Biomedical subjects

Y H Ho

Publications and source records attributed to Y H Ho.

At least 55 records · Page 3Linked to original sources

PubMed1999

Minimizing recurrence after sigmoid volvulus.

BACKGROUND: This study was a retrospective review of a series of patients with sigmoid volvulus to identify risk factors for recurrence and recommend appropriate treatment. METHODS: Thirty-five patients with sigmoid volvulus were treated over 8 years. RESULTS: Six patients had emergency surgery for peritonitis. Twenty-eight of the other 29 patients had successful endoscopic decompression; 15 of these patients had elective surgery during the same admission. Twelve of the 14 patients who refused operation after endoscopic decompression developed recurrent volvulus, a median of 2.8 months later. Eight subsequently agreed to surgery and underwent elective operation following repeat decompression. Of 29 patients who had surgery, 27 had sigmoid colectomy (two were initial Hartmann procedures) and two had subtotal colectomy. Six patients who had sigmoid colectomy developed recurrent volvulus. Concomitant megacolon and megarectum at the time of initial surgery were significant predictors of recurrence. CONCLUSION: Subtotal colectomy, carried out as the primary procedure if there is concomitant megacolon or megarectum, might reduce the risk of recurrent sigmoid volvulus.

Adolescent↗

PubMed1999

Surgery may be curative for patients with a localized perforation of rectal carcinoma.

BACKGROUND: Perforation at the time of operation adversely affects the prognosis of rectal cancer. These procedures have been termed 'palliative' or 'non-curative'. The long-term outcome of generalized perforations may be different from that of localized or contained perforations. Although the oncological results may be compromised when the tumour is perforated, results in cases where the perforation is contained may not be as bad as previously thought. An attempt was made to examine the intermediate and long-term results for locally contained perforated rectal cancers. METHODS: Some 848 patients with rectal cancer were operated on between March 1989 and December 1995. Of these, 42 (5 per cent) had a locally contained perforation of the rectum. Median follow-up was 23 (range 12-74) months. RESULTS: The survival of patients with locally contained tumour perforation who underwent resection without macroscopic residual disease (40 per cent at 5 years) was significantly better than that of patients with metastatic disease at the time of surgery (zero at 4 years) (P < 0.01). The survival of patients in whom the tumour was inadvertently perforated during operation was similar to that of patients with locally contained spontaneous tumour perforations. The incidence of local recurrence in these perforated cases was low provided that a wide tumour clearance was achievable at the time of operation. Operative mortality and morbidity rates were not significantly different but the incidence of postoperative wound infection was marginally higher among patients with perforation. CONCLUSION: If clear margins can be obtained at the time of operation the prognosis of locally contained perforated rectal cancers is good and approaches that of a potentially curative resection.

Adult↗

PubMed1999

Folate deficiency induces a cell cycle-specific apoptosis in HepG2 cells.

The human hepatoma HepG2 cell line was chosen as a representative of solid tissue-derived cell systems in which folate metabolism and apoptosis induction have not been thoroughly investigated. HepG2 cells were cultivated in the control or folate-deficient media (control media lacking of folate, glycine, thymidine and hypoxanthine) for 4 wk. This resulted in a decrease in intracellular folate levels to 32% of the control within 1 wk, which was followed by growth arrest and greater cell death rates. These disturbances of folate deficiency coincided with apoptotic induction, as characteristically shown by nucleosomal DNA fragmentation of 180-200 base pair multimers, nuclear chromatin condensation and positive terminal transferase-mediated dUTP nick end labeling assay. Apoptosis coincided with an accumulation of cells in S-phase, a subsequent G2/M phase block and a significant increase in mean protein content as evaluated by flow cytometric analyses employing a double-staining method. The growth and cell cycle arrest under folate-deficient conditions was independent of a change of p53 expression as measured by an enzyme-linked immunosorbent assay. Supplementation of 2 micromol/L folate normalized cell cycles and diminished DNA fragmentation. Taken together, these data indicate that HepG2 cells cultivated in folate-deficient medium have a low folate concentration, decreased growth and viability, and increased apoptotic propensity. This occurrence of apoptosis was associated with a cell cycle-specific mechanism and independent of p53-mediated pathway.

