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Biomedical subjects

C Neal Ellis

Publications and source records attributed to C Neal Ellis.

12 recordsLinked to original sources
PubMed2007

Effect of tobacco smoking on advancement flap repair of complex anal fistulas.

PURPOSE: Options for the management of complex anal fistulas include fistulotomy, setons, fibrin sealant, and advancement flaps. This study was performed to evaluate our results with advancement flap repair of anal fistulas and to identify factors associated with failure. METHODS: A retrospective analysis was performed for all patients treated with an anal fistula between June 2000 and May 2003. Data collected included age, gender, fistula anatomy and etiology, previous repairs, comorbidities, smoking history, procedure performed, and fistula recurrence. RESULTS: There were 95 patients (43 males and 52 females) with a mean age of 42 years. Transsphincteric fistulas were present in 51 patients and 44 females had rectovaginal fistulas. A mucosal flap repair was performed for 68 patients and 27 patients had an anodermal flap repair. The median length of follow-up was ten months. The fistula recurred in 31 patients (32.6 percent). Subset analysis showed an association between a history of previous attempts at repair or tobacco smoking and an increased rate of fistula recurrence, but did not reveal any increased risk of recurrence for patients over age 40 years, for those with rectovaginal fistula, or for males. CONCLUSION: A history of previous attempts at repair of an anal fistula or tobacco smoking is associated with an increased risk of fistula recurrence; while age over 40 years, male gender, or a rectovaginal fistula are not.

Adult↗
PubMed2006

Fibrin glue as an adjunct to flap repair of anal fistulas: a randomized, controlled study.

PURPOSE: Both flap repair and fibrin glue are accepted sphincter-preserving techniques for managing anal fistulas. Additionally, the two techniques are not mutually exclusive and can be combined. This trial was undertaken to determine whether the combination of flap repair and fibrin glue resulted in better outcomes than flap repair alone. METHODS: Between July 2000 and March 2004, patients with trans-sphincteric anal fistulas were randomly assigned to advancement flap repair alone or flap repair combined with fibrin glue obliteration of the fistula tract. Data regarding age, gender, fistula anatomy, race, and previous repairs were collected. Fistulas managed by fistulotomy or caused by Crohn's disease, acute obstetric trauma, or radiation were excluded from this study. RESULTS: There were 58 patients randomized to flap repair alone or flap repair with fibrin glue (47 males; median age, 47 (range, 29-68) years). Mucosal advancement flap was performed in 36 patients and anodermal advancement flap was performed in 22. The median follow-up was 22 (range, 12-36) months. Total fistula recurrence rate for all patients was 32.6 percent. The recurrence rate for fistulas repaired by advancement flap alone was 20 percent, whereas the recurrence rate for fistulas repaired by advancement flap with fibrin glue was 46.4 percent (P < 0.05). CONCLUSIONS: The data fail to show improved outcomes when fibrin sealant is used in combination with an advancement flap compared with advancement flap alone for the management of complex anal fistulas.

Adult↗
PubMed2006

Is fecal diversion necessary for nondestructive penetrating extraperitoneal rectal injuries?

BACKGROUND: Current management of penetrating extraperitoneal rectal injury includes diversion of the fecal stream. The purpose of this study is to assess whether nondestructive penetrating extraperitoneal rectal injuries can be managed successfully without diversion of the fecal stream. METHODS: This study was performed at an urban Level I trauma center during a 28-month period from February 2003 through June 2005. All patients who suffered nondestructive penetrating extraperitoneal rectal injuries were managed with a diagnosis and treatment protocol that excluded fecal stream diversion. Patients were placed in one of two management arms based upon clinical suspicion for intraperitoneal injury. In the first arm, patients with suspicion for rectal injury and a positive clinical examination for intraperitoneal injuries were delivered to the operating room for exploratory laparotomy. Proctoscopy was performed before exploratory laparotomy. Extraperitoneal rectal injuries were left to heal by secondary intention. Intraperitoneal rectal injuries were repaired primarily. Patients did not receive fecal diversion or perineal drainage. In the second management arm, patients with a negative clinical examination for intraperitoneal injury and wounding agent trajectory suspicious for rectal injury underwent diagnostic peritoneal lavage (DPL), cystography, and proctoscopy in the emergency room. Positive DPL or cystography warranted laparotomy as above. Patients with positive proctoscopy alone were admitted and placed on a clear liquid diet. Barium enema was performed 5 to 7 days postinjury for all rectal injuries with diets advanced accordingly.A matched historic control group of rectal injury patients who underwent fecal diversion was compared with the nondiversion protocol group. Patients from both groups were matched for penetrating abdominal trauma index (PATI), age and mechanism of injury. RESULTS: There were 14 consecutive patients diagnosed with penetrating rectal injury placed in the nondiversion management protocol. Of these, 9 (64%) patients in the nondiversion group required laparotomy. The average age in the diversion historical control group was 30.5 years and 29.3 years in the nondiversion group. The average PATI in the diversion group was 15.3 and 16.1 in the nondiversion protocol group. The average length of stay for the diversion and nondiversion groups was 9.8 days (range, 7-15) and 7.2 days (range, 4-10), respectively. There were no complications associated with rectal injuries in either group. CONCLUSIONS: Nondestructive penetrating rectal injuries can be managed successfully without fecal diversion. Randomized prospective study will be necessary to assess this management method.

