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Biomedical subjects

R K Pearl

Publications and source records attributed to R K Pearl.

48 records · Page 3Linked to original sources
PubMed1985

Early local complications from intestinal stomas.

A retrospective review of 610 consecutive patients with intestinal stomas constructed at Cook County Hospital, Chicago, was carried out to analyze early local complications with respect to stoma type and to compare complication rates by surgical specialty. A total of 197 complications were recognized in 158 patients for a corrected complication rate of 25.9%. Peristomal skin irritation (42.1%) was the most frequently recognized early complication in this study. Ileostomy was associated with the highest morbidity (40%) of any type of stoma. Emergency stoma formation seems to be associated with the highest complication rates, probably because of suboptimal stoma placement. The morbidity of stoma formation seems to be related to the amount of formal training in gastrointestinal tract surgery. Technical guidelines for stoma construction are presented to help minimize these complications.

Adolescent↗
PubMed1985

Ileoanal anastomosis 24 years after total proctocolectomy for ulcerative colitis.

The efficacy of constructing an ileal pouch in association with an ileoanal anastomosis after mucosal proctectomy has been well established. Ordinarily, the pouch is fashioned at the time of mucosal proctectomy. This report describes a patient whose end ileostomy was successfully converted to a J-pouch 24 years after intersphincteric resection of his rectum for ulcerative colitis. Postoperative anal manometric data are presented, and the potential for applying this operation to other patients who have had previous intersphincteric rectal resections is discussed.

Anal Canal↗
PubMed1985

Parasacrococcygeal approach for the resection of retrorectal developmental cysts.

Congenital developmental cysts are the most common retrorectal tumors. Five adult patients, two men and three women, with congenital developmental cysts were operated on via a posterolateral approach through a parasacrococcygeal incision. All wounds healed primarily with no infection or other complications. Recurrent perianal infections and repeated anorectal operations suggest the possibility of retrorectal growths; thus diagnosis requires physician awareness. Computerized tomography is the best preoperative diagnostic test to delineate anatomy and to rule out bony involvement. Because of an infection rate of approximately 30 percent, as well as the presence of symptoms and malignancy in 8 percent of the patients, surgical excision is the treatment of choice. The authors use a posterolateral approach that provides excellent exposure and obviates the need for removal of the coccyx or transection of the sphincter muscle. The authors believe this to be the procedure of choice for excision of retrorectal cystic lesions.

Adult↗
PubMed1985

A survey of technical considerations in the construction of intestinal stomas.

Reported complications rates for the construction of intestinal stomas are high. Many of these complications result from improper construction, improper location, or other technical errors. In order to sample the techniques of stoma construction currently in use, a survey was conducted at the 69th Annual Clinical Congress of the American College of Surgeons in Atlanta in conjunction with our scientific exhibit "Complications of Intestinal Stomas." A total of 245 surgeons completed the questionnaire with a mean age of 47.8 years. The routine use of fascial-seromuscular tacking sutures and primary maturation of a loop colostomy in the presence of distal obstruction were among the most controversial technical points considered. Many other subtle but important principles of stoma construction were also discussed. In addition, the authors contend that many of the techniques currently in use result from an underemphasis on the importance of proper stoma construction in many surgical training programs.

Adult↗
PubMed1984

End-loop ileocolostomy for massive trauma to the right side of the colon.

In patients with severe trauma to the right side of the colon, who might have intraoperative contraindications to primary ileocolostomy, we use a new technique called end-loop ileocolostomy, which allows for complete diversion of the fecal stream with the distinct advantage that it precludes the need for formal laparotomy at the time of subsequent closure. This has been used successfully in eight patients.

Colon↗
PubMed1984

End-loop colostomy.

A new method of "end loop" colostomy is described which avoids the conventional large bulky loop colostomy. The proximal and distal lumens can be easily irrigated or studied. The possibility of prolapse of the distal limb of the colostomy is minimized. After proper training in irrigation, the patients are able to use a stoma cap instead of colostomy bags.

Colostomy↗
PubMed1980

Complete vagotomy. The evolution of an effective technique.

In the 36 years since the reintroduction of truncal vagotomy for the treatment of duodenal ulcer, recurrent ulcer at a rate of between 7% and 12% has become accepted as the most serious long-term postoperative complication. Although techniques for performance of complete vagotomy have been described, many of these principles of technique have been either forgotten or discarded. The new techniques of vagotomy, that is, selective and highly selective vagotomy, have realerted us to the necessity of performing a careful and wide anatomic dissection of all periesophageal tissue of the esophagogastric junction.

Duodenal Ulcer↗
PubMed1980

The use of a moldable plastic splint to minimize early postoperative thrombosis of an internal arteriovenous fistula in the high-risk renal dialysis patient.

An inexpensive moldable plastic wrist splint was developed to protect the site of an internal arteriovenous fistula from accidental thrombosis in the early postoperative period. This splint, or fistula guard, is easily constructed and has been successfully used in a series of 11 high-risk patients without reported discomfort by the wearer.

Arteriovenous Shunt, Surgical↗
PubMedDate not supplied

Colorectal cancer and peritoneal carcinomatosis.

Colorectal cancer ranks third in new cancer cases and in cancer deaths in men and women combined in the United States. Additionally, the probability of developing an invasive colorectal cancer over one's life-time is around 1 in 16. This amounts to approximately 133,000 new cancer cases and 55,000 cancer deaths yearly. Despite advances in adjuvant therapy for colorectal cancer, the peritoneal surface still remains a considerably high failure site for patients with recurrence of disease. Because of the favorable results of treating peritoneal metastases from ovarian cancer and pseudomyxoma peritonei with cytoreduction and intraperitoneal chemotherapy, this form of therapy has been investigated by several investigators in the management of patients with peritoneal metastases secondary to colorectal cancer. Preliminary studies seem to favor those patients with low-volume, low-grade peritoneal metastases, those with perforated cancers, and those patients in whom definitive cytoreduction is complete. Intraperitoneal chemotherapy with or without hyperthermia is a safe and logical way to administer dose-intensive therapy to the peritoneal cavity.

Antineoplastic Agents↗
PubMedDate not supplied

Technical considerations in the surgical treatment of colon and rectal cancer.

Surgery is the primary mode of therapy for colorectal cancer. Advances beyond exteriorization began to appear at the end of the nineteenth century. The antibiotic era brought on more advances. Dogma abounds with respect to the technical aspects of surgery for colon and rectal cancer and few randomized, prospective trials have been done to evaluate the importance of these techniques. Firmly established are the techniques of resection of lymphatic drainage of tumors, en bloc resection of invaded structures, and obtaining at least 2 cm margins of rectal cancers. Radical lymph node dissection, luminal ligation, oophorectomy, and the "No-Touch Technique" are discussed. Despite the paucity of irrefutable scientific data to support many of the described surgical techniques, differences in outcome between surgeons suggest that technique is important. There is great need for randomized, prospective trials to evaluate the multitude of techniques described for the surgical treatment of colorectal cancer.

Colectomy↗
PubMedDate not supplied

Parastomal hernias.

Parastomal hernia is a common complication of stoma formation, having an incidence of about 10%. As with many other ostomy-associated complications, most parastomal hernias are related to inadequate pre-operative planning or technical errors. Most of these hernias should be managed conservatively; only 10-20% of patients eventually require operative intervention. When an operation is indicated, relocating the stoma generally yields better long-term results than does an attempt at local repair of the hernia.

Colostomy↗