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Biomedical subjects

B G Wolff

Publications and source records attributed to B G Wolff.

At least 109 records · Page 6Linked to original sources
PubMed1987

Ileal pouch-anal anastomosis for chronic ulcerative colitis. Long-term results.

The aim of this study was to determine the long-term outcome among 390 patients with ulcerative colitis who underwent ileal J pouch-anal anastomosis and whether patient or operative factors influenced results. The combined operative morbidity rate for the pouch-anal anastomosis and the subsequent closure of the temporary ileostomy was 29% (bowel obstruction, 22%; pelvic sepsis, 5%), with one death due to pulmonary embolus. The probability of a successful outcome at 5 years was 94%. Of the 24 patients who failed (6% of total), 18 did so within 1 year (4%), three during year 2 (1%), three during year 3 (1%), and none thereafter. Stool frequency (7 stools/24 h), the occurrence of pouchitis (14%), and satisfactory daytime continence (94% of patients) remained stable over 4 years after operation, whereas nocturnal fecal spotting decreased (51% of patients to 20%). Women had more spotting than men, whereas patients over 50 years old had more stools per day than those 50 years or younger. In conclusion, ileal pouch-anal anastomosis achieved a reasonable stool frequency and satisfactory continence in patients with ulcerative colitis over the long-term. These results support the ileal pouch-anal anastomosis as a safe, satisfactory alternative to permanent ileostomy.

Adult↗
PubMed1987

Coloanal anastomosis in the management of benign and malignant rectal disease.

The aim was to determine the efficacy, safety, and long-term clinical and functional results of coloanal anastomosis in patients with complicated benign and malignant rectal disease. Twenty-nine patients underwent coloanal or colopouch-anal anastomosis for either carcinoma of the rectum not technically amenable to conventional low anterior resection, severe radiation injury, large benign lower third tumors, or complications of previous operations. The mean age of the patients was 61 years and 82% were men. A diverting colostomy was constructed in 55% of the patients. The mean (+/- SEM) length of follow-up was 20 +/- 3 months. There was no operative mortality. Transient urinary retention, however, occurred in 40%, anastomotic stricture in 28%, and anastomotic leakage in 3.4%. Four patients (14%) could not have intestinal continuity restored and therefore were considered failures. The stool frequency for all remaining patients (N = 25) was 3 +/- 1 per day (mean +/- SEM) and did not vary with age, sex, or indication for operation. Complete continence was achieved by 84% of patients, but no patient was incapacitated by poor bowel function. In patients in whom a conventional colorectostomy is impractical or unwise, coloanal anastomosis is a safe and efficacious alternative operation that preserves anal continence.

Adenocarcinoma↗
PubMed1987

Closure of postproctectomy perineal sinus with gracilis muscle flaps.

Between 1975 and 1985, 21 patients underwent muscle-flap repair of a persistent perineal sinus. All had previously undergone a proctectomy for ulcerative colitis (7 patients), Crohn's disease (10), trauma (2) or cancer (2). A total of 133 (mean 6.8, range from 1 to 25) previous surgical attempts had been made to eradicate the sinus. At follow-up after muscle-flap repair (mean 47 months), the sinus was completely healed in 14 patients. However, 10 of these patients had required further perineal operations (mean 1.9, range from 0 to 9). In those with a successful result, the average time taken for the sinus to heal was 2.3 months (range from 1 to 24 months). In three patients, a wound that had initially healed reopened (mean 7 months) and has remained unhealed. Although a gracilis flap will likely cure a refractory perineal sinus, the healing period may be prolonged, and reoperation is frequently required.

Adult↗
PubMed1986

Temporary ileostomy for ileal pouch-anal anastomosis. Function and complications.