Apoptosis↗

PubMed1999

Direct mucosal targeting of colonic receptors by prokinetic drugs in an experimental model.

Isolated perfused segments of pig ileum and sigmoid colon were used as an extrinsically denervated model of intestinal fluid propulsion to compare the effects of intraluminal (IL) with intraarterial (IA) administration of cisapride and mebeverine. The ileal segments had a spontaneous mean activity of 0.008 (SEM 0.003) ml Krebs propelled aborally min-1, with propulsive waves at a mean frequency of 8.3 (1.6) min-1. The sigmoid colon segments ejected a mean of 0.013 (0.009) ml Krebs min-1, with propulsive waves at 3.9 (0.8) min-1. IL cisapride produced a dose-dependent response in the dose range 1 x 10(-9) M to 3 x 10(-1) & 1-3 x 10(-7) M in the ileum, and 3 x 10(-11) to 3 x 10(-9) M in the colonic segments, IL cisapride was significantly more effective than IA delivery of equivalent doses. IL instilled mebeverine (1 x 10(-6) M) inhibited the carbachol dose response of the ileal and colonic segments more than an equivalent dose of mebeverine infused IA. We conclude that the isolated perfused pig intestine is an effective model for studying the pharmacological effects of drugs and their routes of delivery. Cisapride and mebeverine were more effective per given concentration, when delivered IL than IA in both the ileum and sigmoid colon preparations. The qualitative effects of either IL or IA drug delivery were not affected by extrinsic denervation.

Animals↗

PubMed1999

Palliative surgery for locally recurrent colorectal cancer.

BACKGROUND: Recurrent colorectal cancer carries a poor prognosis. Radical re-resection is the only chance for long-term survival but suitable candidates are few. AIM: To determine the patterns of recurrence after potentially curative colorectal surgery and analyse the results of palliative surgery for patients with local recurrence. METHODS AND RESULTS: Between May 1989 and May 1995, 1,287 case records of patients with colorectal carcinoma were entered into a customized computer database. Of these, 1,103 underwent potentially curative resections (Duke's stage A, B and C). At a median of 40 months (range 2-72) following surgery, 173 patients had recurrent disease detected (98 males; 75 females) at a median of 14 months (range 3-30) after the index surgery. Twelve percent had recurrent distal and locoregional disease while 6.8% had locoregional recurrent disease alone. Thirty-seven patients with locally recurrent disease underwent surgery. Of these, only 7 patients with local recurrences were suitable candidates for resections. The remaining 30 underwent palliative surgery for emergent indications of obstruction (28) and bleeding (2). The symptoms were palliated surgically by an entero-enterostomy (13), defunctioning stoma (12), lysis of adhesions (1), exploratory celiotomy (2) and formalin application (2). Seventeen patients are alive at follow-up. Twenty patients died at a median of 4 months after surgery (range 1-15). All patients had palliation of their symptoms. CONCLUSION: Low incidences of local recurrences can be achieved after potentially curative resections for colorectal carcinoma. When recurrences occur, a small number can be salvaged with a re-resection which is the procedure of choice. Palliative procedures for emergent indications of obstruction and bleeding can give good palliation despite the absence of the possibility of cure.

Adolescent↗

PubMed1999

Diagnosing and managing faecal incontinence.

The aim of this review was to consolidate the impact of recent advances in investigation technology on the clinical diagnostic workup for faecal incontinence. A literature search was made with emphasis on the recent 15 years. The advent of imaging techniques, particularly endoanal ultrasound has improved the understanding of anal incontinence. Of particular significance was the much higher incidence of anal sphincter injuries after childbirth, than previously suspected. Also important was the clarification of the entity of primary degeneration of the internal anal sphincter. Although endoanal ultrasound provides clear images of anal sphincter defects to guide surgery, some of these defects may be false positive findings especially for the inexperienced. Thus, anal manometry is still required to correlate imaging with functional impairment. Recent data have questioned the correlation of poor surgical outcome after sphincter repair with pudendal nerve dysfunction. Although poor pudendal function is no longer considered a contraindication for surgery, longer term follow-up studies have shown that the late results are poorer probably due to other factors such as poorer tissue associated with nerve dysfunction. Furthermore, new treatment modalities such as the electrostimulated gracilloplasty, artificial anal sphincter, sacral nerve modulation and autologous fat injection into the anal mucosa will require detailed precise diagnosis of faecal incontinence such that the most suitable technique may be successfully employed.

