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S D Wexner

Publications and source records attributed to S D Wexner.

269 records · Page 15Linked to original sources
PubMed1989

Ileal pouch vaginal fistulas: incidence, etiology, and management.

Some of the initial problems associated with the ileoanal reservoir have been solved. In their place, other complications have been recognized. Among these, the ileal pouch vaginal fistula stands out as a recently recognized difficult management problem. This multicenter study was undertaken to gain insight into the causes for, and treatment of, pouch vaginal fistulas. Cases were gathered from 11 surgical practices throughout North America, in which the ileoanal reservoir procedure is frequently performed. Overall, 304 females had undergone ileoanal reservoir procedures by these surgical groups. Twenty-one patients developed 22 pouch vaginal fistulas for an overall incidence of 6.9 percent. Five additional patients with pouch vaginal fistulas, whose restorative proctocolectomies were done elsewhere, were referred to these surgeons for treatment. The courses of these 26 patients form the basis of this report. This study details the risk factors which predispose in the development of a pouch vaginal fistula, as well as the various treatment options available.

Adolescent↗
PubMed1988

Emergency colectomy for cytomegalovirus ileocolitis in patients with the acquired immune deficiency syndrome.

The charts of all patients with the acquired immune deficiency syndrome (AIDS) who underwent emergency intra-abdominal surgery between January 1981 and July 1987 were reviewed. Eleven AIDS patients underwent 13 emergency laparotomies. Seven of these patients (64 percent) had cytomegalovirus (CMV) ileocolitis as the pathologic process requiring emergent surgical intervention. Four patients had hemorrhagic CMV proctocolitis and three had perforations of CMV ulcers of the ileum or rectosigmoid. The operations performed included three subtotal colectomies, two segmental resections, and two diverting stomas. The postoperative mortality rate in the CMV group was 28 percent at one day, 71 percent at one month, and 86 percent at six months. Furthermore, CMV ileocolonic pathology was directly responsible for 70 percent of the deaths in AIDS patients who underwent emergent exploratory laparotomy.

Acquired Immunodeficiency Syndrome↗
PubMed1987

The demographics of anal cancers are changing. Identification of a high-risk population.

One hundred fifty-six consecutive cases of carcinoma of the anal canal and margin diagnosed between 1959 and 1986 were reviewed. There were 27 cases between 1959 and 1967, 41 between 1968 and 1976, and 88 between 1977 and 1986. Although the female-to-male ratio remained constant at 1.5:1, a high-risk group emerged, consisting of male patients with admitted homosexuality, bisexuality, or a history of anal condylomata acuminata. During the earliest period, 8 percent of male patients were in this group; this subset rose to 72 percent during the latest period (P less than .05). While the number of anal margin cancers has decreased, there has been a steady rise in the number of anal canal and in situ carcinomas, especially in the high-risk group.

Adenocarcinoma↗
PubMed1987

Mesenteric panniculitis of the sigmoid colon. Report of two cases.

Mesenteric panniculitis is an extremely rare disease in which the normal fatty architecture of the mesentery is replaced by fibrosis, necrosis, and calcification. Grossly, the mesentery is massively thickened and rubbery, with irregular areas of reddish-brown to pale yellow foci resembling fat necrosis scattered throughout. Microscopically, inflammatory involvement of the fibroadipose tissue shows round cells, foam cells, and giant cells. Macrophages that have ingested fat, also called lipophages, are the hallmark of the diagnosis. One hundred twenty-two cases of mesenteric panniculitis have been described in the literature; only three of these involved the large-bowel mesentery. This paper presents a review of the literature and two new cases that involve exclusively the mesentery of the sigmoid colon.

Humans↗
PubMed1986

The diagnosis and treatment of acute appendicitis in the aged.

Since the turn of the century, the elderly population, particularly those over the age of 80, has been increasing steadily. Consequently, the surgeon will be confronted frequently with the diagnostic challenge of acute appendicitis in this population. Over the past ten years, 13 patients over the age of 80 were treated for acute appendicitis at the St. Lukes-Roosevelt Hospital Center. The mean duration of symptoms was 2.4 days; all patients complained of abdominal pain, with 72 percent of patients having right lower quadrant involvement. Ninety-two percent had perforated prior to surgery, and 23 percent did not survive the disease. This high mortality rate is attributed to both a delay in presentation to the physician and a further delay in proper treatment due to misdiagnosis. This is a disease with which every physician must be familiar and be continually vigilant, as correct diagnosis and prompt treatment are the keys to averting high morbidity and mortality rates.

Aged↗
PubMed1986

The surgical management of anorectal diseases in AIDS and pre-AIDS patients.

The charts of 340 patients with Acquired Immunodeficiency Syndrome (AIDS), AIDS-related complex (ARC), or AIDS-prodrome (AIDS-P), treated between January 1982 and April 1986 at the Roosevelt Division of the St. Luke's-Roosevelt Hospital Center, were reviewed. The incidence of anorectal disease was 34 percent. Fifty-two patients (15 percent) presented with anorectal complaints prior to the diagnosis of AIDS, ARC, or AIDS-P. Over 50 percent of these patients were dead within 7.4 months. Fifty-one patients (15 percent) underwent 73 anorectal surgical procedures. Twenty-two of these patients (43 percent) were dead within six months, and only six patients had satisfactory wound healing 30 days after surgery. In addition to an 88 percent rate of poor healing, there was a 16 percent rate of major complications. Identification of these high-risk groups prior to any anorectal surgery is imperative to avoid unacceptable surgical complications. Aggressive surgical intervention should be reserved only for patients who did not fall into the high-risk groups presented.