The function and complications associated with temporary ileostomies were reviewed in patients undergoing ileal pouch-anal anastomosis. A series of 180 patients had temporary ileostomies established (157 loop, 23 Brooke). Patients with incomplete fecal diversion had a significantly higher incidence of pouch-anal anastomotic complications (44 percent) than did those with complete diversion (14 percent). Patients with loop ileostomies were more likely than patients with Brooke ileostomies to develop technique-related complications (18 percent vs. 13 percent) and peristomal irritation (54 percent vs. 26 percent). The most frequent complications after take-down of the ileostomy were transient bowel obstruction (13 percent) and peritonitis (7 percent). These complications could not be related to the type of stoma used or the interval to closure. Temporary diversion of a pouch-anal anastomosis decreased the incidence of anastomotic complications. These ileostomies, however, are associated with a significant risk of complications, which can be minimized by meticulous surgical technique.

Anal Canal↗
PubMed1986

Ileal pouch-anal anastomosis without temporary, diverting ileostomy.

Of two hundred patients undergoing proctocolectomy with ileal pouch-anal anastomosis, all but nine have had temporary diverting ileostomies. Of these nine patients, eight had successful results. One patient developed abdominal sepsis due to jejunal volvulus and perforation after she had returned home, and at surgery the pouch was excised. Ileal pouch-anal anastomosis without a temporary diverting ileostomy can be performed safely by surgeons experienced with this procedure in carefully selected patients.

Anal Canal↗
PubMed1986

Malignant lymphoma of the rectum.

Malignant lymphoma involving the rectum is rare. Of 61 patients with malignant lymphoma involving the rectum seen at the Mayo Clinic between 1950 and 1977, 49 had extensive lymphoma with secondary involvement of the rectum, and 12 had lymphoma confined to the rectum. Patients with widespread lymphoma were treated with radiation, chemotherapy, or both. Of the 12 patients with lymphoma confined to the rectum, five had surgical excision and seven were treated nonoperatively; the overall five-year survival was 20 percent. Patients with widespread lymphoma had a five-year survival of 15 percent. Patients with lymphoma confined to the rectum had a five-year survival of 50 percent, and patients who had surgical excision did better than those treated nonoperatively.

Adolescent↗
PubMed1986

Preoperative staging of rectal carcinoma by computed tomography and 0.15T magnetic resonance imaging. Preliminary report.

A prospective study was done on 34 patients using magnetic resonance imaging (MRI) and computed tomography (CT) preoperatively to stage patients with known rectal carcinoma. The study was done to determine the accuracy and clinical usefulness of CT and MRI. The Thoeni staging method was used. Twenty-four of 30 cases were staged correctly by CT. Sixteen of 27 were staged correctly by MRI. CT detected lymph node metastases in six of 15 cases with one false-positive. MRI detected lymph node metastases in two of 15 patients with one false-positive. CT was the preferred examination, and was useful in some cases. These cases included patients with small tumors who were considered for local excision and patients with extensive disease who were candidates for preoperative or intraoperative radiation treatment. MRI demonstrated extensive disease, as did CT in our later cases.

Adult↗
PubMed1986

Level of anastomosis and recurrent colonic diverticulitis.

About 7 percent of patients who have resections for diverticular disease later suffer from recurrent disease. In resections for sigmoid disease, the surgeon often has the choice of using either the distal sigmoid colon or the upper rectum for the distal portion of the anastomosis. We examined the courses of 501 consecutive patients who had resection and anastomosis for diverticular disease at the Mayo Clinic between 1970 and 1975. Recurrent diverticulitis developed in 12.5 percent of the patients in whom the sigmoid colon had been used for the distal margin of anastomosis and in 6.7 percent of those in whom the rectum had been used (p = 0.03). Reoperation was required in 3.4 percent of the patients in whom the sigmoid colon was used as the distal anastomotic site and in 2.2 percent of those in whom the rectum had been used (p greater than 0.05). We found no increase in anastomotic leaks or other perioperative complications in patients in whom the rectum had been mobilized. We conclude that the entire distal sigmoid colon should be removed during resection for diverticular disease and anastomosed to the upper rectum to avoid recurrent diverticulitis.

Adult↗
PubMed1986

Crohn's disease: the role of surgical treatment.

The surgical treatment of Crohn's disease is necessitated by complications of the disease or by failure of medical therapy. Despite the fact that the patients with Crohn's disease who undergo operation have the most severe spectrum of problems, about half these patients may never need a further procedure, and the mortality from the disease itself is low. During the past 50 years, the concepts of surgical treatment for Crohn's disease have gradually evolved, and the current feeling among surgeons can be summarized best in the word "moderation." In this article, general guidelines for treatment and the results of various procedures for Crohn's disease are presented, including discussion of the complications of chronic obstruction, fistulization and abscess, bleeding, intractability, and toxic megacolon.

