Biomedical subjects

P N Morreau

Publications and source records attributed to P N Morreau.

5 recordsLinked to original sources

PubMed1999

Comparison of results of laparoscopic and open antegrade continence enema procedures.

Several modifications of the Malone antegrade continence enema (ACE) procedure have now been reported. In this study we have compared the results of our experience with the laparoscopic appendicostomy (LACE procedure) with the published results of previously described open ACE procedures. Children who had the LACE procedure at our institutions were reviewed. Intra- and postoperative problems were identified by review of hospital case notes and from a questionnaire completed by the children's caregivers. These results were compared with the reported results of the original Malone procedure, the Peña modification, and the open appendicostomy as described by Wilcox. Since 1994, 30 children have had LACE procedures performed at our institutions. Two have required conversion to an open procedure because of difficulty locating the appendix. The stoma is being used for regular antegrade colonic washouts in 29 of the 30, compared with 19 of 31 in Malone's series and 16 of 20 in Peña's. Improvement in soiling has been achieved in 27 (90%) of our patients, 15 of whom are completely clean, a rate similar to that of the other types of procedure (61%-78%). Stenosis of the stoma has occurred in 8 children (27%), compared with rates of 10%-33% in other series. Stomal leakage has been troublesome for 2 (6.7%), compared with leak rates between 5.6% and 15% in other series. The LACE procedure is technically the simplest. The laparoscopic approach to the ACE procedure appears to be a simpler and safe alternative to previously described methods. It causes minimal morbidity, has a high long-term viability rate, and resulted in improved control of soiling in 90% of the children with faecal incontinence in whom it has been employed.

Adolescent↗

PubMed1999

Early experience with the laparoscopic ace procedure.

BACKGROUND: In 1990 Malone et al. introduced the reversed appendicocaecostomy as a technique to enable an antegrade continence enema (ACE) to be administered. The aim is to achieve colonic emptying and thus prevent soiling in children with faecal incontinence. The procedure has been modified by suturing the opened appendix directly to the skin as a stoma, and can now also be performed laparoscopically. METHODS: All children undergoing laparoscopic ACE procedures at Christchurch Hospital, Christchurch, New Zealand and Princess Margaret Hospital, Perth, Australia, were reviewed. Intra-operative and postoperative problems were identified retrospectively and questionnaires were completed by the children's caregivers detailing their experience with managing their children following the ACE procedure. RESULTS: Thirty children have had a laparoscopic ACE procedure performed since 1994. Two required conversion to an open procedure because of difficulty locating the appendix. Twenty-nine children are currently using the stoma for regular antegrade colonic washouts. Improvement in continence was seen in 27 children, 15 of whom have been completely continent. Stenosis of the stoma occurred in eight children, two of whom required operative revision of the stoma; the others have been managed by daily dilatation, either with the irrigation catheter or a small perspex dilator. More recently, spatulating the appendix tip has reduced the incidence of stenosis. Two children have had troublesome leaks. CONCLUSIONS: The laparoscopic approach to the ACE procedure results in an improved level of continence in this difficult group of children with faecal incontinence. It is a simpler alternative to previously described methods and causes minimal morbidity. Results to date suggest a satisfactory outcome for both the children and their families.

Child↗

PubMed1999

Case report: Colonic duplication: a rare cause of obstruction.

Complete duplication of the entire large bowel with partial ileal involvement is very rare and diagnosis can often be difficult as illustrated by this case report. We also review the other clinical associations of this rare condition and briefly discuss the embryology of duplications of the gastrointestinal tract.

Child↗

PubMed1999

Plastic migration from implanted central venous access devices.

BACKGROUND: This is the first reported study of histologically confirmed migration from intravenous access devices in children. METHODS: The capsules from around intravenous access devices were examined by light microscopy to determine the extent of the foreign body response; energy dispersive x ray analysis was performed to document the elemental content of the foreign material. RESULTS: A fibroconnective tissue capsule was found around all the samples. Elemental silicon was found in six of 13 tissue samples, and a foreign body giant cell reaction was seen in three of these. CONCLUSIONS: The pseudocapsule that surrounds an implanted vascular access device often has residual foreign material, including silicone.

Catheterization, Central Venous↗

PubMed1998

Tumour cell wound distribution after colectomy in a porcine model.

BACKGROUND: Concerns over tumour implants have impeded the adoption of laparoscopic surgery for cancer. Explanations assume an increased number of malignant cells present in trocar wound sites. The following are tested in the present paper: (i) that the magnitude of wound contamination following surgery is related to the location of the tumour cells; and (ii) the surgical approach. METHODS: We have used a porcine sigmoid colectomy model to compare the number of tumour cells on laparoscopic wounds after resections in the presence of intraluminal, intramural and intraperitoneal 51Cr-labelled, fixed HeLa tracer cells. Open colectomies were also performed in the presence of intraperitoneal tracer cells and their numbers on laparotomy wound surfaces were determined by gamma counting. RESULTS: With intraperitoneal cells, laparotomies had 1087 (+/- 106) tracer cells per mm (n = 4) while trocar wounds had 103 (+/- 54) cells per mm (n = 10) (P > 0.05). Resection of intramural tumours resulted in lower trocar wound contamination (0.9 +/- 0.6 cells/mm, n = 3). Resection of colon including intraluminal tracer cells resulted in 2.9 +/- 2.1 cells/mm on trocar wounds (n = 3). CONCLUSIONS: More tumour cells were deposited on open than laparoscopic trocar wound surfaces. Also, the risk of wound implantation is less with intraluminal or intramural tumours than with intraperitoneal cells (P > 0.05).

Animals↗