anatomic abnormality. Biofeedback is effective treatment.

Biofeedback, Psychology↗

PubMed1995

Anal canal inflammation after ileal pouch-anal anastomosis. The need for treatment.

UNLABELLED: One technique used during restorative proctocolectomy to prevent loss of continence involves preservation of the anal canal. This technique retains a small amount of colonic mucosa and transitional mucosa that may become inflamed or develop dysplastic or neoplastic changes. PURPOSE: This study was designed to determine the presence and severity of anal canal inflammation and the need for treatment. METHOD: Records of 217 patients with mucosal ulcerative colitis who underwent restorative proctocolectomy with a stapled ileal pouch-anal anastomosis without anal mucosectomy from 1987 through 1990 were retrospectively reviewed. RESULTS: Anal canal inflammation was evident on both endoscopy and biopsy in 48 patients (22.11 percent); 18 patients (8.29 percent) had a normal ileal pouch (9 had symptoms; 5 required topical treatment), and 30 patients (13.82 percent) had associated ileal pouch inflammation (23 with symptoms requiring systemic treatment because of pouchitis; 10 patients had concomitant topical treatment). CONCLUSION: Symptomatic inflammation of the retained mucosa occurred in 32 (14.7 percent) patients. Nine (4.1 percent) patients had inflammation of the anal canal alone, and 23 (10.6 percent) had pouchitis in addition. The need for treatment occurred in 28 (12.9 percent) of the total ((2.3 percent) patients with anal canal inflammation and 23 (10.6 percent) with anal canal inflammation plus pouchitis).

Administration, Rectal↗

PubMed1995

Coloanal anastomosis for rectal cancer. Long-term results at the Mayo and Cleveland Clinics.

PURPOSE: This study was designed to determine functional outcomes and rates of survival and recurrence of coloanal anastomosis in rectal cancer patients. METHODS: Between 1981 and 1991, 117 patients underwent coloanal anastomosis. Fifteen percent of the patients had a J-pouch; the rest had a straight coloanal anastomosis. Thirty-eight percent had no diverting stoma. Median distance of the tumor from the anal verge was 6.7 cm. RESULTS: Local recurrence rate was 7 percent. Five-year survival was fully 69 percent. Satisfactory fecal continence was achieved by 78 percent of patients; no J-pouch patient had frequent incontinence. Sixty-two percent of the patients had major (anastomotic leak = 18 percent) or minor complications; complications were not mitigated by a diverting stoma or worsened by adjuvant therapy. CONCLUSION: Although coloanal anastomosis is associated with a high chance of complications, the long-term outcome, in terms of disease-free survival and satisfactory function, is excellent.

Adult↗

PubMed1995

Safety of urgent restorative proctocolectomy with ileal pouch-anal anastomosis for fulminant colitis.

PURPOSE: Subtotal colectomy with ileostomy is the operation of choice for patients with fulminant colitis. Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is preferred for patients who undergo elective surgery for ulcerative colitis. We retrospectively evaluated the safety of RPC with IPAA in patients with a moderate form of fulminant colitis. METHODS: A chart review of 737 patients who underwent RPC with IPAA for ulcerative and indeterminate colitis from 1983 through 1992 was performed. Moderate fulminant colitis was defined as acute disease requiring hospitalization and parenteral steroid therapy, but without hypotension (systolic blood pressure, < 100 mmHg), tachycardia (> 120 beats/min), or megacolon. RESULTS: Twelve patients with moderate fulminant colitis underwent urgent surgery (1.6 percent). They had been treated preoperatively for 5.1 +/- 2.3 days with intravenous high-dose steroids, total parenteral nutrition, and antibiotics. These patients had a shorter length of disease (P = 0.01), lower hemoglobin, hematocrit, and albumin (P = 0.001), and higher temperature (P = 0.002) and leukocyte count (P = 0.007) than patients undergoing elective surgery. No early septic complications occurred, although perianal abscess occurred in one patient and pouch-anal fistula in another patient, 13 and 14 months after surgery, respectively. CONCLUSION: In carefully selected, hemodynamically stable patients with fulminant colitis and without megacolon, RPC with IPAA can be safely performed.

Acute Disease↗

PubMed1995

Management of gastrointestinal bleeding after strictureplasty for Crohn's disease.

PURPOSE: To determine the incidence, clinical features, and optimal management of poststrictureplasty hemorrhage in Crohn's disease. METHODS: Retrospective analysis of 139 patients with Crohn's disease seen at the Cleveland Clinic who underwent a total of 523 strictureplasties between June 1984 and June 1992. RESULTS: Poststrictureplasty hemorrhage occurred in 13 patients (9.3 percent). Average drop in hemoglobin and hematocrit in these patients was 5.8 g/dl and 0.174, respectively. All patients were managed nonoperatively. Mean follow-up was 29.6 (range, 7-62) months. CONCLUSION: Strictureplasty in Crohn's disease is a safe procedure in selected patients. Poststrictureplasty hemorrhage is uncommon; however it can be managed nonoperatively in most cases. An algorithm for management of such patients is presented.