Anal Canal↗

PubMed1998

Transanal approach to rectocele repair may compromise anal sphincter pressures.

PURPOSE: This study prospectively assessed the functional results, particularly anal sphincter impairment, following transanal repair of rectocele for chronic intractable constipation. METHOD: Twenty-one consecutive women (mean age, 47.7 (standard error of the mean, 2.7) years) had the diagnosis of rectocele obstructing defecation made on synchronized anal manometry, electromyography, and cinedefecography. All underwent a standardized transanal repair with controlled anal stretching (maximum of 4 cm) from self-retaining anal retractors. The clinical function and anorectal manometry were assessed before surgery and were repeated six months later. RESULTS: All 21 patients were subjectively satisfied with the relief from constipation after surgery. There were significant improvements in the straining at defecation (before, n = 19; after, n = 3; P = 0.001), need to digitate per vagina (before, n = 16; after, n = 0; P = 0.001), stool frequency (before, 3.8 (0.7) times weekly; after, 8.6 (1.2); P = 0.004), and laxative requirements (before, n = 7; after, n = 0; P = 0.03). Although none were clinically incontinent, there was a mean 28 mmHg impairment in resting (P < 0.05) and 42.6 mmHg impairment in maximum squeeze anal pressures (P < 0.05) after operations. There was no other morbidity. CONCLUSION: Transanal rectocele repair effectively improves constipation problems, at the risk of impaired anal sphincter function. Although clinical incontinence was minimum, an alternative approach to rectocele repair should be considered when anal sphincters are lax.

Anal Canal↗

PubMed1998

Clinical outcome and bowel function following total abdominal colectomy and ileorectal anastomosis in the Oriental population.

UNLABELLED: Total abdominal colectomy with ileorectal anastomosis is a commonly performed surgical procedure. The postoperative outcome of these patients, however, has not been studied in detail in the Asian population. AIM: The purpose of this study was to analyze the functional outcome of patients following total abdominal colectomy and ileorectal anastomosis. METHOD: All patients subjected to a total abdominal colectomy with ileorectal anastomosis during a six-year period from February 1989 to October 1995 were reviewed. RESULTS: Sixty-six patients (male:female, 40:26) with a mean age of 55.2 (range, 20-88) years underwent total abdominal colectomy with ileorectal anastomosis. Median follow-up after surgery was 26 (range, 4-78) months. Indications for surgery were synchronous or metachronous tumors (18), complicated pancolonic diverticular disease (15), obstructed tumors with impending perforation (13), familial adenomatous polyposis (7), slow-transit constipation (6), and others (7). Mean operative time was 137 +/- 48 minutes. Mean postoperative hospitalization was 13.3 +/- 11.9 days. Time to first bowel movement and commencement of solid diet were 4.7 +/- 1.8 and 7.2 +/- 2.4 days, respectively. Four patients had prolonged postoperative ileus. Average stool frequencies per day were 5.5 at one week, 4.3 at one month, 3.9 at six months, 3.2 at one year, and 2.9 at two years postoperatively. Thirty-three patients (50 percent) required antidiarrheal treatment for a transient period, but none required long-term therapy. Ninety-seven percent of all patients rated the functional outcome as good to excellent, and 3 percent said it was fair. There was two perioperative mortalities. Five cases required re-laparotomy, three for anastomotic complications and two for hemoperitoneum. Five patients had recurrent admissions for adhesion colic, which resolved with nonsurgical therapy. Ten patients succumbed on follow-up, six to tumor recurrence, two to unrelated cancers (stomach and bladder), and three to medical conditions. CONCLUSION: The functional outcome of ileorectal anastomosis is generally rated as good to excellent by patients. Acceptable bowel function and control is regained within six months of the operation and levels off at one year after surgery, and no patient requires long-term antidiarrheal medication.

