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  1. Article ; Online: Sphincter-Sparing Operations for Chronic Ulcerative Colitis

    Pemberton, John H. / Beart, Jr., Robert W.

    Digestive Surgery

    1987  Volume 4, Issue 1, Page(s) 1–9

    Abstract: Traditionally, proctocolectomy and Brooke ileostomy has been offered to patients with chronic ulcerative colitis requiring an operation for therapeutic or prophylactic indications. The functional results of this approach were good but the patients were ... ...

    Abstract Traditionally, proctocolectomy and Brooke ileostomy has been offered to patients with chronic ulcerative colitis requiring an operation for therapeutic or prophylactic indications. The functional results of this approach were good but the patients were incontinent. Our hypothesis has been that by facilitating control of enteric content, the quality of life after proctocolectomy would be enhanced. Ideally, an operation which provides such control should not only excise all diseased and potentially diseased bowel, but should preserve the anal continence mechanism. The aim of this report is to detail how a new sphincter-sparing operation, ileal pouch-anal anastomosis, may fulfill these ideal criteria, while the more traditional continence-preserving approach of ileorectal anastomosis may not. Finally, the current and future role of ileorectal anastomosis is assessed in light of the recent introduction of ileal pouch-anal anastomosis.
    Keywords Ileal pouch-anal anastomosis ; Continence-preserving operations ; Ileorectal anastomosis ; Chronic ulcerative colitis, operations ; Mechanisms of continence
    Language English
    Publisher S. Karger AG
    Publishing place Basel
    Publishing country Switzerland
    Document type Article ; Online
    ZDB-ID 605888-7
    ISSN 1421-9883 ; 0253-4886 ; 0253-4886
    ISSN (online) 1421-9883
    ISSN 0253-4886
    DOI 10.1159/000171758
    Database Karger publisher's database

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    In stock of ZB MED Cologne/Königswinter

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  2. Article: Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection.

    Fazio, Victor W / Cohen, Zane / Fleshman, James W / van Goor, Harry / Bauer, Joel J / Wolff, Bruce G / Corman, Marvin / Beart, Robert W / Wexner, Steven D / Becker, James M / Monson, John R T / Kaufman, Howard S / Beck, David E / Bailey, H Randolph / Ludwig, Kirk A / Stamos, Michael J / Darzi, Ara / Bleday, Ronald / Dorazio, Richard /
    Madoff, Robert D / Smith, Lee E / Gearhart, Susan / Lillemoe, Keith / Göhl, Jonas

    Diseases of the colon and rectum

    2006  Volume 49, Issue 1, Page(s) 1–11

    Abstract: Introduction: Although Seprafilm has been demonstrated to reduce adhesion formation, it is not known whether its usage would translate into a reduction in adhesive small-bowel obstruction.: Methods: This was a prospective, randomized, multicenter, ... ...

    Abstract Introduction: Although Seprafilm has been demonstrated to reduce adhesion formation, it is not known whether its usage would translate into a reduction in adhesive small-bowel obstruction.
    Methods: This was a prospective, randomized, multicenter, multinational, single-blind, controlled study. This report focuses on those patients who underwent intestinal resection (n = 1,701). Before closure of the abdomen, patients were randomized to receive Seprafilm or no treatment. Seprafilm was applied to adhesiogenic tissues throughout the abdomen. The incidence and type of bowel obstruction was compared between the two groups. Time to first adhesive small-bowel obstruction was compared during the course of the study by using survival analysis methods. The mean follow-up time for the occurrence of adhesive small-bowel obstruction was 3.5 years.
    Results: There was no difference between the treatment and control group in overall rate of bowel obstruction. The incidence of adhesive small-bowel obstruction requiring reoperation was significantly lower for Seprafilm patients compared with no-treatment patients: 1.8 vs. 3.4 percent (P < 0.05). This finding represents an absolute reduction in adhesive small-bowel obstruction requiring reoperation of 1.6 percent and a relative reduction of 47 percent. In addition, a stepwise multivariate analysis indicated that the use of Seprafilm was the only predictive factor for reducing adhesive small-bowel obstruction requiring reoperation. In both groups, 50 percent of first adhesive small-bowel obstruction episodes occurred within 6 months after the initial surgery with nearly 30 percent occurring within the first 30 days. Additionally no first adhesive small-bowel obstruction events were reported in Years 4 and 5 of follow-up.
    Conclusions: The overall bowel obstruction rate was unchanged; however, adhesive small-bowel obstruction requiring reoperation was significantly reduced by the use of Seprafilm, which was the only factor that predicted this outcome.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carboxymethylcellulose Sodium/therapeutic use ; Digestive System Surgical Procedures/adverse effects ; Female ; Follow-Up Studies ; Humans ; Hyaluronic Acid/therapeutic use ; International Cooperation ; Intestinal Obstruction/prevention & control ; Intestine, Small ; Intraoperative Period ; Male ; Middle Aged ; Postoperative Complications/prevention & control ; Prospective Studies ; Time Factors ; Tissue Adhesions/prevention & control ; Treatment Outcome
    Chemical Substances Seprafilm ; Hyaluronic Acid (9004-61-9) ; Carboxymethylcellulose Sodium (K679OBS311)
    Language English
    Publishing date 2006-01
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1007/s10350-005-0268-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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