Biomedical subjects

R Stitz

Publications and source records attributed to R Stitz.

8 recordsLinked to original sources

PubMed1997

Laparoscopic colectomy.

BACKGROUND: Laparoscopic colectomy has developed with the explosion of technology that has followed laparoscopic cholecystectomy. Accumulation of skills in general laparoscopic surgery has made complex surgery, such as colectomy, feasible. METHODS: Three hundred fifty-nine laparoscopic cases were prospectively studied. Data has been kept on benign and malignant cases, operative results, hospital stay, and morbidity. Special care has been taken to follow malignant cases, looking for recurrence of disease. RESULTS: There were 359 cases (206 females, 153 male) average age 58.8 years (18-94), and 149 patients had malignancy. All types of resections were performed, including 151 anterior resections, 66 right hemicolectomies (RHC), 36 total colectomies, and 22 rectopexies. Operating times fell with experience-the last 20 cases of anterior resection took 150 min (110-240) and of RHC took 130 min (65-210). Twenty-six (7%) cases were converted to open surgery. Hospital stays for anterior resection lasted 5-7 days (2-33); in the last 20 cases the average stay was 4 days. Morbidity included seven leaks (2.7%), four strictures (1.2%), 12 wound infections (3.3%), and nine ileus (2.5%). There were six deaths within 30 days-sepsis, myocardial infarction, aspiration pneumonia, and disseminated liver metastases. One hundred forty-nine cancer cases have had ten recurrences: one pelvic recurrence, six liver metastases, two para-aortic nodal, and one case of disseminated disease. Average time of recurrence was 33 months (15-46 months). CONCLUSIONS: Laparoscopy in the hands of experienced laparoscopic surgeons is a safe, efficient procedure. All types of procedures are possible. Early results in 149 malignancies are encouraging and recurrence rates are low. Prospective studies, now that skills are developed to a level comparable to that of open surgery, are now being performed to further assess laparoscopy's possible role in treating cancer.

Adolescent↗

PubMed1996

A long-term follow-up of patients undergoing colectomy for chronic idiopathic constipation.

BACKGROUND: Chronic idiopathic constipation is a condition that mainly affects young women and is commonly associated with symptoms of abdominal pain and bloating. It has been proposed that patients with severe symptoms who are unresponsive to conservative measures can be managed by colonic resection. The aim of the present study was to assess the long-term outcome of such surgery on patients with a diagnosis of chronic idiopathic constipation. METHODS: Ninety-six patients (92 females, 4 males) underwent either a total colectomy and ileorectal anastomosis (n = 86) or subtotal colectomy and caecorectal anastomosis (n = 10) between 1986 and 1994. RESULTS: Postoperative mortality was 2.1%, 3.1% suffered from an anastomotic leak and 11.5% developed a pelvic abscess. Follow up was completed in 92.7% of patients at a mean of 5.0 +/- 2.3 years. Following surgery, symptomatic improvement was reported by 81.6% of patients. However, 51.2% still experienced difficulty with straining, 50.6% had some degree of anal incontinence, 55.2% continued to experience abdominal pains and 75.9% continued to be troubled by abdominal bloating. Reoperation was performed on 35.6% of patients (mainly for division of adhesions), and 9.2% of patients required an ileostomy. CONCLUSIONS: Colectomy is associated with relief of constipation in a majority of patients with chronic idiopathic constipation. However, it is associated with a considerable morbidity and is less effective in resolving symptoms of abdominal pain and bloating.

Adolescent↗

PubMed1996

Laparoscopic anterior resection: a consecutive series of 84 patients.

Laparoscopic colorectal surgery is in its infancy. From a series of over 200 colorectal procedures undertaken over the last 30 months, we have performed 84 anterior resections. In 55 women and 29 men, median age 64 years (range 32-86), median weight 72 kg (range 36-125), surgery was undertaken for benign pathology (n = 57) and adenocarcinoma (n = 27). Anterior resection was completed laparoscopically in 75 cases (89%) with a median operating time of 210 min (range 85-420). Minor morbidity occurred in 17 patients (20%) with major morbidity in 10 cases (12%). There was one post-operative death. Flatus was passed a median of two days (range 1-7) after surgery and feces at a median of four days (range 2-9). Total hospital stay was six days (range 2-33). Delayed morbidity during a maximum of 30 months' follow-up included two anastomotic strictures but no evidence of malignant seeding. Laparoscopic anterior resection appears both feasible and safe for both benign and malignant disease, with the caveat that long-term outcome in malignant disease is not yet available.

Adult↗

PubMed1995

The treatment of internal fistulae that complicate diverticular disease of the sigmoid colon by laparoscopically assisted colectomy.

