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  • 1
    ISSN: 1128-045X
    Keywords: Key words Ileo-anal pouch ; Laparoscopy ; Familial adenomatous polyposis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: We compared the intraoperative and early post-operative results of open (ORPC) and laparoscopic restorative proctocolectomy (LRPC) for familial adenomatous polyposis (FAP). We studied all our patients undergoing restorative proctocolectomy for FAP. The first 8 patients who underwent LRPC were prospectively studied and compared with the records of 27 patients who had undergone ORPC. Twenty-seven patients (5 males) and 8 patients (3 males) underwent ORPC and LRPC. The median length of time of surgery was 160 min (range 135–180 min) and 150 min (range 60–360 min) for LRPC and ORPC, respectively (P = ns). The median length of the wound was 8.5 cm (range 5–16 cm) and 25 cm (range 18–34 cm) for LRPC and ORPC, respectively (P 〈 0.0001). There was no significant differences in time to ileostomy function, first fluid intake or time to solid diet intake between the two groups. There was a significant improvement in hospital stay (median 7 days vs 10 days) in the LRPC group. Thus, LRPC may be performed with no significant increase in operative time compared to the open technique. Furthermore, the wound length is significantly shorter in LRPC and the time taken for hospital stay is significantly improved.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1128-045X
    Keywords: Key words Physiology ; Radiotherapy ; Rectal cancer ; Surgery ; Rectum
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: We compared bowel function and anorectal physiology testing in rectal cancer patients who had undergone surgery alone, i.e. low anterior resection with colonic pouch (SA), to those also having preoperative radiotherapy (PREOP) or postoperative radiotherapy (POSTOP). The PREOP group were recruited from those who received 50.4 Gy (28 daily fractions over 5 1/2 weeks), and had their ileostomies closed for at least 1 year. Equivalent gender- and age-matched SA and POSTOP (50.4–54 Gy) patients who were operated upon during the similar time period were recruited. Bowel function questionnaire, anorectal manometry, anal electrosensation, pudendal nerve motor terminal latencies, barostat rectal sensation measurements and endoanal ultrasound were performed. There were 6 patients in each group. Bowel function questioning revealed that PREOP had significantly more incontinent episodes than SA patients (SA 2.9 ± 1.3, PREOP 10.3 ± 3.4, POSTOP 3.8 ± 0.6 episodes per week: p 〈 0.05; values expressed as mean ± SEM). The rectal volume of initial distension sensation on barostat ramp program testing was more impaired in the POSTOP than in PREOP group (SA 27.4 ± 5.3, PREOP 17.8 ± 4.3, POSTOP 37.5 ± 6.8 ml; p 〈 0.05). The left pudendal nerve motor terminal latency was more prolonged in the POSTOP than in the SA patients (SA 1.9 ± 0.2, PREOP 2.3 ± 0.1, POSTOP 4.3 ± 0.7 ms; p 〈 0.05). Patients who had preoperative radiotherapy had more incontinent episodes, and the rectal sensation may be more impaired after postoperative radiotherapy.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1128-045X
    Keywords: Key words Surgical technique ; Functional end-to-end anastomosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: The use of staplers for ileostomy closure may facilitate the procedure and improve outcome by creating a wide, functional end-to-end anastomosis. We retrospectively compared 136 sutured ileostomy closures with 152 stapled closures. Perioperative data and outcome parameters were analyzed. Patient characteristics were similar in both groups. Highly significant reduction was found in operating time (p 〈 0.001) and hospitalization (p = 0.001) in the stapled group compared to the sutured group. Recovery of intestinal function and complication rates showed no differences. Our results show that both techniques are comparably safe but stapling is considerably faster to perform. The higher expenses of using a stapling device may be economically compensated by the shorter operation time under certain circumstances.
    Type of Medium: Electronic Resource
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