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  • 1
    Keywords: CHILDREN ; FECAL INCONTINENCE ; MULTIDISCIPLINARY BEHAVIORAL TREATMENT
    Abstract: The ARM-Net (anorectal malformation network) consortium held a consensus meeting in which the classification of ARM and preoperative workup were evaluated with the aim of improving monitoring of treatment and outcome. The Krickenbeck classification of ARM and preoperative workup suggested by Levitt and Pena, used as a template, were discussed, and a collaborative consensus was achieved. The Krickenbeck classification is appropriate in describing ARM for clinical use. The preoperative workup was slightly modified. In males with a visible fistula, no cross-table lateral X-ray is needed and an anoplasty or (mini-) posterior sagittal anorectoplasty can directly be performed. In females with a small vestibular fistula (Hegar size 〈5 mm), a primary repair or colostomy is recommended; the repair may be delayed if the fistula admits a Hegar size 〉5 mm, and in the meantime, gentle painless dilatations can be performed. In both male and female perineal fistula and either a low birth weight (〈2,000 g) or severe associated congenital anomalies, prolonged preoperative painless dilatations might be indicated to decrease perioperative morbidity caused by general anesthesia. The Krickenbeck classification is appropriate in describing ARM for clinical use. Some minor modifications to the preoperative workup by Levitt and Pena have been introduced in order to refine terminology and establish a comprehensive preoperative workup.
    Type of Publication: Journal article published
    PubMed ID: 25609592
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  • 2
    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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  • 3
    ISSN: 1128-045X
    Keywords: Key words Laparoscopy ; Constipation ; Colonic inertia ; Sigmoidocele ; Rectal Prolapse ; Colectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: The aim of this study was to evaluate the safety, outcome and disability of various forms of laparoscopic-assisted colectomy for constipation. Between August 1991 and February 1995, 14 patients with constipation who underwent laparoscopic assisted total abdominal colectomy with ileorectal anastomosis (TAC + IR) or sigmoidectomy with colorectal anastomosis (SC + CR) with or without rectopexy were analyzed. Parameters included age, sex, preoperative medical treatment and evaluation, constipation score, indication for surgery, procedure performed, length of surgery, postoperative ileus, and hospitalization as well as morbidity, cosmesis, functional outcome and return to partial and full activity. Surgery was undertaken for colonic inertia (6 patients) and obstructing sigmoidocele with or without prolapse (8 patients) in 12 females and 2 males with a mean age of 47.5 (range 22–77) years. The mean history of laxative- or enema-dependent constipation was 18.3 (range 7–35) years and the mean constipation score was 24.4 (range 20–29). The overall mean operating time was 217.5 (range 125–325) min; 260 (range 195–315) min in the patients with TAC + IR, and 185.6 (range 125–325) min in the patients with SC + CR with or without rectopexy (P 〈 0.05). The mean length of postoperative ileus was 3.8 (range 2–7) days, and the length of hospitalization was 7.6 (range 4–15) days. There were 3 (21%) cases of intraoperative complications, and 4 cases of (29%) postoperative complications. At a mean follow-up of 37.8 (range 18–60) months, the mean frequency of bowel movements had increased from 2.5 per week preoperatively to 8.4 per week postoperatively (P 〈 0.0001). Ten patients reported excellent or good results relative to cosmesis. The mean time to return to partial activity was 1.7 (range 1–3) weeks, and return to full activity was 5.1 (range 3–10) weeks. Although laparoscopic procedures for constipation have definite advantages including better cosmesis and more rapid return to partial and full acitivity, disadvantages include the long operating time that may preclude its routine application.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1128-045X
    Keywords: Key words Case series ; Colorectal cancer ; Research methodology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: Although case series reports are the most frequent type of article published in surgical periodicals, their scientific value has recently been judged questionable for assessing the effectiveness of a treatment. It has also been suggested that strict rules, such as those published for randomised controlled trials (the CONSORT statement) could improve their quality. Forty papers on surgery for colorectal tumours were reviewed and a check list of items considered useful for reporting a case series was drawn up. Some items were borrowed from the CONSORT statement. The final list was checked against the 40 articles reviewed. Virtually all the published papers were defective in one or more aspects (selection of patients, details of clinical, pathological and technical data, methods of follow-up and statistical analysis). The quality of observational studies can be improved. Data collection is easier in prospective studies, and strict follow-up and appropriate statistical analysis may render a case series more reliable.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1128-045X
    Keywords: Key words Endoscope ; Occlusion ; Savory dilatation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: Complete occlusion of a colorectal anastomosis could be treated with a technique using two endoscopes. A sharp end of a guidewire perforated the occluded anastomosis and was guided outside the anus with a second coloscope. A Savory dilatation was possible through a rigid rectoscope. A reoperation was prevented with this special technique.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1128-045X
    Keywords: Key words Rectal mucosal prolapse ; Stapler ; Constipation ; Enterocele
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: Submucosal saline injection and triple purse-string are reported to prevent peritoneal stitching and mucosal pocketing, two intraoperative complications in patients who undergo a stapled transanal excision for internal mucosal prolapse causing obstructed defaecation.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Techniques in coloproctology 3 (1999), S. 107-108 
    ISSN: 1128-045X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Techniques in coloproctology 3 (1999), S. 105-106 
    ISSN: 1128-045X
    Keywords: Key words Appendicolithiasis ; Appendicitis ; Ureterolithiasis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: An unusual clinical presentation of appendicitis with violent colicky pain as seen classically in urolithiasis is here presented. The pathophysiology of colic and the differential diagnosis of appendicolithiasis is briefly discussed.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1128-045X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1128-045X
    Keywords: Key words Haemorrhoids ; Elderly
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Haemorrhoids are believed to be rare in elderly patients, occurring mainly in young and middle-aged subjects. Symptoms of haemorrhoids in elderly patients, in addition, require a precise differential diagnosis in order to rule out neoplasia. In this paper we report our experience in dealing with haemorrhoidal disease in 291 patients older than 65 years. Symptoms of presentation were those commonly reported by younger patients. Accurate clinical examination, proctoscopy and flexible sigmoidoscopy allowed reaching a differential diagnosis in the majority of patients. Extensive colorectal diagnostic screening was required in 28.5% of patients due to the clinical presentation. Treatment was conservative in most cases, with 57.2% of the patients treated medically and 36.7% undergoing rubber band ligation (RBL). In this group of patients no complications occurred although several risk factors were present (e.g. anticoagulant medications, diabetes, cardiovascular diseases). A further 13% of the patients underwent surgery with no complications or mortality. Haemorrhoids in elderly patients occur with features similar to those of other ages and ambulatory treatment can be performed. In particular, RBL can be performed safely even in those patients presenting with associated illness.
    Type of Medium: Electronic Resource
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