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At least 811 records · Page 45Linked to original sources
PubMed1996

Total anorectal reconstruction results in complete anorectal sensory loss.

Six patients underwent objective measurement of anorectal sensory function following abdominoperineal excision of the rectum and total anorectal reconstruction. No patient perceived neorectal distension as a desire to defaecate or as a feeling of flatus. Anal mucosal sensation was preserved in two patients in whom some anal mucosa was retained. These sensory deficiencies may result in faecal retention and incontinence in patients undergoing reconstructive surgery. The loss of rectal sensation suggests that the prime sensors of rectal filling may lie within the rectum itself.

Aged↗
PubMed1996

Salvage surgery for ileal pouch outlet obstruction.

Sixteen patients with ileal pouch outlet mechanical obstruction had major abdominal revision of the ileoanal anastomosis. Before operation all had severe difficulty in evacuation which required catheterization in 11. Eleven patients had a long efferent limb and/or long anorectal cuff, and five had a persistent stricture at the ileoanal anastomosis. None had pouchitis. The pouch was fully mobilized abdominally and the obstructing lesion resected. A new handsewn ileoanal anastomosis was formed. In two cases pouch volume was increased by incorporating an additional loop of ileum. All anastomoses but one were covered by a loop ileostomy. There were no deaths. Major complications occurred in two patients. Function was assessed in 15 patients; in one the ileostomy had not been closed. Median (interquartile range) frequency of defaecation per 24 h fell from 15 (7.3-19.5) to 6 (4.5-6.0) (P = 0.0033). Of the 11 patients who required a catheter before operation six evacuated spontaneously, three were improved but intubated on some occasions and two were unchanged after revisional surgery. Of the ten incontinent patients, five became continent, four were improved and one remained unchanged. There was a new continence disturbance in four (minor nocturnal in three) of the remaining five patients. One patient underwent further abdominal salvage surgery and another required establishment of an ileostomy because of poor function. Combined abdominoanal salvage surgery for outlet mechanical obstruction was successful in averting an ileostomy in 13 of 16 patients, and significantly improved pouch function in 12 of 15.

Adenomatous Polyposis Coli↗
PubMed1996

Results from pouch salvage.

Over an 11-year period, 17 salvage procedures were performed on a failed ileal pouch-anal anastomosis carried out for ulcerative colitis from a series of 157 patients. Ten pouches were saved, four excised and three defunctioned. Salvage procedures included five operations for fistulas (three of five successful), six reoperations on the ileoanal anastomosis (five of six successful), three new pouches after previous pouch excision (all failed), and three miscellaneous: excision of an efferent limb (successful), pouchpexy for a pouch prolapse (successful) and postanal repair for incontinence (failed). Pouch salvage may be successful in the motivated patient who wishes to avoid a permanent ileostomy.

Adolescent↗
PubMed1996

Laser Doppler blood flow measurement in rectal resection for carcinoma--comparison between the straight and colonic J pouch reconstruction.

Lower rates of anastomotic leakage have been reported after rectal resection with a colonic pouch-anal anastomosis than with a conventional straight anastomosis. The microcirculation in the bowel segment that was used for construction of a colonic pouch or a conventional straight anastomosis was examined. Transmural colonic blood flow was measured by laser Doppler flowmetry during the operation before the construction of a straight (n = 16) or pouch (n = 14) anastomosis. The blood flow recordings were first done before dissection of the bowel at one point close to the planned bowel end and at another point 8 cm more proximally. A second recording was done at the same sites after dissection and, where appropriate, after construction of the pouch, but before the anastomosis was completed. In the straight group (end-to-end anastomosis), blood flow levels at the site intended for the anastomosis were significantly decreased following dissection of the bowel. In the pouch group (side-to-end anastomosis), blood flow levels at the site of the anastomosis were similar following dissection of the bowel and pouch construction. It is concluded that unaffected blood flow at the site of the anastomosis of the pouch may be a favourable factor for anastomotic healing.

Adult↗
PubMed1996

Effect of terminal ileal transposition on intestinal absorption following proctocolectomy.

A terminal ileal transposition procedure, in which a distal jejunal segment is interposed between the terminal ileum and the anus following proctocolectomy, is described. Adult mongrel dogs had either terminal ileal transposition (n = 5) or ileoanal anastomosis (n = 6) following two-stage proctocolectomy. Untreated dogs were used as controls (n = 7). Twelve weeks after the second-stage operation, a perfusion study was performed. After terminal ileal transposition the transposed terminal ileum showed a high absorptive capability for sodium, chloride and bile acids (P < 0.05, P < 0.05 and P < 0.001 respectively). After ileoanal anastomosis the absorptive capability of the terminal ileum was not enhanced significantly. In the mid-jejunum, the absorption of bile acids, chloride and glucose was enhanced (all P < 0.05) only after terminal ileal transposition. Terminal ileal transposition improves the absorptive capability of the terminal ileum and the mid-jejunum compared with conventional ileoanal anastomosis in this model.