Anal Canal↗
PubMed1986

An appraisal of endoscopic removal of malignant colonic polyps.

The issue of whether patients who have invasive carcinoma in an otherwise benign polyp should undergo surgical resection of that bowel segment is controversial. We examined the records of 83 patients with such polyps that were removed endoscopically between 1978 and 1981. After exclusion of 18 patients from the study for various reasons, our study group consisted of 65 patients who had undergone complete endoscopic removal of 69 polyps that contained a malignant process. Carcinoma in situ was found in 34 polyps, and 3 patients with such polyps had a recurrent malignant lesion of the same degree. These recurrent tumors were treated successfully by aggressive endoscopic removal. Seventeen polyps that contained invasive carcinoma were treated endoscopically without resection, and two patients in this group subsequently had recurrent carcinoma at the site of the original polyp. These recurrent lesions were resected, and neither patient had evidence of nodal metastasis. Of the 18 patients who underwent immediate resection of invasive carcinoma, 2 had residual carcinoma at the time of the resection, although no lymph node metastasis was found. We conclude that colonic polyps with carcinoma in situ can be treated safely with complete endoscopic removal. Invasive carcinoma in a polyp can be treated safely with complete polypectomy, and immediate resection may not be necessary. This group of patients, however, should undergo thorough follow-up studies and periodic endoscopic reexamination.

Adenocarcinoma↗
PubMed1985

Pregnancy following ileal pouch-anal anastomosis.

Of 92 women undergoing proctocolectomy with ileal "J" pouch-anal anastomosis, between January 1981 and May 1983, six have successfully conceived and carried a pregnancy to term. Three patients had transient deterioration of anorectal function during the third trimester of pregnancy which resolved after delivery. Four patients delivered vaginally without perceptible alteration in subsequent continence. Ileal pouch-anal anastomosis is compatible with normal childbearing postoperatively. The route of delivery should be individualized in these patients.

Adult↗
PubMed1985

Anterior resection for complete rectal prolapse.

One hundred thirteen patients underwent anterior resection for complete rectal prolapse between 1968 and 1980. These patients were followed for an average of seven years; recurrence developed in eight patients (9 percent). Recurrences were found to occur at three months to eight years postoperatively, and the probability of a recurrence at two, five, and ten years was 3 percent, 6 percent, and 12 percent, respectively. Operative mortality was 1 percent and morbidity was 29 percent. Low anterior resection, with anastomosis in the deperitonealized portion of the colon, was found to increase morbidity without significantly decreasing recurrence when compared with high anterior resection. The effects of repair on patient continence were unpredictable. High anterior resection is preferable to low anterior resection in the treatment of rectal prolapse and offers results comparable to those of other repairs currently being performed.

Adolescent↗
PubMed1985

Anorectal Crohn's disease. A long-term perspective.

A group of 86 patients with anorectal Crohn's disease were followed up from ten to 40 years to determine the course of the disease and the number of patients who later required proctectomy. The overall cumulative probability of avoiding proctectomy was 91.6 percent at ten years and 82.5 percent at 20 years. Resection of all proximal Crohn's disease did not ameliorate the anorectal disease, except in patients who had all proximal disease removed and had no recurrence.

Adolescent↗
PubMed1985

Mechanisms of rectal continence. Lessons from the ileoanal procedure.

To clarify mechanisms of rectal continence, we evaluated 34 patients who had straight or J-pouch ileoanal anastomosis. This evaluation included pressures, anal inhibitory reflex, neorectal capacity, neorectal compliance, and the ability to discriminate stool from gas. Both groups of patients had satisfactory anal sphincter resting pressures and neorectal capacities, and all could discriminate stool from gas despite the absence of any rectal mucosa. We conclude that normal rectal mucosa is not necessary to be able to discriminate stool from gas; a long rectal muscular cuff is not necessary for rectal sensation; essentially normal sphincter function is preserved, and this procedure does not normally fail because of inadequate sphincter function or the absence of the anal inhibitory reflex; and in the presence of normal sphincter function, continence is not dependent on the presence of normal mucosa or the anal inhibitory reflex but correlates with reservoir capacity and compliance as well as with the frequency and strength of intrinsic bowel contractions.