Abdominal Injuries↗
PubMed2005

Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised).

The American Society of Colon and Rectal Surgeons is dedicated to assuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Standards Committee is composed of Society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This Committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by developing Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive, and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. It should be recognized that these guidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all of the circumstances presented by the individual patient.

Abscess↗
PubMed2005

Practice parameters for the surgical treatment of ulcerative colitis.

The American Society of Colon and Rectal Surgeons is dedicated to assuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Standards Committee is composed of Society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by developing Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive, and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. It should be recognized that these guidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all of the circumstances presented by the individual patient.

Colectomy↗
PubMed2005

Enterocolitis associated with cocaine use.

PURPOSE: Cocaine use has been reported to cause gastrointestinal complications. This retrospective review describes the presentation and clinical course of cocaine-associated enterocolitis. METHODS: Charts with a diagnoses of colitis or abdominal pain, between 1991 to 2001, were reviewed for a positive urine drug screen or documented cocaine use. Data about the patients' symptoms and physical findings, results of clinical studies, and outcome were collected. RESULTS: There were 18 patients identified. The interval from last use to the onset of pain was fewer than one day for seven patients, one to three days for seven patients, and more than three days for four patients. Physical examination demonstrated diffuse peritonitis in 2 patients, tenderness localized to a single quadrant in 11 patients, and tenderness in two or more quadrants in 5 patients. Computed tomography was obtained in 11 patients with 10 demonstrating signs of inflammation or ischemia. The anatomic locations of disease were proximal colon (14 patients), small bowel/gastric (1 patient), and distal colon (3 patients). The initial management was nonoperative in 15 patients. One patient presented in shock and died. Another developed peritonitis and underwent laparotomy. Surgical intervention occurred in four patients (3 initially, 1 on Day 4) for peritonitis. Two died postoperatively, a 50-percent surgical mortality. CONCLUSIONS: Cocaine-associated enterocolitis usually presents within three days of cocaine use. Inflammatory or ischemic changes are most common in the proximal colon. The majority of patients will recover with nonoperative therapy; however, those who develop peritonitis and undergo laparotomy have a 50 percent mortality.

Adult↗
PubMed2004

Anterior levatorplasty for the treatment of chronic anal fissures in females with a rectocele: a randomized, controlled trial.

PURPOSE: It is postulated that an anterior anal fissure can result from mucosal trauma occurring during distention of a rectocele and that repair of the rectocele by anterior levatorplasty can lead to healing of these anal fissures. This study was designed to compare anterior levatorplasty with internal sphincterotomy for the management of anterior anal fissures in females with a rectocele. METHODS: From June 2000 until May 2002, 54 consecutive females with an anterior anal fissure and a rectocele were randomized to be managed by internal sphincterotomy or anterior levatorplasty. Preoperatively, manometry was performed, continence was measured using the Cleveland Clinic scoring system, pain scores were obtained using a visual analog scale, and the symptoms of bleeding and straining to defecate were assessed. Postoperatively, pain scores were obtained at Days 2, 7, and 21. Manometry, continence scores, and resolution of symptoms were measured between 8 and 12 weeks. Patient satisfaction and fissure healing also were assessed between 8 and 12 weeks. The average length of follow-up was 20 (range, 6-30) months. RESULTS: Postoperatively, lateral sphincterotomy caused a decrease in the resting pressures and anterior levatorplasty resulted in an increased length of the anal canal. Anterior levatorplasty also caused increased postoperative pain scores. There were no differences in fissure healing and patient satisfaction. CONCLUSIONS: These data suggest that anterior levatorplasty is an option for the management of patients with a rectocele, which may avoid the risk of incontinence with lateral internal sphincterotomy and better address the etiology of anterior anal fissures.

Adult↗
PubMed2002

Laparoscopy-assisted loop ileostomy: an acceptable option for temporary fecal diversion after anorectal surgery.

PURPOSE: Temporary fecal diversion may be desired after many anorectal procedures. The aim of this study was to describe a technique for laparoscopy-assisted creation of a loop ileostomy in patients undergoing anorectal and perineal surgery and to relate short-term outcomes. METHODS: A retrospective review of the medical records of 53 consecutive patients who underwent laparoscopy-assisted creation of a loop ileostomy as an adjunct to anorectal or perineal surgery between 1993 and 1999 was performed. Data were obtained for age of the patient, previous abdominal surgical procedures, anorectal or perineal surgical procedure performed, American Society of Anesthesiology scores, operative times for both creation and takedown of the ileostomy, and postoperative return of bowel function. RESULTS: The average duration of operation for laparoscopy-assisted creation of the loop ileostomy was 47 (range, 28-75) minutes, with no conversions to laparotomy. All patients were able to tolerate a regular diet on the first postoperative day. Closure was accomplished 69 (range, 63-96) days later with an average operative time of 52 (range, 35-90) minutes. One patient developed ileus after takedown of his stoma. The other 52 patients were able to tolerate a regular diet by the second postoperative day. CONCLUSION: Laparoscopy-assisted creation of a loop ileostomy is an effective method for temporary fecal diversion in patients undergoing anorectal surgery.

Adult↗