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  • 1
    Electronic Resource
    Electronic Resource
    Faecal incontinence after childbirth (1997)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 104 (1997), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To measure the prevalence and severity of postpartum faecal incontinence, especially new incontinence, and to identify obstetric risk factors.Design A cohort study with information on symptoms collected in home-based interviews and obstetric data from hospital casenotes.Setting Deliveries from a maternity hospital in Birmingham.Participants Nine hundred and six women interviewed a mean of 10 months after delivery.Main outcome measures New faecal incontinence starting after the birth, including frank incontinence, soiling and urgency.Results Thirty-six women (4%) developed new faecal incontinence after the index birth, 22 of whom had unresolved symptoms. Twenty-seven had symptoms several times a week, yet only five consulted a doctor. Among vaginal deliveries, forceps and vacuum extraction were the only independent risk factors: 12 (33%) of those with new incontinence had an instrumental delivery compared with 114 (14%) of the 847 women who had never had faecal incontinence. Six of those with incontinence had an emergency caesarean section but none became incontinent after elective sections.Conclusions Faecal incontinence as an immediate consequence of childbirth is more common than previously realised, and medical attention is rarely sought. Forceps and vacuum extraction deliveries are risk factors, with no protection demonstrated from emergency caesarean section. Identification and treatment is a priority.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1997.tb10648.x
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  • 2
    Electronic Resource
    Electronic Resource
    Perforating ileocecal Crohn's disease does not carry a high risk of recurrence but usually re-presents as perforating disease (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 519-524 
    Details
    ISSN: 1530-0358
    Keywords: Crohn's disease ; Perforating disease ; Nonperforating disease ; Ileocecal resection ; Complications ; Recurrence rate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The aim of this study was to study the natural history of perforating and nonperforating ileocecal Crohn's disease. METHODS: One hundred sixty-five cases of primary ileocecal Crohn's disease operated on between 1975 and 1995 were reviewed. Perforating disease was defined as acute free perforation, subacute perforation with an abscess, or chronic perforation with an internal or external fistula. RESULTS: Perforating disease was identified in 72 patients (44 percent); 11 with acute free perforation, 18 with abscess formation, and 43 with fistulas. Postoperative complications occurred in 29 percent of perforating and in 23 percent of nonperforating disease (not a significant difference). There was no significant difference in the cumulative reoperation-free rate for recurrence at the ileocolonic anastomosis (perforating, 78 percentvs. nonperforating, 73 percent at 5 years and perforating, 61 percentvs. nonperforating, 55 percent at 10 years), or in the median time interval from the primary to the secondary operation (perforating, 49vs. nonperforating, 37 months). Seventy percent of perforating disease re-presented with perforating recurrence. Likewise, 83 percent of nonperforating disease re-presented with nonperforating (P〈0.0001) recurrence. Re-reoperation rate for re-recurrence at the ileocolonic anastomosis and median duration from the second operation to the third operation did not differ between perforating and nonperforating disease. Seventy-nine percent of perforating disease re-presented again with perforating disease, and 87 percent of nonperforating disease re-presented again with nonperforating disease as before (P=0.001). CONCLUSIONS: These data suggest that perforating ileocecal disease usually re-presents in the way it did originally but does not represent a high-risk group for recurrence.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02234180
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  • 3
    Electronic Resource
    Electronic Resource
    Persistent perineal sinus after proctocolectomy for Crohn's disease (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 96-101 
    Details
    ISSN: 1530-0358
    Keywords: Crohn's disease ; Perineal wound healing ; Persistent perineal sinus ; Proctocolectomy ; Extrasphincteric dissection ; Intersphincteric dissection ; Rectus abdominis flap ; Gracilis transposition ; Omentoplasty