Seven patients with internal fistulae complicating colonic diverticular disease were treated by laparoscopic assisted colectomy over a 24-month period. Prospective review of these patients was carried out to ascertain efficacy of the treatment. No intraoperative complications were encountered and return of gastrointestinal function was apparent within two days in all cases. Postoperative hospital stay was limited to an average of 4.7 days. No long-term complication or fistula recurrence has been noted in the mean 11-month follow-up period. This study indicates laparoscopic assisted colectomy is an effective means of treatment for diverticular fistulae.

Aged↗

PubMed1995

Harry E. Bacon Oration. Comparison of the functional results of restorative proctocolectomy for ulcerative colitis between the J and W configuration ileal pouches with sutured ileoanal anastomosis.

PURPOSE: This study was designed to compare function of patients who had undergone reconstruction following proctocolectomy for ulcerative colitis using the J or W configuration ileoanal pouch. METHODS: Of 126 patients who underwent restorative proctocolectomy between January 1981 and March 1993, 101 had surgery for ulcerative colitis. Eighty-seven of these patients were available for review by personal or postal interview. All operative procedures were performed by one surgeon. The group comprised 35 W-pouches and 52 J-pouches. RESULTS: More patients with a J-pouch had a stool frequency of greater than 8 per 24 hours (P = 0.044), and they were also more likely to use a perineal pad (P = 0.019). No difference in the rates of nocturnal stool frequency, fecal incontinence, or use of constipating agents between the two pouch designs was found. Significantly more patients with a J-pouch have had episodes of pouchitis (P = 0.001). Of the total patient group 91.9 percent felt that restorative proctocolectomy had improved their quality of life. CONCLUSION: Minor differences in the function of the W configuration ileoanal pouch and the J configuration ileoanal pouch are demonstrated in this study.

Adult↗

PubMed1992

Loss of heterozygosity at the human RAP1A/Krev-1 locus is a rare event in colorectal tumors.

Kirsten-ras-revertant-1 (Krev-1/Rap1A) is a recently identified tumor suppressor gene which induces flat revertants when introduced into a variety of ras-transformed cell lines in vitro. Since 47% of colorectal carcinomas have transforming mutations in ras protooncogenes, and since Krev-1 is expressed at high levels in normal colonic mucosa, we hypothesized that inactivation at the Krev-1 locus may be necessary for transformation of colonic cells. Loss of heterozygosity is a common method of inactivation of tumor suppressor genes in colorectal tumors. Therefore, we analyzed loss of heterozygosity in 52 patients with sporadic colorectal cancer. Because Krev-1 had no previously described polymorphisms, we first identified a BclI restriction fragment length polymorphism which showed 40% heterozygosity in 50 unrelated individuals. However, only one tumor from 18 informative patients showed allelic loss at the Krev-1 locus. This suggests that loss of heterozygosity is not a common mechanism of inactivation at the Krev-1 locus in colorectal cancer. However, the results do not exclude a role for Krev-1 in the etiology of this neoplasm because inactivation may occur by other mechanisms.

Alkaline Phosphatase↗

PubMed1992

Single dose ceftriaxone as prophylaxis for sepsis in colorectal surgery.

During the period May 1986 to July 1989, a prospective, double blind, randomized trial of antibiotic prophylaxis in colorectal surgery was undertaken at the Royal Brisbane Hospital. Three hundred and thirty patients were considered eligible for the trial. Three regimens were compared: a combination of 2 g ceftriaxone and 1 g metronidazole; a single dose of 2 g ceftriaxone; or 1 g cefazolin and 1 g metronidazole, as antibacterial prophylaxis in colorectal surgery. Fifty patients were excluded from analysis. The overall incidence of wound sepsis was 7.9% (22 patients). There was no statistical difference in the incidence of wound infections between the three groups. The presence of drains and the non-performance of a bowel anastomosis at the time of surgery predisposed patients to wound infection. Staphylococcus aureus or Staphylococcus epidermidis were the cause of wound infection in 16 cases. Patients in the cefazolin and metronidazole group had a significantly higher number of postoperative urinary tract and respiratory tract infections than the other two groups combined (P less than 0.01). There did not appear to be any change in sensitivity patterns to ceftriaxone during the 3 year trial. During the 3 year period of the study, ceftriaxone was found to be a safe and effective drug in antibacterial prophylaxis in colorectal surgery.

Cefazolin↗

PubMed1987

Carcinoma of the anal canal.

During the period 1973 to 1982, 35 patients with carcinoma of the anal canal were seen at this hospital. The main form of treatment was abdominoperineal excision, unless specific contraindications to this procedure were present. Between 1982 and 1984, a further 18 such patients were seen; the primary method of treatment then was combination chemotherapy and radiotherapy. Abdominoperineal excision was reserved for those patients who failed to respond to therapy or whose carcinoma recurred during the period of follow-up. The over-all five-year survival rate for the first 35 patients was 50%; the actuarial disease-free survival at two years for those who went into complete remission was 78% in the 18 patients who were seen in the second part of the study. We conclude that conservative treatment by chemoradiation is of value in the management of anal carcinomas.

Adult↗