Biomedical subjects

S A Fengler

Publications and source records attributed to S A Fengler.

5 recordsLinked to original sources

PubMed1997

Management of recurrent rectal prolapse.

PURPOSE: Many operations have been described for the management of rectal prolapse. Despite an overall recurrence rate of greater than 15 percent, few reviews address how to deal with this problem. This report summarizes our experience with recurrent rectal prolapse and includes suggestions for reoperative management of failed repairs from both abdominal and perineal approaches. PATIENTS AND METHODS: Fourteen patients (3 male) ranging in age from 22 to 92 (mean, 68) years underwent operative correction of recurrent rectal prolapse. Average time from initial operation to recurrence was 14 (range, 6-60) months. Initial operations (before recurrence) were as follows: perineal proctectomy and levatorplasty (10), anal encirclement (2), Delorme's procedure (1), and anterior resection (1). Operative procedures performed for recurrence were as follows: perineal proctectomy and levatorplasty (7), sacral rectopexy (abdominal approach; 3), anterior resection with rectopexy (2), Delorme's procedure (1), and anal encirclement (1). Average length of follow-up was 50 (range, 9-115) months. RESULTS: No further episodes of complete rectal prolapse were observed during this period. Preoperatively, three patients were noted to be incontinent to the extent that necessitated the use of perineal pads. The reoperative procedures failed to restore fecal continence in any of these three individuals. One patient died in the postoperative period after anal encirclement from an unrelated cause. CONCLUSION: Surgical management of recurrent rectal prolapse can be expected to alleviate the prolapse, but not necessarily fecal incontinence. Perineal proctectomies can be safely repeated. Resectional procedures may result in an ischemic segment between two anastomoses, unless the surgeon can resect a previous anastomosis in the repeat procedure. Nonresectional procedures such as the Delorme's procedure should be strongly considered in the management of recurrent rectal prolapse if a resectional procedure was performed initially and failed.

Abdomen↗

PubMed1997

The York Mason approach to repair of iatrogenic rectourinary fistulae.

BACKGROUND: We report our experience of 8 patients who underwent repair of iatrogenic rectourinary fistulae via the transsphincteric (York Mason) approach. PATIENTS AND METHODS: Eight patients developed rectourinary fistulae in the course of treatment of prostate cancer. Three fistulae developed after radiation therapy alone, three after prostatectomy, and two after both surgery and radiation therapy. Five patients underwent fecal diversion in conjunction with repair. RESULTS: All fistulae remained closed after repair. All patients were continent of stool after primary surgery or after colostomy closure if they had been diverted. Two patients had complications associated with urethral catheters that resolved with changing the catheters. CONCLUSION: The transsphincteric (York Mason) approach in the repair of rectourinary fistulae results in successful closure of the fistulae without impairment of continence to stool. This procedure is much simpler than complicated transabdominal or transperineal approaches to these fistulae.

Aged↗

PubMed1995

Pull-through procedures performed months to years after permanent proctectomy.

PURPOSE: Patients who have undergone proctectomy without concomitant rectal reconstruction or coloanal anastomosis were not normally considered candidates for re-establishment of anal continuity until a case report published in 1985. With the addition of nine patients, reported herein is a series of ten patients who have undergone delayed pull-through procedures months to years after permanent proctectomy. PATIENTS: Ten patients (including the single case reported in 1985) have undergone delayed pull-through procedures up to 24 years after permanent proctectomy and ostomy formation. Delayed ileal pouch-anal anastomoses were performed in nine patients, and delayed coloanal anastomosis was performed in one patient. There were four males and six females, each of whom had evidence of external sphincter contraction on physical examination. Average age was 33 (range, 24-51) years at the time of reconstruction. Average duration of follow-up is 32 (range, 1-96) months. RESULTS: One patient is awaiting ileostomy closure. Five of nine patients use constipating agents. Two patients are constipated and use enemas to aid in evacuation. None are wearing protective undergarments. One patient had his ileostomy reconstructed eight years after delayed pull-through for uncontrollable diarrhea associated with chemotherapy for multiple myeloma and recently died. Postoperative complications included wound infection (3), enterocutaneous anastomotic stricture requiring anoplasty (2), small bowel obstruction (1), pneumonia (1), presacral abscess (1), and pouchitis (1). CONCLUSIONS: Delayed pull-through procedures performed months to years after permanent proctectomy can be performed in selected patients, with results comparable to rectal reconstruction done at the time of proctectomy.

Adult↗

PubMed1990

Disseminated coagulopathies and advanced malignancies.

Among patients with various malignancies, three to 15 per cent may have associated idiopathic thrombosis. In a two-year period, we saw three patients with signs and symptoms demonstrating the association of neoplasia and coagulopathy. Their clinical courses and eventual outcomes are summarized. All had thrombophlebitis of multiple sites. There were difficulties in demonstrating their underlying occult malignancies, and all three patients showed resistance to oral anticoagulation drugs. Current hypotheses concerning the pathophysiology of coagulopathy associated with cancer are discussed, and recommendations for management of such patients were presented.

Adenocarcinoma↗

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↗