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Persistent perineal sinus is a source of morbidity after proctocolectomy for Crohn's disease. This study examined the factors responsible for persistent sinus after proctocolectomy for Crohn's disease. We also assessed the outcome of surgical treatment for persistent perineal sinus. METHODS: The records of 145 patients who underwent proctocolectomy for Crohn's disease between 1970 and 1997 were reviewed. RESULTS: Persistent sinus occurred in 33 (23 percent) patients after proctocolectomy. Factors associated with a significantly greater risk of perineal sinus were younger age (P=0.006), rectal involvement (P=0.02), perianal sepsis (P=0.0005), high fistulas (P=0.04), extrasphincteric excision (P=0.0004), and fecal contamination at operation (P=0.0003). Multivariate analyses showed that age (P=0.0001), rectal involvement (P=0.007), and fecal contamination (P=0.009) were significant independent predictive factors for perineal sinus. Fifty-six operations, including 24 radical excisions, two rectus abdominis flaps, four gracilis transpositions, and two omentoplasties were performed in 24 patients with persistent sinus, but only 9 achieved healing. Long sinuses (〉10 cm) and sinuses presenting late (〉12 weeks after proctocolectomy) were seldom cured by surgical treatment. CONCLUSION: Persistent perineal sinus is more likely to occur if an extrasphincteric dissection is needed because of extensive anorectal disease or if fecal contamination occurs at operation. Attempted surgical eradication of perineal sinus is often ineffective.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02235190
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  • 4
    Electronic Resource
    Electronic Resource
    Disruption of a stapled anastomosis following therapeutic ultrasonics—Is there a risk? (1995)
    Springer
    Diseases of the colon & rectum 38 (1995), S. 993-995 
    Details
    ISSN: 1530-0358
    Keywords: Stapled intestinal anastomosis ; Ultrasound ; Anastomotic leakage ; Surgical technique
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: We examined the theoretic possibility that therapeutic ultrasound can disrupt a stapled gastrointestinal anastomosis. METHOD: A case is reported in which leakage of a stapled ileocolic anastomosis occurred following therapeutic ultrasound. Calculations are performed on the power of the ultrasound beam and its adsorption and dispersion in the tissue between the probe and anastomosis to establish its intensity at the anastomosis. RESULTS: Ultrasound intensity at the anastomosis in this patient was calculated at 10 to 46 mW/cm 2.CONCLUSION: Although the calculated ultrasound intensities at the anastomosis do not appear to be very high, other factors such as “pressure doubling” and “stress concentration” at the stapled surface suggest that therapeutic ultrasound may cause staple disruption.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02049740
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  • 5
    Electronic Resource
    Electronic Resource
    Pouch salvage (1997)
    Springer
    Diseases of the colon & rectum 40 (1997), S. 548-552 
    Details
    ISSN: 1530-0358
    Keywords: Ileoanal ; Restorative ; Pouch ; Proctocolectomy ; Salvage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The aim of this study was to determine the outcome of pouch salvage operations and the factors that may influence successful reconstructions. METHODS: This retrospective review includes data from 198 patients who had undergone restorative proctocolectomy at a single institution during an 11-year period. All patients who had undergone attempted pouch salvage and who still had a pouch in situ were reviewed by both postal questionnaire and at interview in the outpatients clinic. RESULTS: Of 198 patients who underwent restorative proctocolectomy and ileal pouch-anal anastomosis, 27 (13.6 percent) presented with pouch-specific complications requiring pouch salvage. A further five patients requiring pouch salvage were referred from other centers. Of 32 patients who underwent attempted pouch salvage, 16 (50 percent) had a successful outcome, 12 (37.5 percent) had pouch excision, and 3 (9 percent) are still defunctioned. There was one death (3 percent) in this series. Pelvic sepsis was a major cause of pouch failure, being present in 50 percent (8/16) of failed salvage procedures, and accounting for 58 percent (7/12) of pouch excisions. CONCLUSIONS: Salvage surgery for major complications following ileoanal pouch construction is worthwhile in the absence of major pelvic sepsis. Overall success rate is 50 percent, and these results may be acceptable to highly motivated patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02055376
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  • 6
    Electronic Resource
    Electronic Resource
    An audit of strictureplasty for small-bowel crohn's disease (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 797-803 
    Details
    ISSN: 1530-0358
