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Biomedical subjects

A P Wetherall

Publications and source records attributed to A P Wetherall.

5 recordsLinked to original sources
PubMed1993

Endoscopic transanal resection in the management of patients with sessile rectal adenomas, anastomotic stricture and rectal cancer.

Forty patients underwent 61 endoscopic transanal resections using a urological resectoscope. Preoperative diagnoses were adenoma in 28 patients, carcinoma in seven and benign anastomotic stricture in five. Four patients with adenomas were found to have frank carcinoma. Ablation of 22 of 23 adenomas was achieved, 11 with a single transanal resection. Open operation was required for one patient. Locally advanced rectal malignancy was palliated in five of seven patients. All those with benign anastomotic stricture were cured by a single resection. The median operating time was 25 min, with 11 procedures exceeding 30 min. There were complications in seven cases (six bleeding, one septicaemia). The median hospital stay for the procedure alone was 3.5 days. There were no deaths within 30 days of operation. Endoscopic transanal resection is minimally invasive, quick, safe and effective. Histological surveillance is a major advantage and appears reliable. Low complication rates can be achieved by opting for several 'easy' resections and by restricting use of the procedure to lesions within 15 cm of the anal verge.

Adenoma↗
PubMed1992

Use of disposable skin staplers for bowel anastomosis to reduce laparotomy time in war.

Laparotomy for penetrating wounds to the abdomen is demanding in terms of time, skill and resources. Any modification of existing techniques that will lessen these demands will be of benefit at surgery in forward areas in war. A previous paper (1) compared a method of small bowel anastomosis using disposable skin staplers with a two-layer handsewn anastomosis using fresh pig ileum. The stapled method was both significantly faster to perform and mechanically superior. In two further studies on a total of 12 pigs the stapled method has been compared with a single-layer and a double-layer handsewn small bowel anastomosis. All 12 pigs recovered from laparotomy without complication. Construction times were recorded. The quality of healing of the anastomoses was assessed by clinical observation, post-mortem and histological examination, and tensiometry. The skill required to perform the stapled anastomoses was estimated subjectively. The stapled technique was consistently faster than the handsewn methods. A Kolmogorov two-sample test showed an improvement in times when comparing the stapled method with the single layer, with a significance of P = 0.05. An improvement was also seen when the stapled method was compared with the double layer, with a significance of P = 0.01. There was no statistically significant difference between the construction times for the two handsewn methods. There was no evidence of anastomotic failure or haematoma at post-mortem and no adverse reaction to the metal staples. No features were identified on histology to indicate impaired healing with the stapled method. Tensiometry of the anastomoses showed that the stapled anastomosis is as mechanically reliable as the handsewn anastomosis. The level of skill required to perform the stapled anastomosisis judged to be within the capabilities of relatively junior surgeons once the technique has been mastered in an anastomosis workshop.

Anastomosis, Surgical↗