Adenomatous Polyposis Coli↗

PubMed1998

Marsupialization of fistulotomy wounds improves healing: a randomized controlled trial.

BACKGROUND: Marsupialization of anal fistulotomy wounds leaves less raw unepithelialized tissue to granulate and may improve wound healing. METHODS: Some 103 consecutive patients with uncomplicated intersphincteric or trans-sphincteric fistula in ano were recruited into a randomized controlled trial. Fistula tracts were identified and laid open under general anaesthesia. The patients were randomized to have either the wounds left open (LO group) or wound edges marsupialized to the fistula tract with interrupted absorbable sutures (MS group). Anal manometry was performed before operation, and 6 weeks and 3 months after surgery. RESULTS: Some 52 patients were randomized to the LO group and 51 to the MS group. There were no differences in the age, sex, fistula type and fistula length distribution between the groups. Mean follow-up times were 9 and 10.2 months respectively. Wounds in the MS group healed faster (mean(s.e.m.) 6.0 (0.4) weeks) than those in the LO group (10.0(0.5) weeks) (P < 0.001). Only one patient (2 per cent) in the MS group was incontinent of liquids after operation compared with six (12 per cent) in the LO group. There was less impairment in maximum anal squeeze pressure at 3 months after marsupialization compared with leaving fistulotomy wounds open (P < 0.05). Apart from a slightly longer operative time required for marsupialization, the hospitalization and complication rates were the same. CONCLUSION: Anal fistulotomy wounds healed faster after marsupialization. Anal squeeze pressures were better preserved and this may improve anal continence.

Adult↗

PubMed1998

Young age is not a poor prognostic marker in colorectal cancer.

BACKGROUND: There is still considerable controversy and debate regarding the features and prognosis of colorectal cancer in young patients. METHODS: One hundred and ten patients (5.1 per cent) under the age of 40 years with colorectal cancer (group Y; male: female ratio 48:62) were compared with 2064 patients with colorectal cancer aged 40 years or more (group O; 917 women, 1147 men). Mode of presentation, stage at diagnosis, tumour characteristics and survival were analysed. RESULTS: Predisposing malignant conditions and family history of colorectal cancer were present in 20.9 per cent of patients in group Y versus 2.2 per cent in group O (P < 0.001). Common chief complaints included change in bowel habits, bleeding from the rectum and a significantly higher incidence of abdominal pain in group Y. There was no difference in stage at presentation between the two groups (the proportion of Dukes stage A, B, C and 'D' lesions in group Y was 8.2, 24.5, 37.3 and 30.0 per cent respectively versus 10.5, 27.9, 33.4 and 28.1 per cent in group O). Tumour site and characteristics were similar in both groups. The incidence of mucinous/signet ring cell and poor grade tumours was 6.9 and 11.8 per cent respectively in group Y and 4.5 and 10.5 per cent in group O. With a mean follow-up of 31.8 months, the overall 5-year survival rate was 54.8 per cent in group Y and 54.1 per cent in group O. Comparing stage for stage, survival was not significantly different in the two groups. However, the adjusted hazard ratios of the age groups Y, M (40-59 years), S (60-79 years), and E (80 years and above) were 1.3, 1 (baseline for calculations), 1.4 and 2.4 respectively, suggesting an adverse outcome for patients in group Y compared with patients aged 40-59 years. CONCLUSION: This study revealed no difference in tumour characteristics and survival in patients with colorectal cancer aged less than 40 years compared with those aged above 40 years. However, a higher hazard ratio in the youngest group may connote a worse prognosis than that for those aged 40-59 years. A significant family history of colorectal cancer and predisposing conditions in the young warrants aggressive screening, surveillance and treatment of the underlying conditions. The detection of colorectal cancer in young patients should be no different from that in the old but demands a high index of suspicion.

Adult↗

PubMed1998

Management of anorectal foreign bodies: a cause of obscure anal pain.