Adult↗

PubMed1995

Effect of rectosigmoid stump length on restorative proctocolectomy after subtotal colectomy.

BACKGROUND: The length of the rectosigmoid stump left after subtotal colectomy and ileostomy is believed to affect postoperative complications, including sepsis, success of future restorative proctocolectomy, and long-term functional outcome. METHODS: We reviewed the charts of 60 patients with toxic ulcerative colitis who were treated with subtotal colectomy leaving either a short (25) or long (35) rectosigmoid stump and who eventually underwent restorative proctocolectomy between 1983 and 1992 at a large tertiary care center. Data were collected on preoperative disease duration and steroid use, operative time, blood loss, transfusion requirements, length of stay, stool frequency, fecal incontinence, and sexual dysfunction. RESULTS: There were no statistically or clinically significant differences between groups. CONCLUSIONS: Rectosigmoid stump length does not appear to affect complications or long-term outcome in patients with toxic ulcerative colitis treated with subtotal colectomy and restorative proctocolectomy.

Adult↗

PubMed1995

Use of laparoscopic techniques in oncologic right colectomy in a canine model.

BACKGROUND: The purpose of this study was to evaluate the feasibility of laparoscopic oncologic righ colectomy (RC) with intraperitoneal ileocolic anastomosis (ICA) in a canine model. METHODS: In 21 dogs a laparoscopic RC with transection of the main right colic artery and removal of adjacent lymph nodes (LN) was carried out using an Nd:YAG contact laser and endoscopic stapler. Two weeks after surgery, all animals were killed. The number of remaining right colon mesenteric LN, length of remaining right colic artery, bursting pressure (BP) of ICA, and postoperative morbidity were evaluated. RESULTS: No major intraoperative complications were recorded. One dog died of pneumonia and heartworms. There were no postoperative septic or anastomotic complications. All dogs passed feces within the first 24 h postoperatively. Median operative time was 135 min (range 105-180 min). Length of remaining right colic artery after oncologic resection was 4.5 mm (range 3-7 mm), the number of remaining LN was 0, and the median anastomotic BP was 232 mm Hg (range 132-312 mm Hg). CONCLUSION: Oncologic resection of the right colon with high vascular ligation, wide mesenteric clearance of LN, and intraperitoneal anastomosis is feasible and safe in a canine model.

Anastomosis, Surgical↗

PubMed1995

Management and outcome of patients with invasive carcinoma arising in colorectal polyps.

BACKGROUND & AIMS: Treatment for invasive adenocarcinoma in colorectal polyps (malignant polyps) is controversial. The aim of this study was to evaluate our institutional treatment strategy for malignant polyps. METHODS: Malignant polyps were designated as having favorable histology (grade I or II carcinoma with at least a 2-mm free margin) or unfavorable histology (grade III invasive adenocarcinoma, invasive adenocarcinoma with an unassessable margin, or a margin of < 2 mm). Malignant polyps with favorable histology were considered treated adequately by endoscopic polypectomy, whereas further therapy was recommended for malignant polyps with unfavorable histology. Recurrence, residual adenocarcinoma in a follow-up resection specimen, or metastasis during follow-up were considered adverse outcomes. RESULTS: Of the 47 patients identified, 17 (36%) had favorable histology. Sixteen patients (94%) were treated with polypectomy alone. None had an adverse outcome (median follow-up, 70 months). Thirty patients (64%) had unfavorable histology, and 21 patients (70%) underwent colectomy. Five patients underwent radiation therapy alone. Four patients underwent no additional therapy. Ten of 30 patients with unfavorable histology had adverse outcomes that differed significantly from the favorable histology group (P = 0.03). CONCLUSIONS: Endoscopic polypectomy alone is adequate therapy for malignant polyps with favorable histology.

Adenocarcinoma↗

PubMed1995

Hemorrhoids, anal fissure, and carcinoma of the colon, rectum, and anus during pregnancy.

The pregnant patient afflicted with a variety of colorectal conditions merits special consideration for reasons related to the safety and timeliness of operation while preserving fetal viability and fertility. The literature is scanty with respect to hemorrhoids, fissures, and colorectal and anal carcinoma. Therefore, the patient has to have a forthright discussion with her physician(s) about the pros and cons of operative and nonoperative approaches, which can result in either therapeutic abortion and timely surgery versus preserving the fetus and taking on the unknown factor of whether delay in treatment will cause an adverse outcome. This underscores the need for a frank discussion with the patient with regard to anticipated outcomes. In benign conditions, there is more latitude to adopt a conservative approach, as the patient's ability to tolerate the symptoms of her condition would dictate the need for definitive operative therapy. In the patient with malignancy, delaying surgical or radiation therapy carries an unknown risk to the patient. Here, the patient's personal views regarding abortion and future fertility dictate the timing of definitive treatment.

