Biomedical subjects

M Nafe

Publications and source records attributed to M Nafe.

7 recordsLinked to original sources

PubMed1996

[Defecation flowmetry. A new study technique for evaluating the evacuation function of the rectum].

In a prospective study carried out on 78 patients with chronic constipation (31, with slow transit, 47 with obstructive defecation disorders) the evacuation function of the rectum during defecation was assessed by defecoflowmetry. These patients were compared to a control group of normal volunteers (n = 32). The following parameters were evaluated: defecation and retention volume, defecation fraction, defecation time, maximum flow, mean flow rate and time to maximum flow. As expected, there was no difference in evacuation function between the group of patients with slow transit and the control group. Significant differences, however, existed between the two types of constipation, as well as between obstructive defecation disease and controls, regarding all parameters mentioned above. Evacuation function depends neither on rectal neck pressure nor on intrarectal pressure. In patients with obstructive defecation disorders, three subgroups were discernable: one with prolonged time of defecation and satisfactory evacuation, one with prolonged time of defecation and poor evacuation, and one small group of patients who were not able to defecate. Each group is based on a different underlying pathomechanism. We conclude that changes in evacuation function of the rectum refer either to volume or to time of defecation, or to both. Changes are found only in obstructive type constipation, not in slow transit constipation. Therefore, defeconflowmetry as a dynamic procedure can be used in screening for the classification of chronic constipation.

Adult↗

PubMed1996

[Endo-anal and transperineal continence preserving closure techniques in surgical treatment of Crohn fistulas. A prospective long-term study of 186 patients].

UNLABELLED: Our aim was to review the results and to investigate the prognosis in a prospective study of aggressive surgical treatment in 186 patients (59% women, 41% men, age 18 to 65 years) treated during the past 9 1/2 years by conventional laying open of the fistula (n = 71), endorectal advancement flap repair (n = 89) and by fistulectomy without internal sphincterotomy (n = 37). 54 (29%) patients had intersphincteric, 57 (30.5%) transsphincteric, 10 (5.5%) suprasphincteric, 37 (20%) low rectovaginal and 28 (15%) had complex fistulas without internal opening. Four sphincter saving techniques were performed by the high and fistulas (n = 89) with primary occlusion of the intraanal ostium and endorectal mucosal flap (n = 29), endorectal advancement flap (n = 41), anodermal flap (n = 8) and transperineal repair with levator interposition (n = 11). Postoperatively 18 cases (20.2%) of suture leakage occurred, 27% in the mucosal flap group, 17.6% in the advancement flap group, 12.5% in the anodermal group, and 27% in the transperineal group. A complete primary healing of perianal wounds was noted in 73% of the patients within 6 months. The presence of rectal disease (n = 77) did not adversely influence the rate and duration of healing. Persistent or recurrent fistula occurs in 29 patients (15.6%), 22% in the sphincter saving group, 4% in the intersphincteric group and 32% in the complex type of fistulas. Disturbance of continence was observed in 9 patients (4.8%). Postoperatively, there was no significant change in resting anal pressure and maximum voluntary conctraction pressure in any fistula group (n = 104). CONCLUSION: The presented clinical and functional long term results of patients with Crohn's fistulas underline the importance of experience in the treatment of perianal fistula disease. A successful treatment depends primarily on an aggressive therapeutic strategy and the appropriate method of operation.

Adolescent↗

PubMed1995

[Transanal rectal advancement flap versus mucosa flap with internal suture in management of complicated fistulas of the anorectum].

A prospective study was carried out on 55 patients with complicated anal fistulas (41 transsphincteric, 5 suprasphincteric and 9 rectovaginal) to evaluate the value of two sphincter-conserving techniques with primary occlusion of the internal ostium and endorectal advancement flap (group A, n = 34) or mucosal flap (group B, n = 21). Ten of the patients had Crohn's disease. Both techniques consist in one-stage fistulectomy without drainage of the intersphincteric space. The inflamed proctodeal and granulation tissue was carefully cleared. The site of the former primary orifice of the fistula was adapted by means of two or three peranally performed single stitches. The peranally applied suture included the layers of the internal anal sphincter muscle only. A mobilized flap of rectal wall (group A) and rectal mucosa and submucosa (group B) about 4 cm x 3 cm in size was stitched below the muscular sphincter. The perianal part of the wound was left to heal by second intention. Postoperatively there were 16 cases of suture leakage (23.5% in group A, and 38% in group B), and 19 patients (26% or 47% in both groups) had to have revision surgery because of recurrent fistula or sutur leakage; 2 patients (3.6%) developed incontinence with intermittent fecal soiling. Complete incontinence was not observed in any patient. No significant difference in clinical and functional results was determined between the two groups.