BACKGROUND: Few patients with anorectal foreign bodies will freely admit to transanal introduction. The results of long-term follow-up in these patients have been sparse. METHODS: Data from April 1989 to April 1997 were extracted from a prospective computerized database. The clinical features and the results of a departmental management protocol for anorectal foreign bodies were analysed. In addition, long-term outcomes were obtained by telephone interview. RESULTS: Thirty patients (25 men, 5 women) with a mean age of 46 (range 16-72) years) were treated for this condition. While 10 patients (33.3%) admitted to transanal insertion, the remaining 20 (66.7%) complained of anal pain. Among the latter, the foreign body was subsequently found on routine digital rectal examination in nine patients (45%), on X-ray in nine (45%) and it was passed out unexpectedly after fleet enema in two (10%). Factors which raised suspicion for X-rays included atypical gender behaviour, lax anal sphincters and bloody or mucoid rectal discharge. Transanal recovery was successful with sedation in 12 (40%), general anaesthesia in 13 (43.3%), and laparotomy was needed in three (10%; which included one perforated bowel at presentation). There were two complications (6.7%; one minor rectal abrasion and one bronchopneumonia). There was no long-term faecal incontinence or re-impaction of foreign bodies at 63 (range 8-96) months of follow-up. CONCLUSIONS: Foreign bodies should be suspected in patients with obscure anal pain. Judicious transanal extraction under sedation or general anaesthesia was usually successful with minimal short- and long-term complications.

Adolescent↗

PubMed1998

Management of colonic lipomas.

BACKGROUND: Little is known of colonic lipomas, especially in an Asian population, and their management is controversial. METHODS: A computerized colonoscopy database was analysed and patients with colonic lipomas were reviewed. RESULTS: There were 16 colonic lipomas (incidence of 0.15%) in a series of 10658 consecutive colonoscopies. There were seven men and nine women, with a mean age of 61.8 years (range: 28-80 years). The size of the lipomas ranged from 1.5 to 6 cm; all those larger than 3.5 cm were symptomatic (P = 0.05). The most common symptom was mild bleeding per rectum. Right-sided lipomas were palpable while left-sided lipomas presented with obstructive symptoms. Colonoscopic removal by hot biopsy or snare polypectomy was possible where the lipomas were 2.5 cm and pedunculated. Surgery was performed in six patients (four open, two laparoscopic) for symptoms and to exclude malignancy. There was no morbidity or mortality. CONCLUSIONS: Small or pedunculated lipomas may be safely removed colonoscopically and the diagnosis confirmed histologically. Larger lipomas require surgical resection for relief of symptoms or to exclude malignancy.

Adult↗

PubMed1998

Randomized controlled trial comparing same-day discharge with hospital stay following haemorrhoidectomy.

BACKGROUND: A randomized controlled trial was conducted to compare traditional hospital stay haemorrhoidectomy (STAY) with same-day discharge haemorrhoidectomy (DAY) with regard to costs, clinical outcome and patient satisfaction. METHODS: A total of 54 consecutive patients were randomized to either STAY or DAY groups. A standardized excision of three piles was performed and the wounds were left open. The DAY patients went home on the same day but the STAY patients remained in hospital until their bowels had opened. A linear analogue pain score and patient satisfaction questionnaire were administered. During a mean follow-up of 60.5 (standard error of mean = 1.2) weeks, the complications and the total medical costs were recorded RESULTS: There were no differences in the age and sex distributions in both groups (STAY: 11 men, 16 women; mean age 40.6 (+/- 1.8) years; DAY: 10 men, 17 women; mean age 40.6 (+/- 1.9) years). Despite accounting for any readmissions, the DAY patients accumulated shorter total hospitalization stays (P < 0.001) and incurred less total medical costs (P = 0.04). The pain scores, analgesia requirements, postoperative complications, patient satisfaction and time taken off work were not different between the two groups. However, more patients in both groups preferred to stay after surgery if they should need another haemorrhoidectomy. CONCLUSIONS: Haemorrhoidectomy (with excision of three piles) can be safely performed as a day procedure, with reduced hospitalization and medical costs.

Adult↗

PubMed1998

The surgical management of colorectal complications from irradiation for carcinoma of the cervix.