Adult↗

PubMed1995

Ileal pouch-anal anastomoses complications and function in 1005 patients.

BACKGROUND: Restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has become an established surgery for patients with chronic ulcerative colitis and familial adenomatous polyposis. PURPOSE: The authors report the results of an 11-year experience of restorative proctocolectomy and IPAA at a tertiary referral center. METHODS: Chart review was performed for 1005 patients undergoing IPAA from 1983 through 1993. Preoperative histopathologic diagnoses were ulcerative colitis (n = 858), familial adenomatous polyposis (n = 62), indeterminate colitis (n = 75), and miscellaneous (n = 10). Information was obtained regarding patient demographics, type and duration of diseases, previous operations, and indications for surgery. Data were collected on surgical procedure and postoperative pathologic diagnosis. Early (within 30 days after surgery) and late complications were noted. Follow-up included an annual function and quality-of-life questionnaire, physical examination, and biopsies of the pouch and anal transitional zone. RESULTS: Of the 1005 patients (455 women), postoperative histopathologic diagnoses were as follows: ulcerative colitis (n = 812), familial adenomatous polyposis (n = 62), indeterminate colitis (n = 54), Crohn's disease (n = 67), and miscellaneous (n = 10). During a mean follow-up time of 35 months (range 1-125 months), histopathologic diagnoses were changed for 25 patients. The overall mortality rate was 1% (n = 10 patients, early = 4, late = 6); one death (0.1%) was related to pouch necrosis and sepsis. The overall morbidity rate was 62.7% (1218 complications in 630 patients; early, n = 27.5%; late, n = 50.5%). Septic complication and reoperation rates were 6.8% and 24%, respectively. The ileal pouch was removed in 34 patients (3.4%), and it is nonfunctional in 11 (1%). Functional results and quality of life were good to excellent in 93% of the patients with complete data (n = 645) and are similar for patients with ulcerative colitis, familial adenomatous polyposis, indeterminate colitis, and Crohn's disease. Patients who underwent operations from 1983 through 1988 have similar functional results and quality of life compared with patients who underwent operations after 1988. CONCLUSION: Restorative proctocolectomy with an IPAA is a safe procedure, with low mortality and major morbidity rates. Although total morbidity rate is appreciable, functional results generally are good and patient satisfaction is high.

Adenomatous Polyposis Coli↗

PubMed1994

Strictureplasty without concomitant resection for small bowel obstruction in Crohn's disease.

The efficacy of strictureplasty in the treatment of Crohn's disease is often attributed in part to concomitant resection of strictured small bowel segments. Fifty-four patients with obstructive Crohn's disease who underwent 215 strictureplasty procedures (Heineke-Mikulicz, 179; Finney, 36) without concomitant resection of small bowel were reviewed. The median age was 38 (range 18-66) years and the median follow-up 3 (range 1-7) years. The mean number of strictureplasties per patient was 4 (range 1-13). Twenty-four patients had undergone at least one previous small bowel resection. There was no operative death. Intra-abdominal abscess and enterocutaneous fistula occurred in two patients each and reoperation for sepsis was needed in one. At 1 year after surgery the median weight gain was 4 kg; all but two patients had relief of obstructive symptoms and 26 of 37 were weaned off steroids. Symptomatic recurrence occurred in 14 patients and seven required reoperation. Rates of recurrent stricture and of new stricture or perforative disease were 2.3 per cent of strictureplasty sites and 26 per cent of patients respectively.

Abscess↗

PubMed1994

Monopolar electrosurgery and Nd:YAG Contact Laser in laparoscopic intestinal surgery.

In a prospective randomized study using a canine model, we compared the use of monopolar electrosurgery (EC) (n = 23) and the Nd:YAG Contact Laser (CL) (n = 21) on intra- and postoperative morbidity in laparoscopic large-bowel resection. In EC, cutting was performed with scissors and coagulation was performed with electrosurgery. In CL, cutting and coagulation were carried out with the Nd:YAG Contact Laser. Laparoscopic oncologic right colectomy with intraperitoneal ileocolic stapled anastomosis was performed in all dogs. Intraoperative smoke development, difficulty of dissection, hemostasis, and postoperative adhesions were judged using a five-point score. Two weeks after surgery, all dogs were sacrificed and zoopsy was carried out. Three dogs died postoperatively from pneumonia and one from an anastomotic leak. There were no other postoperative complications. Operative time was 135 min (range 105-180) in the CL group and 145 min (range 60-210) in the EC group. Intraoperative smoke development, difficulty of dissection, and postoperative amount of adhesions were not different between groups (P > 0.05). Hemostasis in the CL group (median score of 1, range 1-2) was significantly better (P = 0.01) than in the EC group (median score of 2, range 1-5). Scissors and electrosurgery as well as Nd:YAG Contact Laser can be used successfully in intestinal laparoscopic surgery. Although the use of the Contact Laser did not cause less postoperative morbidity than the conventional method, there was significantly better hemostasis using the Nd: YAG Contact Laser.

Animals↗