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B M Stephenson

Publications and source records attributed to B M Stephenson.

At least 19 recordsLinked to original sources
PubMed2005

Laparoscopic or trephine faecal diversion: is there a preferred approach and why?

BACKGROUND: Faecal diversion is often indicated in perineal sepsis and in the palliation of advanced ano-rectal malignancy. This can be performed open or laparoscopically. The aim of this study was to assess the outcome of these two approaches to stoma creation. METHODS: Prospective evaluation of laparoscopic or 'trephine' stoma creation in 49 consecutive unselected patients. RESULTS: Eighteen (37%) patients (median age 68 years) underwent a laparoscopic approach in which there were no conversions. One patient required a laparotomy for stoma mal-orientation and there were two (11%) deaths. Thirty-one patients (median age 70 years) had a trephine stoma formed with two (6%) conversions but no deaths. Thirteen (42%) of these patients had surgery performed under regional anaesthesia. There was no difference in the hospital stay between the two groups and at a mean follow-up of 16 months, 20 (41%) patients had died mainly from disease progression. CONCLUSION: Both approaches to faecal diversion give adequate results in the short term. Laparoscopic techniques should be reserved for fitter patients as a trephine stoma can be performed under regional anaesthesia.

Adult↗
PubMed2000

Obstructed defecation after undiverted ileoanal pouch reconstruction for ulcerative colitis: pharmacologic approach. Report of a case.

PURPOSE: Obstructed defecation after ileal pouch construction has been reported only after closure of the diverting loop ileostomy, and biofeedback was an effective treatment modality. METHOD: This is a case report of a patient with immediate obstructed defecation after ileal pouch-anal anastomosis without a covering loop ileostomy and its successful pharmacologic management. RESULTS: A 38-year-old female underwent restorative proctectomy and stapled ileal J-pouch-anal anastomosis without a covering loop ileostomy. On the seventh postoperative day, her pouch catheter (in lieu of a covering loop ileostomy) was removed and she failed to evacuate. After ruling out any technical complications, diltiazem was commenced with successful spontaneous pouch emptying. Obstructed defecation reoccurred after cessation of diltiazem one week later, but the symptoms resolved once the diltiazem was recommenced. CONCLUSIONS: Obstructed defecation has been reported in patients after pelvic pouch reconstruction. However, in all those patients a diverting loop ileostomy had been raised and their obstructive symptoms were only apparent after closure of the ileostomy and when the pouch had healed. The concern regarding our patient was the complete outlet obstruction so soon after surgery, with undue strain on the anastomosis and the potential risk of disruption. Our only two options were either to create a diverting loop ileostomy or to try a fast-acting pharmacologic agent (diltiazem) to treat the presumed levator spasm. The latter option spared the patient a further operation.

Administration, Oral↗
PubMed1999

Hard to swallow.

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Anesthesia Recovery Period↗