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G Pinedo

Publications and source records attributed to G Pinedo.

5 recordsLinked to original sources
PubMed2001

Percutaneous endoscopic sigmoidopexy in sigmoid volvulus with T-fasteners: report of two cases.

PURPOSE: We report two cases of percutaneous endoscopic sigmoidopexy in patients with sigmoid volvulus. METHODS: Two patients with recurrent sigmoid volvulus were considered unfit for resective surgery or general anesthesia (American Society of Anesthesiologists physical status III-IV). Fixation of the sigmoid colon to the abdominal wall was performed percutaneously under sedation in the endoscopy suite. Fixation was obtained using three T-fasteners in a triangular disposition in the bowel. The T-fasteners were cut at the skin after 28 days. RESULTS: Both procedures were successfully performed in approximately 20 minutes and were well tolerated. Feeding commenced the same day. One patient died after seven months of follow-up, without recurrence, of causes not related to volvulus. The other patient had no recurrence after 18 months of follow-up. CONCLUSION: The authors purpose was to show a new technique for colonic fixation performed in patients with recurrent sigmoid volvulus who otherwise had contraindication for elective surgery. Future studies will be required to verify the effectiveness and safety of this novel technique.

Aged↗
PubMed1999

Results of repeat anal sphincter repair.

BACKGROUND: Patients with a poor outcome from anterior sphincter repair may be candidates for dynamic graciloplasty, artificial bowel sphincter implantation or a secondary repair. This study examines the outcome of repeat overlap repairs in these patients. METHODS: Twenty-six of 235 patients undergoing a sphincter repair (median age 43 (range 23-63) years) underwent repeat repair from May 1994 to April 1997. Twenty-three patients were available for follow-up. Clinical evaluation included a satisfaction scale from 1 to 10, the patient's assessment of percentage improvement, ability to defer defaecation before and after operation, and Wexner continence scores before and after operation. Manometric studies were performed in 21 patients before and 17 patients after operation, and anal ultrasonography was undertaken in 17 patients before and 14 patients after operation. External sphincter defects were present on all preoperative scans. RESULTS: At a median follow-up of 20 (range 5-42) months, 15 patients felt that they were 50 per cent or more improved after operation. On the satisfaction scale of 1-10 the median score was 7 (range 1-10). There was a significant improvement in the Wexner continence score from 19 (range 17-20) before operation to 12 (range 1-20) after operation (P < 0.001). Ability to defer defaecation improved significantly from less than 5 min in all patients before operation to greater than 15 min in six patients after operation. Ultrasonography showed good overlap of the external sphincter muscle in eight of 14 patients. All patients who failed to improve showed a residual defect on ultrasonography. CONCLUSION: Repeat anterior repair produces a significant improvement in continence score and ability to defer defaecation in patients with obstetric sphincter damage. Clinical improvement correlates closely with an improvement in the appearance on endoanal ultrasonography.

Adult↗
PubMed1998

Labial fat pad grafts (modified Martius graft) in complex perianal fistulas.

Complex perianal fistulas may at times be very difficult to treat. New vascularised tissue can reach the perineum from leg muscles and the omentum. A less well-known source is the labial fat tissue (modified Martius graft) which has a robust posterolateral pedicle and which can be useful as an adjunctive technique for high anterior anal and rectovaginal fistulas. Between November 1993 and July 1997, eight women (age range 18-55 years) underwent modified Martius grafting, six of the eight having a rectovaginal fistula and two a high complex (suprasphincteric) perianal fistula. Anorectal advancement flaps were performed in five patients and three had a transperineal approach with simultaneous anterior sphincter repair because of concurrent anal incontinence. All patients had a defunctioning stoma. The fistula healed in six of the eight patients (75%) and recurred in two patients. The stoma has been closed in five of the eight patients (one patient's fistula has healed but her stoma cannot be closed because of anal incontinence). This is a useful technique when confronted with a difficult anterior fistula in women.

Adipose Tissue↗