Bowel injury from radiation given for carcinoma of the cervix is a complex management problem. Prospectively collected computerized data from April 1989 to June 1997 (8 years) were analysed. There were 84 women with a mean age of 60.6 (standard error 1.2) years. Bleeding from radiation proctitis presented much earlier [mean 19.9 (1.9) months after radiotherapy] than either strictures [mean 81.9 (18.4) months, P = 0.008] or rectovaginal fistula [mean 95.5 (39.0) months]. Topical formalin application successfully controlled bleeding in 49 of 55 patients (89.1%) with radiation proctocolitis. The remaining 6 patients, as well as all 14 patients with symptomatic strictures and all 14 patients with rectovaginal fistula underwent surgery. Rectal strictures were successfully dilated in 2. Bowel resection with reanastomosis (with stoma defunction) was performed in 12 and stoma was created in the remaining 20 because of poor general medical condition or advanced recurrent malignancy. The postoperative mortality was 3% (1 bronchopneumonia) and morbidity was 9% (1 anastomotic leak, 1 urinary infection and 1 wound infection). At a mean follow up of 35 (2.4) months, 7 (21.2%) other postoperative patients have since died (all of these from recurrent cancer). We conclude that topical formalin is effective for controlling bleeding radiation proctitis. When not successful or where other radiation complications occur, judicious surgery dependent upon the patient's general condition can be safely and effectively performed. The longer term results are worthwhile, especially where there is no recurrent cancer.

Aged↗

PubMed1998

Local recurrence following rectal resection for cancer.

Recurrent rectal carcinoma following surgery carries an extremely poor prognosis and subsequent intervention is usually palliative. The incidence of local recurrence (LR) following curative surgery for rectal cancer has been reported to range from 3.7 to 50%. Current treatment strategy for rectal cancer aims at minimizing LR by either pre-operative radiotherapy or adjuvant chemoradiotherapy. Three hundred and fifty-four patients underwent surgical resection for rectal cancer in our department between April 1989 and March 1994, of which 47 (13%) were Dukes A, 88 (25%) Dukes B, 143 (40%) Dukes C and 76 (22%) Dukes D. Two hundred and seventy-eight (79%) patients were defined as having had curative resection (Dukes A, B and C). Overall, total LR occurred in 43 (12.2%) of 354 patients, while LR following curative resection occurred in 16 (9.4%) of the 278 patients. The incidence of LR became higher with increasing depth of invasion and lymph nodal involvement as shown by its direct relationship to stage of disease: Dukes A (0%), B (5.7%), C (14.6%) and D (22.3%). Local recurrence following resection for rectal cancer in our series is low. Pre-operative radiotherapy or adjuvant chemoradiotherapy may not further reduce this low incidence of LR significantly and its role needs to be re-evaluated for institutions with low local recurrence rates.

Adult↗

PubMed1997

Clinical behavior of complicated right-sided and left-sided diverticulosis.

PURPOSE: The aim of the study was to characterize the clinical entity of multiple right-sided (RS) diverticular disease, which is uniquely common in Asians. METHODS: Patients hospitalized with proven diverticular disease from June 1989 to January 1996 were reviewed. Data were retrieved from a prospectively collected computerized database. RESULTS: One hundred eighty consecutive patients were admitted to the Department of Colorectal Surgery, Singapore General Hospital, with multiple diverticular disease. Average age was 65.1 (standard error of the mean, 13.9) years. There were 96 men and 84 women. Women presented, on average, 8.4 years later than men (P < 0.005). Eighty-five patients (47 percent) had massive rectal bleeding, 65 (36 percent) had diverticulitis, 21 (12 percent) had obstructive symptoms, and 9 (15 percent) had enteric fistulas. The diverticula were RS in 76 patients(42 percent), left-sided (LS) in 62 patients (34 percent), and on both sides in 42 patients (24 percent). RS diverticulosis tended to present with massive rectal bleeding (42/76; 55 percent) more often than LS disease (14/62; 23 percent; P < 0.005). Surgery for bleeding was also required more often for RS (17/42; 41 percent) than for LS disease (1/14; 7 percent; P < 0.05); however, diverticulitis was more common on the left (RS, 25/76, 33 percent; LS, 32/62, 52 percent; P < 0.05). Seventy-eight patients (43 percent) required surgery for these complications of diverticular disease. At a mean follow-up of 15.2 (standard error of the mean, 2) months, mortality was 2 in 78 patients who underwent surgery (3 percent), and morbidity was 15 percent. CONCLUSIONS: In comparison with LS, RS diverticular disease tended to present more often with massive bleeding than with diverticulitis and fistulation. This bleeding was often more severe and required surgical intervention.