    Keywords: Small-bowel Crohn's disease ; Strictureplasty ; Complications ; Recurrence ; Short-bowel syndrome ; Small-bowel carcinoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The aim of this study was to review the long-term outcome of strictureplasty for small-bowel Crohn's disease. METHODS: We reviewed 111 patients who underwent 285 primary strictureplasties (Heineke-Mikulicz, 236; Finney, 49) between 1980 and 1997. RESULTS: Eighty-seven patients (78 percent) had had previous bowel resections. Forty-six patients (41 percent) required synchronous resection for perforating disease (abscess or fistula) or long strictures (〉20 cm). The mean number of strictureplasties was three (range, 1–11). There were no operative deaths. Septic complications (fistula or intra-abdominal abscess) related to strictureplasty developed in eight patients (7 percent), of whom two required a proximal ileostomy. Abdominal symptoms were relieved in 95 percent of patients. The majority (95 percent) of patients with preoperative weight loss gained weight (median gain, +2 kg; range, −6 to +22.3 kg). After a median follow-up of 107 months, symptomatic recurrence occurred in 60 patients (54 percent). In 11 patients symptomatic recurrence was successfully managed by medical treatment. Forty-nine patients (44 percent) required reoperation for recurrence: strictureplasty alone in 22 patients, resection alone in 19 patients, strictureplasty and resection in 6 patients, and ileostomy alone in 2 patients. Eighteen patients (16 percent) required a third operation. One patient died from a small-bowel carcinoma which developed in the vicinity of a previous stricture-plasty. Two of 19 patients with diffuse jejunoileal disease developed short-bowel syndrome, and were receiving long-term parenteral nutrition. Two other patients were taking corticosteroids for recurrent symptoms. All other patients were asymptomatic, receiving neither medical treatment nor nutritional support. CONCLUSIONS: Strictureplasty is a safe and efficacious procedure for small-bowel Crohn's disease in the long-term.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236939
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  • 7
    Electronic Resource
    Electronic Resource
    Fecal diversion in the management of Crohn's disease of the colon (1993)
    Springer
    Diseases of the colon & rectum 36 (1993), S. 757-762 
    Details
    ISSN: 1530-0358
    Keywords: Crohn's disease ; Colitis ; Ileostomy ; Resection ; Proctocolectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The clinical course of 44 patients undergoing elective proximal fecal diversion for Crohn's disease of the colon is reported. Sustained disease remission was obtained in 31 patients (70 percent). Diversion was associated with a significant reduction in steroid requirements (P〈0.01) and a significant improvement in hemoglobin (P〈0.001), erythrocyte sedimentation rate (P〈0.001), and albumin (P〈0.05). Sixteen patients (36.4 percent) have required a proctocolectomy, 19 patients (43.2 percent) remain defunctioned, and four patients (9 percent) have died. Five patients have had intestinal continuity restored, which has remained intact in four patients for a mean follow-up of 99 (range 21–153) months. Fecal diversion for Crohn's disease of the colon produces a high incidence of sustained disease remission, but for the majority of patients the prospect of future restoration of intestinal continuity is limited.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02048367
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  • 8
    Electronic Resource
    Electronic Resource
    Cytokine production in pouchitis is similar to that in ulcerative colitis (1995)
    Springer
    Diseases of the colon & rectum 38 (1995), S. 831-837 
    Details
    ISSN: 1530-0358
    Keywords: Cytokine ; Pouchitis ; Ulcerative colitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Controversy exists as to whether pouchitis represents a reactivation of the immunologic mechanisms that lead to ulcerative colitis (UC). The aims of this study were to determine local levels of the cytokines: interleukin-1 β (IL-1 β ), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor alpha (TNF α ) in the mucosa of patients with “asymptomatic” ileoanal pouch (n=25), pouchitis (n=9), active UC (n=20), normal ileum (n=15), proctitis (n=10), and normal colon (n=15). METHODS: Lamina propria mononuclear cells were isolated from mucosal biopsies by enzymatic dispersion and cultured for 48 hours. Proinflammatory cytokine levels were measured in the supernatants by enzyme-linked immunosorbent assay. RESULTS: IL-1 β,IL-6, IL-8, and TNF α secretions were significantly greater in pouchitis and active UC than in the noninflamed ileoanal pouch and normal controls ( P 〈0.001). There was significant correlation ( r =0.63,P 〈 0.05) between levels of cytokines expressed in pouchitis and active UC. CONCLUSIONS: Increased cytokine expression occurs in both active UC and pouchitis and to a lesser extent in the long-standing ileoanal pouch.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02049839