Anal Canal↗
PubMed1985

Oophorectomy and colon cancer. Impact on survival.

Data on survival and survival free-from-recurrence were analyzed retrospectively in a group of 571 women who had undergone curative resection for colon cancer at the Mayo Clinic between 1972 and 1978. Of these women, 75 (group 1) had required bilateral oophorectomy before or at colon resection, while 496 (group 2) retained one or both ovaries. Average age, location and grade of tumor, and duration of follow-up were similar for both groups. Five-year-survival rate for the 571 women was 73.6%, as compared with 84.3% for matched controls. The 5-year survival rates were not significantly different for group 1 (78.0%) and group 2 (72.9%). Five-year survival free-from-recurrence also was not significantly different (82.9%, group 1 and 79.5%, group 2). Women in group 1 who had grade 1 or 2 tumors or lesions in the sigmoid and cecum fared the best (no significant difference from controls). Incidence studies of ovarian metastases from colon cancers suggest that three to eight per cent of women should benefit from bilateral oophorectomy. This agrees with the difference in survival observed between groups 1 and 2 in this study. Our sample size is too small to statistically confirm the reliability of this difference. The design of a prospective study testing this hypothesis is outlined.

Adult↗
PubMed1985

Ileal "J" pouch-anal anastomosis. Clinical outcome.

One hundred eighty-eight patients undergoing abdominal colectomy with distal mucosal proctectomy and endorectal ileal pouch-anal anastomosis were reviewed to assess long-term functional results and to identify factors that might influence them. There was no postoperative mortality, but 10 patients (5.3%) required permanent ileostomy because of postoperative complications or the development of unsuspected Crohn's disease. Immediate postoperative complications, including pelvic sepsis, small bowel obstruction requiring surgery, anastomotic stricture, and ileostomy dysfunction, were observed in 11%, 9%, 14% and 9% of patients, respectively. No males were impotent but nine (9%) developed retrograde ejaculation. Pouchitis occurred in 8% of patients. Among 157 patients assessed at least 60 days after ileostomy closure (mean +/- SD, 375 +/- 216 days), all evacuated their neorectum spontaneously, and stool frequency was 6.0 +/- 2.6 daily and 1.2 +/- 1.3 nightly. While continence was generally good, 2.5% of patients during waking hours and 4.5% during sleep had occasional frank soilage. Moreover, seepage was noted in 25 and 47% of patients during daytime and nighttime, respectively. Both stool frequency and degree of continence improved with time. Patients less than 50 years of age and those with polyposis coli had fewer stools and better continence than those older than 50 or those with ulcerative colitis. It is concluded that ileal "J" pouch-anal anastomosis can be performed safely and will provide acceptable anorectal function without late deterioration.

Adolescent↗
PubMed1984

The endorectal ileal pouch-anal anastomosis. Current clinical results.

One hundred thirteen patients with either chronic ulcerative colitis (108 patients) or familial polyposis coli (five patients) received an ileal J pouch-anal anastomosis after sphincter-saving proctocolectomy. There were no postoperative deaths. Leaks (radiologic and/or clinical) from the pouch or ileoanal anastomosis occurred in 14 per cent of patients. Small-bowel obstruction, requiring operative correction, occurred in 7 per cent and 3 per cent, respectively, of patients after either proctocolectomy or closure of the loop ileostomy. All 66 patients whose diverting ileostomy had been closed for at least three months could defecate spontaneously and their mean (+/- SE) stool frequency per 24 hours was 9.0 +/- 1 at one month and 5.9 +/- at 12 months. Major fecal incontinence was observed in 3 per cent of patients, and two patients eventually required a permanent ileostomy. The ileal J pouch-anal anastomosis has become our procedure of choice in selected patients who require proctocolectomy.

Adolescent↗