Anastomosis, Surgical↗
PubMed1996

Stapling instruments for intestinal anastomosis in colorectal surgery.

The circular stapling instrument has had a major impact in the practice of colorectal surgery. Stapling technology was pioneered in the early part of this century and subsequently modified. Russian initiatives led to development of the original circular stapling instrument and further progress has resulted in instruments that are widely available, reliable and totally disposable. Mechanical failure is now rare and malfunction is generally due to operator error. Complications related to the stapling technique are uncommon, although anastomotic stricture may be more frequent than when handsewn anastomosis is performed. A stapling instrument facilitates and may expedite a surgical procedure but it is an adjunct to, and not a substitute for, meticulous surgical technique.

Anastomosis, Surgical↗
PubMed1996

Prospective randomized controlled study of clinical function and anorectal physiology after low anterior resection: comparison of straight and colonic J pouch anastomoses.

Clinical function and anorectal physiology were studied prospectively in patients with rectal cancer after low anterior resection, randomized to either a straight anastomosis or an 8-cm colonic J pouch anastomosis. Sixteen patients (mean(s.e.m.) age 61.2(3.2) years; ten men, six women) had a straight anastomosis and 17 (mean(s.e.m.) age 61.2(3.8) years; six men, 11 women) a colonic pouch anastomosis. At 1 year after low anterior resection, a bowel function questionnaire was administered and anorectal physiology tests were performed. Patients with a straight anastomosis had significantly more frequent stools (median 6 (range 3-7) daily) compared with those who had a pouch (median 3 (range 2-7) daily; P = 0.02). A frequent sensation of incomplete defaecation was found in three patients with a straight anastomosis compared with ten who had a pouch anastomosis (P = 0.02). The mean resting anal pressures were lower after colonic pouch anastomosis (P = 0.049) but there were no differences in anal squeeze pressure, rectal sensation, volume of first sensation and compliance between the two groups. The decreased stool frequency with an 8-cm colonic pouch was not associated with measured improvements in rectal reservoir function. It is possible that reversed propulsive activity may be important in smaller colonic J pouches.

Adenocarcinoma↗
PubMed1996

Disconnection, pouch revision and reconnection of the ileal pouch-anal anastomosis.

The aim of this retrospective study was to determine the outcome of patients with a dysfunctional pelvic ileal reservoir in whom disconnection of an ileal pouch-anal anastomosis (IPAA), pouch revision and reanastomosis had been carried out. There were 23 patients (15 women). At the revision operation functional problems were found to be due to a long efferent spout (nine patients), sepsis and/or fistula (four), a redundant blind limb (three), a twisted pouch (three), anastomotic problems (three) or no reservoir (one). The pouch was salvaged in 16 patients and a new pouch was constructed in seven. The pouch-anal anastomosis was resutured in 22 patients and stapled in one. Postoperative complications (all minor) occurred in six patients. Two patients underwent two revision of IPAA. At a median follow-up of 5 (range 1-10) years, 11 patients reported good to excellent function, five reported fair function and one reported recurrent pouchitis. Revision surgery was unsuccessful in six of 23 patients (three had gross incontinence, two excessive bowel movements and one Crohn's disease), and they subsequently underwent pouch excision. It is concluded that revision of an ileal reservoir and IPAA can be undertaken safely with good results in carefully selected patients.

Adenomatous Polyposis Coli↗
PubMed1996

Ambulatory manometric examination in patients with a colonic J pouch and in normal controls.

Anorectal function after anterior resection may be impaired as a result of reduced luminal capacity in the pelvis. The aim of this study was to evaluate the colonic J pouch neorectum by means of ambulatory manometry. Twelve patients with a colonic pouch following anterior resection and seven healthy controls were studied for a median of 6 (range 6-24) h using a probe with two pouch-rectal and two anal canal transducers. Records were interpreted by visual inspection. Pressure values and wave frequencies were determined by software analysis. Pouches had been functioning for a median of 32 (range 11-55) months. All patients with a pouch had an acceptable stool frequency. Seven of 12 patients complained of incomplete evacuation. Resting anal canal pressure (73 versus 100 cmH2O), pouch-rectal pressure (29 versus 15 cmH2O) and anal canal pouch-rectal pressure gradients (60 versus 85 cmH2O) were similar in patients and controls. The frequency of slow-wave activity in patients with a pouch was significantly lower than that in controls (7 versus 16 cycles per min, P = 0.001). Coordination between the colonic J pouch and the anal canal, in the form of sampling episodes, was observed in more than half of the patients with a functioning pouch. Large isolated contractions (pressure greater than 30 cmH2O and lasting longer than 20 s) and rhythmic contractions were the most frequent pattern of pouch motility.

Adult↗