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  • 9
    Electronic Resource
    Electronic Resource
    Audit of single-stage proctocolectomy for Crohn's disease (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 249-256 
    Details
    ISSN: 1530-0358
    Keywords: Single-stage proctocolectomy ; Crohn's disease ; Complications ; Delayed perineal wound healing ; Stomal complications ; Long-term results ; Recurrence ; Risk factor for recurrence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This study was undertaken to review our overall experience of single-stage proctocolectomy for Crohn's disease. METHODS: One hundred three patients who underwent single-stage proctocolectomy for Crohn's disease between 1958 and 1997 were reviewed. Factors affecting the incidence of recurrence were examined using a multivariate analysis. RESULTS: Principal indications for proctocolectomy were chronic colitis (49 percent), acute colitis (37 percent), and anorectal disease (14 percent). The commonest postoperative complication was delayed perineal wound healing (n=36; 35 percent), followed by intra-abdominal sepsis (17 percent) and stomal complications (15 percent). In 23 patients the perineal wound healed between three and six months after proctocolectomy, whereas in 13 patients the wound remained unhealed for more than six months. There were two hospital deaths (2 percent) caused by sepsis. The 5-year, 10-year, and 15-year cumulative reoperation rates for small-bowel recurrence were 13, 17, and 25 percent, respectively, after a median follow-up of 18.6 years. From a multivariate analysis, factors affecting reoperation rate for recurrence were gender (male; hazard ratio 2.4vs. female;P=0.03) and age at operation (≤30 years; hazard ratio 2.6vs. 〉30 years;P=0.04). The following factors did not affect the reoperation rate: duration of symptoms, smoking habits, associated perforating disease, coexisting small-bowel disease, postoperative complications, and medical treatment. CONCLUSIONS: Proctocolectomy for Crohn's disease is associated with a high incidence of complications, particularly delayed perineal wound healing. Proctocolectomy carries a low recurrence rate in the long term. However, young male patients are at high risk of recurrence.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236990
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  • 10
    Electronic Resource
    Electronic Resource
    Risk factors for intra-abdominal sepsis after surgery in Crohn's disease (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 1141-1145 
    Details
    ISSN: 1530-0358
    Keywords: Crohn's disease ; Surgery ; Anastomosis ; Risk factors ; Postoperative septic complications ; Anastomotic leak ; Intra-abdominal sepsis ; Abscess ; Fistula
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This study examined risk factors for intra-abdominal sepsis after surgery in Crohn's disease. METHODS: We reviewed 343 patients who underwent 1,008 intestinal anastomoses during 566 operations for primary or recurrent Crohn's disease between 1980 and 1997. Possible factors for intra-abdominal sepsis were analyzed by both univariate (chi-squared test) and multivariate (multiple regression) analyses. RESULTS: Intra-abdominal septic complications, defined as anastomotic leak, intra-abdominal abscess, or enterocutaneous fistula, developed after 76 operations (13 percent). Intra-abdominal septic complications were significantly associated with preoperative low albumin level (〈30 g/l;P=0.04), preoperative steroids use (P=0.03), abscess at the time of laparotomy (P=0.03), and fistula at the time of laparotomy (P=0.04). The intra-abdominal septic complication rate was 50 percent (8/16 operations) in patients with all of these four risk factors, 29 percent (10/35 operations) in patients with three risk factors, 14 percent (14/98 operations) in patients with two risk factors, 16 percent (33/209 operations) in patients with only one risk factor, and 5 percent (11/208 operations) in patients with none of these risk factors (P〈0.0001). The following factors did not affect the incidence of septic complications; age, duration of symptoms, number of previous bowel resections, site of disease, type of operation (resection, strictureplasty, or bypass), covering stoma, and number, site, or method (sutured or stapled) of anastomoses. CONCLUSIONS: Preoperative low albumin level, steroid use, and the presence of abscess or fistula at the time of laparotomy significantly increased the risk of septic complications after surgery in Crohn's disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236563
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