Aged↗

PubMed1997

Hartmann's procedure vs. abdominoperineal resection for palliation of advanced low rectal cancer.

UNLABELLED: In managing advanced low rectal adenocarcinomas in medically fit patients, surgical resection offers the best palliation. Tenesmus, bleeding per rectum, sacral pain, and sciatic pain are common complaints, which are not relieved by radiotherapy or fulguration. The most appropriate resection, however, remains controversial. Abdominoperineal resection is faster and simpler to perform but leaves behind a perineal wound with associated complications. Hartmann's procedure requires adequate mobilization below the tumor and may be technically more demanding but avoids a perineal wound. Therefore, an analysis of outcome in patients treated by Hartmann's procedure vs. abdominoperineal resection was made. METHOD: Fifty-four symptomatic patients with advanced rectal adenocarcinoma arising within a median of 5 (range, 4-8) cm from the anal verge treated between June 1989 and October 1995 were studied. Twenty-eight patients (17 males; mean age, 67.6 +/- 10.3 years) had Hartmann's procedure, and 26 patients (12 females; mean age, 68.8 +/- 8.3 years) were treated by abdominoperineal resection. Mean follow-up was 23.5 months (+/-17.5) and 18.6 months (+/-12.9) in Hartmann's procedure and abdominoperineal groups, respectively. RESULTS: Mean operative time was 138.4 +/- 26.7 minutes for Hartmann's procedure group and 124.6 +/- 27.1 minutes for the abdominoperineal resection group (P > 0.05; not significant). Postoperatively, Hartmann's procedure group started oral intake at a mean of 2.3 days, and stomas were functioning at a mean of 3.1 days compared with 2.6 days for oral intake and 3 days for stoma functioning in the abdominoperineal resection group. Hartmann's procedure group was ambulant after a mean of 2.4 days vs. a mean of 3.2 days in the abdominoperineal resection group. Postoperative abdominal wound infection occurred in 18 and 19 percent, respectively, in Hartmann's procedure and abdominoperineal resection groups. Forty-six percent of patients had perineal wound sepsis, and 38 percent had perineal wound pain in the abdominoperineal resection group. These complications were absent in Hartmann's procedure group. Postoperative stay was similar in both groups. CONCLUSION: We conclude that Hartmann's procedure offers superior palliation compared with abdominoperineal resection because it provides good symptomatic control without any perineal wound complications and pain.

Abdomen↗

PubMed1997

Biofeedback is effective treatment for levator ani syndrome.

PURPOSE: The effects of biofeedback (BF) on pain relief and anorectal physiology in patients with levator ani syndrome (LAS) were prospectively studied. METHOD: Sixteen consecutive patients (9 men, 7 women; mean age, 50.1 (range, 39-66) years) with LAS were treated with BF from July 1993 to October 1995. Mean duration of pain was 32.5 (standard error of the mean, 6.7) months. All underwent a full course of BF using a manometric balloon technique. Mean follow-up was 12.8 (standard error of the mean, 2.6) months. Pain score and anorectal physiology tests were administered prospectively by an independent observer before and after BF. RESULTS: After BF, the pain score was significantly improved (before BF: median, 8 (range, 6-10); after BF: median, 2 (range, 1-4); P < 0.02). Analgesic requirements were also significantly reduced (all 16 patients needed nonsteroidal anti-inflammatory drugs (NSAID) before BF; only two patients needed NSAID after BF; P < 0.03). There were no significant changes to the anorectal physiology parameters after BF. To date, there have been no side effects or regressions. CONCLUSION: Although BF had a negligible effect on anorectal physiologic measurements in LAS, it was effective in pain relief, with no side effects.

Anal Canal↗