Biomedical subjects

M A Luchtefeld

Publications and source records attributed to M A Luchtefeld.

24 records · Page 2Linked to original sources

PubMed1993

Rectopexy.

Many surgical procedures have been described for the management of full-thickness rectal prolapse. Currently, the three procedures most frequently used are anterior resection with or without suture rectopexy, transabdominal mesh fixation without resection, and perineal proctosigmoidectomy. Only the latter procedure avoids a laparotomy, and the mesh fixation technique has a high incidence of severe constipation postoperatively. Recently, there have been two reports of laparoscopic mesh fixation for rectal prolapse which were successful. However, the long-term concerns are probably very similar. Therefore, the purpose of this paper is to report a series of 6 laparoscopic-assisted anterior resections performed for rectal prolapse at Ferguson-Blodgett Hospital from January 1, 1992 through October 30, 1992. There were no perioperative mortalities and the only complication was a port site bleed which required re-exploration. The mean time for resumption of oral intake was 2.75 +/- 1.5 days and the length of hospital stay was 4.0 +/- 0.8 days. No early recurrences (< 1 yr) have been noted in this series. The authors feel that laparoscopic-assisted anterior resection is a safe and effective method of treating full-thickness rectal prolapse, thereby avoiding a laparotomy and reducing hospital stay.

Adult↗

PubMed1993

Open colectomy versus laparoscopic colectomy: are there differences?

Laparoscopic colectomy has been increasingly reported as an option for the treatment of colonic pathology. However, there is very little information regarding perioperative morbidity and the cost effectiveness of this technique. The purpose of this study is to review our first year of experience with laparoscopic colon resection. Data collected includes: age, technique (open laparotomy, laparoscopic, laparoscopic/converted open), Karnofsky score, complications, specimen size/nodes, OR time, hospital stay, and cost. This is a consecutive series of 140 elective colonic resections including 102 open laparotomies (O) and 38 laparoscopic (L) cases. The indications for surgery have included adenocarcinoma col/rect (O = 59, L = 9), diverticular disease (O = 10, L = 10), adenomatous polyp (O = 3, L = 7), IBD (Crohn's, CUC) (O = 15, L = 4), rectal prolapse (O = 3, L = 4), and other (O = 12, L = 4). There were no significant differences with respect to age (O = 60.7 +/- 1.5; L = 54.8 +/- 3.8; C = 66.1 +/- 3.1), perioperative morbidity (O = 11%; L = 15%; C = 17%). The laparoscopic and laparoscopic converted cases required significantly more time compared to the open laparotomy group (O = 2.1 +/- 0.2 hours; L = 2.9 +/- 0.2; C = 3.4 +/- 0.2). There were significantly less intraoperative blood loss associated with laparoscopic procedures compared with either open or converted groups of patients (O = 687 +/- 54 cc; L = 157 +/- 19; C = 491 +/- 50).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗

PubMed1991

Is colonoscopic screening appropriate in asymptomatic patients with family history of colon cancer?

Colonoscopy has been advocated by some investigators as the most appropriate means of screening asymptomatic patients with a positive family history of colorectal cancer. However, results of such screening have been widely disparate. The purpose of this study was to evaluate the yield of colonoscopy in a cohort of completely asymptomatic individuals with one or two first-degree relatives with a history of colorectal cancer and to compare this yield with that of colonoscopy in a group of patients with apparent anal bleeding. Patients with possible genetic disorders, such as familial polyposis, were excluded. A total of 160 asymptomatic patients and a comparison group of 137 patients with nonacute anorectal bleeding underwent colonoscopy. Colonoscopy was completed in 143 of the 160 study patients (89 percent) and in all of the comparison patients and did not result in any complications. Twenty-two adenomas were found in 17 study patients (10.6 percent); 16 of the 22 adenomas were less than 1 cm in size. In the comparison group, eight adenomas were identified (5.8 percent of patients). No cancers were identified. The difference in polyp frequency between groups was not significant. The relatively low yield of colorectal neoplasms discovered at colonoscopy in this study may in part be due to the small sample size or to the strict criteria used to define these asymptomatic patients but does not lend strong support to the notion that colonoscopy is an appropriate first step in screening the asymptomatic patient with one or two first-degree relatives with colon cancer.

Adult↗

PubMed1989

Colorectal anastomotic stenosis. Results of a survey of the ASCRS membership.

Anastomotic stenosis is a poorly understood and underexamined complication of gastrointestinal surgery, reportedly most frequent in the coloproctostomy. In order to better define this problem, a questionnaire was sent to members of the American Society of Colon and Rectal Surgeons regarding patients with gastrointestinal anastomotic stenosis. A total of 123 patients with intestinal anastomotic stenosis were analyzed. Eighty-two anastomoses were stapled and 41 were handsewn. Nearly all stenoses occurred in the distal bowel (70 rectal, 23 sigmoid colon). Preoperative risk factors identified were obesity (28 patients) and abscess (12 patients). Incomplete "doughnuts" were noted in 12 patients. Postoperative anastomotic leaks (15 patients), pelvic infection (13 patients), and postoperative radiation (7 patients) were believed to be contributing factors. Dilatation, using a variety of techniques, was the sole treatment for 65 patients, however, intra-abdominal surgery was necessary in 34 patients. Large intestinal anastomotic stenosis probably occurs most commonly following coloproctostomy (both with handsewn and stapled anastomoses). Dilatation alone resulted in adequate treatment in most patients in the study. Major surgery was required to correct this problem in a significant number of patients (28 percent) in this series. The true incidence of anastomotic stenosis in colorectal surgery is unknown and warrants further study.

Adult↗

PubMed1987

Late development of metachronous colorectal cancer.

The incidence of metachronous colorectal cancer has been reported to be 1 to 5 percent, with most of the cases being discovered within ten years of the initial cancer. A retrospective review of all colorectal cancer patients was conducted at the Southern Illinois University Affiliated Hospitals to determine the incidence of metachronous colorectal cancer at the authors' institution. In this study, a metachronous cancer was defined as a second colorectal primary occurring at least three years following discovery of the initial lesion. Between 1978 and 1984, there were 24 patients with metachronous colorectal cancer identified in an operative series of 707 patients for a frequency of 3.4 percent. These metachronous cancers were discovered at intervals ranging from 3 to 35 years. Sixteen (67%) metachronous lesions occurred 11 years of more after the original cancer. Synchronous or interval adenomatous colorectal polyps were noted in 17 (71 percent) of the patients. Thirteen of the metachronous cancers appeared in the right colon, while six were distributed throughout the transverse and descending colon, and five were in the rectosigmoid region. The incidence of late-appearing metachronous colorectal cancers and the propensity to occur in the right colon underscores the need for evaluation of the entire colon as part of lifelong follow-up of the colorectal cancer patient.

Adult↗

PubMedDate not supplied

Laparoscopic bowel resection.

Patient selection for laparoscopic colon surgery is a crucial factor in the success of the operation. Ideally, the underlying pathological process requiring an operation should be benign. Patients undergoing laparoscopic colon surgery are prepared preoperatively as for conventional laparotomy. However, problems may be encountered in positioning the patient because the procedure requires that the OR bed be rotated laterally and using Trendelenberg positions. Potential advantages of laparoscopic colon surgery primarily concern improved pain control and a shortened recovery period. However, the procedure takes longer to complete and overall costs may be higher.

Colectomy↗