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Biomedical subjects

D P Launer

Publications and source records attributed to D P Launer.

5 recordsLinked to original sources
PubMed1991

Pouch-anal anastomosis without diverting ileostomy.

Ileal diversion is an important adjunct to restorative proctocolectomy but may produce increased morbidity and requires a second-stage closure. This study reports results utilizing a one-stage procedure designed to retain the benefits of proximal decompression without the liabilities of additional surgical procedures. Eight patients, three men (with ulcerative colitis) and five women (one with familial polyposis coli and four with ulcerative colitis), were selected for the single-stage restorative proctocolectomy with intraluminal decompression in lieu of diverting loop ileostomy. The abdominal proctocolectomy was performed to the level of the anorectal junction. In five patients, the rectum was closed using the TA 55 (U.S. Surgical Corporation, Norwalk, CT), 4.8-mm stapler. AJ-pouch was constructed with multiple firings of the GIA90 (U.S. Surgical Corporation) stapler. These patients had continuity restored utilizing a transanal, circular stapler. Three patients had an S-pouch constructed by suture technique. Fecal diversion was accomplished with a 25-mm intraluminal bypass tube (Coloshield; Deknetel, Fall River, MA) in all cases. There was no mortality. There were no anastomotic complications or morbidity related to the bypass tube. The tube dislodged and passed between days 18 and 26 (mean, 22.1 days). All patients had three to six bowel movements per 24 hours, and all are continent day and night. This experience suggests that, in selected patients, the intraluminal bypass tube may be an excellent alternative to diverting ileostomy.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

The Ripstein procedure: a 16-year experience.

A retrospective study was undertaken, evaluating 54 patients who underwent 57 Ripstein procedures at the Cleveland Clinic Foundation during the years 1963-1978. The patients were evaluated for their preoperative characteristics as well as early and late postoperative results. Patients who experience procidentia are generally middle-aged women who have had previous gynecologic and anorectal surgery and who generally had significant disorders of bowel function. Although the operative mortality was zero, and the majority of patients were satisfied with the results of their Ripstein procedure, there was significant operative morbidity (26 per cent). Twelve and one-half per cent of patients had recurrent rectal prolapse, and 18 per cent of patients had significant long-term obstructive symptoms. The Ripstein procedure still remains the treatment of choice for rectal prolapse.

Adolescent↗
PubMedDate not supplied

Colorectal infarction following resection of abdominal aortic aneurysms.

Infarctions of the colon and rectum (incidences approximately 1 and 0.5 per cent, respectively) are caused by compromised collateral circulation to the colon and rectum, usually as a result of arteriosclerotic disease of the superior and inferior mesenteric arterial systems, as well as the hypogastric arteries. Patients who have colorectal ischemia after operations for abdominal aortic aneurysms have diarrhea (sometimes bloody), abdominal pain, and distention. The diagnosis may be established by sigmoidoscopic examination. Treatment includes surgical removal of the compromised bowel and creation of a temporary or permanent end colostomy. Prevention of this complication is aided by preservation of primary and collateral circulation, avoidance of hypotension, and preoperative bowel preparation.

Aorta, Abdominal↗
PubMedDate not supplied

Thoracoscopic partial pericardiectomy in 13 dogs.

Thirteen dogs with cardiac tamponade resulting from pericardial effusion were prospectively evaluated to determine feasibility and outcome of thoracoscopic partial pericardiectomy. A lateral thoracoscopic approach allowed adequate exposure to remove a 4- to 5-cm-diameter section of pericardium in all dogs. Complete resolution of cardiac tamponade occurred in all dogs for which there was follow-up (11 dogs). Ten of 13 dogs (76.9%) had neoplastic pericardial effusion. One of these dogs remains alive at 220 days postoperatively and is asymptomatic. The mean survival of the remaining 9 patents with neoplastic effusion was 128 days (range, 14-544 days; median, 38 days). Three of 13 patients (23.1%) had idiopathic pericardial effusion. Two of these dogs remain alive at 585 and 1,250 days postoperatively. One dog with idiopathic pericardial effusion developed cardiomyopathy and was euthanized 18 days after the procedure. Results indicate that the procedure was technically successful in all dogs. No anesthetic complications occurred. Procedural complications included phrenic nerve transection (1 dog), lung laceration (1 dog), and moderate intraoperative bleeding (1 dog). No adverse clinical manifestations of the complications were apparent. We conclude that thoracoscopic partial pericardiectomy is technically feasible and offers several advantages over conventional open thoracic surgical pericardiectomy.

Animals↗