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  • 1
    Electronic Resource
    Electronic Resource
    Laparoscopic total abdominal colectomy (1992)
    Springer
    Diseases of the colon & rectum 35 (1992), S. 651-655 
    Details
    ISSN: 1530-0358
    Keywords: Laparoscopic colectomy ; Laparoscopy ; Ileoanal reservoir ; Restorative proctocolectomy ; Colonic inertia ; Ulcerative colitis ; Familial adenomatous polyposis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of this study was to prospectively assess the impact of laparoscopy upon the outcome of total abdominal colectomy (TAC). Specifically, patients underwent standard laparotomy with TAC and ileoproctostomy (TAC + IP), TAC and ileoanal reservoir (TAC + IAR), laparoscopically assisted TAC + IP (L-TAC + IP), or laparoscopically assisted TAC + IAR (L-TAC + IAR). Parameters studied included the length of surgery, length of ileus, length of hospitalization, morbidity, and mortality. Five patients underwent standard TAC (Group I), and five underwent L-TAC (Group II). Group I consisted of five patients of a mean age of 32 (range, 24–51) years who had mucosal ulcerative colitis (n=1), familial adenomatous polyposis (n=3), or colonic inertia (n=1). Group II consisted of five patients of a mean age of 33 (range, 17–43) years who had mucosal ulcerative colitis (n=1), familial adenomatous polyposis (n=3), or colonic inertia (n=1). This preliminary prospective study indicates that laparoscopically assisted TAC is feasible. L-TAC resulted in a slightly longer length of ileus and length of hospitalization; these differences were not statistically significant. Moreover, the length of time required for the laparoscopic procedures was 35 percent longer than for the open procedures. Although these results may improve as more cases are performed, dramatic differences in rates of postoperative recovery have not yet been realized. In conclusion, L-TAC, while technically feasible, dose not appear to offer any immediately recognizable benefits to the patient as compared with standard laparotomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02053755
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  • 2
    Electronic Resource
    Electronic Resource
    Recovery of anal sphincter function after the ileoanal reservoir procedure in patients over the age of fifty (1994)
    Springer
    Diseases of the colon & rectum 37 (1994), S. 1002-1005 
    Details
    ISSN: 1530-0358
    Keywords: Ileoanal reservoir ; Pouch ; Restorative proctocolectomy ; Continence ; Ileoanal anastomosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This study was undertaken to postoperatively assess the progression of anal sphincter function and clinical outcome in patients ≥50 years old (Group I) compared with those 〈50 years old (Group II). METHODS: Clinical data were assessed after ileostomy closure by a questionnaire. These data were compiled to obtain an incontinence score, which ranged from 0 (perfect continence) to 20 (total incontinence). Anorectal manometry was performed preoperatively (MN1) and postoperatively, before (MN2) and after (MN3) ileostomy closure. Wilcoxon and paired t-test were used to compare the clinical and functional results, respectively. RESULTS: Group I consisted of 22 patients (mean age, 56 years) and Group II, 50 patients (mean age, 32 years). No differences were found relative to either preoperative pressures or clinical outcome. However, both the mean and high resting pressures were significantly lower in Group I at the MN2 examination. CONCLUSION: The effect on anal sphincters of ileoanal reservoir in patients over the age of 50 years is similar to that noted in younger patients. Transient impairment of internal anal sphincter function observed after ileoanal reservoir is more severe in older patients (P=0.01). However, as in younger patients, it does completely recover after ileostomy closure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02049312
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  • 3
    Electronic Resource
    Electronic Resource
    Optimization of sphincter function after the ileoanal reservoir procedure (1994)
    Springer
    Diseases of the colon & rectum 37 (1994), S. 419-423 
    Details
    ISSN: 1530-0358
    Keywords: Kegel exercises ; Pelvic muscle exercises ; Ileoanal reservoir ; J-pouch ; Restorative proctocolectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Impairment of sphincter function in patients who undergo ileoanal reservoir is usually most severe immediately after ileostomy closure. Therefore, a prospective, randomized trial was undertaken to assess the potential value of preileostomy closure sphincter-strengthening exercises to improve early functional outcome. METHODS: Patients were randomized either to a control group (Group 1) or to undergo a five-week pelvic floor exercise program (Group 2). An incontinence score from 0 to 20 was used to clinically assess the functional results. Anorectal manometric assessment included: highpressure zone length, mean resting pressure, highest resting pressure, mean squeezing pressure, and highest squeezing pressure. The paired t-test was used to compare the functional results preoperatively and at the time of ileostomy closure. This time corresponded to the conclusion of the exercise program or the equivalent time period for the control group. RESULTS: Twenty-six patients who underwent double-stapled ileoanal reservoir between July 1991 and June 1992 were studied. They included 16 males and 10 females with a mean age of 38 (range, 17–69) years. When both evaluations were compared, the mean incontinence score decreased from 0.2 to 2.8 (Δ=2.6) in Group 1 and from 0.2 to 2.0 (Δ = 1.8) in Group 2 (P=0.07). None of the changes between the preoperative and postoperative clinical and physiologic evaluations were statistically significant (P〉0.05). CONCLUSION: Sphincter-strengthening exercises before ileostomy closure did not minimize the transient impairment of functional results.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02076184
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  • 4
    Electronic Resource
    Electronic Resource
    Retained mucosa after double-stapled ileal reservoir and ileoanal anastomosis (1992)
    Springer
    Diseases of the colon & rectum 35 (1992), S. 1051-1056 
    Details
    ISSN: 1530-0358
    Keywords: Ileoanal reservoir ; Ileal pouch-anal anastomosis ; Mucosal ulcerative colitis ; Ulcerative colitis ; Double-stapled ; Dysplasia ; Restorative proctocolectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A study was undertaken to assess the incidence of inflammation and dysplasia in retained mucosa after double-stapled ileoanal reservoir (IAR) for mucosal ulcerative colitis (MUC). Between September 1988 and February 1992, 56 patients with MUC underwent an IAR. Forty-five patients had a double-stapled IAR (DS-IAR), seven patients had a transanal pursestring stapled IAR (PS-IAR), and four patients had a PS-IAR with mucosectomy. Distal donuts obtained from the stapled IAR were submitted for pathologic review in 55 patients. Nine patients had only small bowel, connective tissue, and/or muscle noted on review. Mucosa was qualified as squamous epithelium (SE), transitional epithelium (TE), or columnar epithelium (CE). All samples were examined for evidence of inflammation and dysplasia. Four patients had SE only, one patient had TE, and 18 had CE. In addition, three patients had SE and CE, seven patients had SE and TE, two patients had CE and TE, and nine patients had all three types. The distance from the dentate line to the anastomosis ranged from 0 to 2.5 cm (mean, 1 cm). In 19 patients (35 percent), the distal donut revealed MUC. Of these 19 patients, six had persistent MUC (43 percent) at the time of subsequent biopsy. An additional four patients had MUC evident on follow-up biopsy but not on distal donuts; two of these four patients had no mucosa in their distal donuts. Only one of the patients with evidence of MUC on donuts and/or biopsy experienced any symptoms referable to active MUC (1.8 percent). None of the specimens examined had any evidence of dysplasia. In 31 patients, no MUC was present in the initial donuts or follow-up biopsies. Although the double-stapled technique appears safe, periodic monitoring is suggested.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02252995
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