Anal Canal↗

PubMed1994

Treatment of high anal fistulae by primary occlusion of the internal ostium, drainage of the intersphincteric space, and mucosal advancement flap.

In a prospective study on 224 patients with so-called high-fistula in ano (189 transsphincteric, 35 suprasphincteric) the long-term results of a sphincter-saving operation technique were assessed. The follow-up period was 1 to 7.5 years. This technique consists of one-stage fistulectomy as well as of drainage of the intersphincteric space by internal sphincterotomy. The site of the former primary orifice of the fistula is adapted by multiple peranally performed single stitches, including mucosal advancement flap distal to the original fistulous opening. Postoperatively, 24 cases of suture leakage occurred (9% with the transsphincteric and 20% with the suprasphincteric fistula). 27 patients developed late complications like fistula recurrences or combinations of fistula and anal abscess (10.7% with the transsphincteric and 19.9% with the suprasphincteric fistula). Anal manometry was carried out preoperatively as well as postoperatively. A significant decrease in the postoperative resting pressure compared to the preoperative value was determined. The two fistula groups differed statistically both with regard to the resting pressure and the contraction pressure. Significant impairment of continence developed in 21% of patients with transsphincteric fistula but in 43% of patients with suprasphincteric fistula (intermittent fecal spoiling/use of perineal pads). The total percentage of complications rose with the number of previous fistula operations.

Drainage↗

PubMed1994

[Results of anterior levator and externus-plasty in idiopathic anorectal incontinence. A prospective manometric, electromyography and radiology study].

A prospective clinical manometric and radiological study has been performed, before and after anterior levatorplasty and sphincter plication on 18 patients (mean age 61.6 years) with neurogenic faecal incontinence. Continence was improved on 15 (83%) patients, 13 (72%) patients were continent to solid and liquid stool, 3 (17%) of whom regained normal continence only, at a minimum of 6 months follow-up (phi 21.5 months). Postoperatively there was a significant increase in the resting anal pressure (p = 0.05) an maximum voluntary contraction pressure (p = 0.001). No significant change in sphincter length, duration of the action potentials, pudendal nerve terminal motor latency (PNTML), pelvic descent or anorectal angle was seen postoperatively. The incontinence and defaecation-score showed postoperatively a significant difference concerning soiling, time from urgency to defaecation, and discrimination between flatus and stool.

Aged↗

PubMed1994

[Indications and technique of retro-ileal colorectal anastomosis after expanded left-sided hemicolectomy].

Retroileal colorectal anastomosis following a complete resection of left-sided colon was performed in 28 patients with differing diseases of the colon. Concerning the rate of leakage of anastomosis dextraposition appeared to be as safe as conventional techniques. Turnbull originally created this technique to perform a tension-free anastomosis after resection of the left sided colon. In doing so the retained colon reduces the risk of incontinence especially seen with elderly patients.

Adult↗

PubMed1994

[Postoperative results of colostomy and ileostomy closure. A retrospective analysis of three different closure techniques in 182 patients].

On 182 patients undergoing closure of a stoma 149 colostoma and 33 ileostoma closures were performed. The complication rate with 5-8% leakages in site of the anastomosis comes out very high. Furthermore the surgeon has to count with a high quote of wound infections. The complication rate of the ileostoma closures with 18% appears distinctly higher than those of the colostoma closures with 6.7%. One patient belonging to the group of colostoma closures died. The extraperitoneal closure with Turnbull's procedure was conspicuous by reason of the high rate of enterocutaneous fistulas and the high rate of incisional herniations, so that this method should only be used in special cases. We routinely enforce an intraperitoneal closure of the stoma. The resection with an end-to-end anastomosis in comparison to the suture of the anterior wall implies in our opinion neither advantages nor disadvantages.

Adult↗