AIDS-Related Complex↗
PubMed1986

The initial management of left lower quadrant peritonitis.

The majority of patients admitted to the hospital with left lower quadrant peritonitis and suspected acute diverticulitis are treated empirically without colon radiography either for the duration of their hospital course, or until such time as it is deemed safe to perform a barium enema to confirm this diagnosis. Unlike barium, a water-soluble contrast agent such as Gastrografin can be used safely and accurately immediately on hospitalization. Early establishment of an accurate diagnosis can help eliminate complications, morbidity, mortality, and lengthy hospitalizations. Seventy-one patients admitted with left lower quadrant peritonitis, temperatures above 99.5 degrees F, and leukocytosis were evaluated. Treatment either was based on a diagnosis established by results of a barium enema or water-soluble contrast enema, or was empiric in nature. The early use of a water-soluble contrast enema in the elucidation of the cause of left lower quadrant peritonitis proved to be the most accurate and also the most cost-effective means of diagnosis.

Acute Disease↗
PubMed1984

Sensitivity of hemoccult testing in patients with colorectal carcinoma.

This paper is a retrospective study of 100 sequentially selected cases of colorectal carcinoma treated at The Roosevelt Hospital between 1978 and 1983. In 44 of these patients, the admitting physical digital rectal examination was hemoccult-negative (HN). This group of patients showed no significant difference in tumor location, stage, size, or in presenting symptoms when compared with the 56 patients who were found to be hemoccult-positive (HP). It is concluded that a negative stool hemoccult examination should not alter the course of the patient's work-up if any suspicion of colorectal carcinoma exists. Furthermore, hemoccult sensitivity does not appear to be affected by the size, location or Dukes' classification of a colorectal neoplasm.

Carcinoma↗
PubMedDate not supplied

Laparoscopic colorectal surgery: ascending the learning curve.

The aim of this study was to prospectively assess the results of our first 100 consecutive patients who underwent laparoscopic or laparoscopy-assisted colorectal operations. The parameters studied included the type and length of procedure, intra- and postoperative complications, conversion to open surgery, length of ileus, and hospitalization. A total of 100 laparoscopic and laparoscopy-assisted procedures were performed between May 1991 and April 1994. The mean patient age was 49 years (12-88 years). The procedures included 36 total abdominal colectomies (TACs) (ileoanal reservoir 28, ileorectal anastomosis 6, end-ileostomy 2), 39 segmental resections of the colon and small bowel, 8 resections of the rectum, 7 diverting stoma creations, 7 reversals of Hartmann's procedure, and 3 other procedures. In seven cases (7%) the laparoscopic procedure was converted to a laparotomy. A group of 22 patients sustained 26 complications that included enterostomy (n = 5), hemorrhage (n = 6), intraabdominal abscess (n = 4), prolonged ileus (n = 4), wound infection (n = 2), anastomotic leak (n = 1), aspiration (n = 1), cardiac arrhythmia (n = 1), upper intestinal bleeding (n = 1), and postoperative small bowel obstruction (n = 1). There were no deaths. When divided into three equal, consecutive groups, the patients in the early (n = 33) and intermediate (n = 33) groups had a significantly higher complication rate (42% and 27%, respectively), than those in the late group (n = 34, 12%;p < 0.05). The complication rate in each group was also directly related to the number of TACs performed (18 in the early, 13 in the intermediate, and 5 in the late group). The overall complication rate in TAC cases was significantly higher (42%) when compared to that of all other procedures (segmental resection 9%, nonresectional 12%;p < 0.01). The mean operating time was 4 hours (2.5-6.5 hours) for TAC, 2.5 hours (1.5-5.5 hours) for segmental colonic resection, and 1.6 hours (1.0-2.5 hours) for the nonresectional procedures. The length of ileus was 3.5 days (2-7 days) after TAC, 3 days (2-7 days) after the segmental resections, and 2 days (1-4 days) after the nonresectional procedures. The mean hospital stay was 7.3 days (2-40 days): 8.4 (5-40), 7.0 (4-12), and 6.8 (2-11) days for the TAC, segmental resection, and nonresectional procedures, respectively. We conclude that the feasibility of laparoscopic colorectal surgery has been well established. The morbidity associated with laparoscopic colorectal surgery correlates with a steep learning curve but is also related to the type of procedure. TAC is associated with a higher complication rate than are other laparoscopic colorectal procedures.

Adolescent↗
PubMedDate not supplied

Coincidence of connective tissue growth factor expression with fibrosis and angiogenesis in postoperative peritoneal adhesion formation.

PURPOSE: To investigate the relationship between connective tissue growth factor (CTGF) and fibrosis and angiogenesis in postoperative peritoneal adhesion formation. METHODS: Adhesions were performed in 35 rats by creation of a peritoneal patch. Animals were sacrificed at 7 different time-points over 3 weeks. Adhesions and uninjured peritoneum from all animals were assessed by Northern blotting for CTGF and collagen-I mRNA and by immunohistochemistry for CTGF localization, degree of fibrosis and angiogenesis. RESULTS: Persistent adhesions formed in all animals. CTGF and collagen-I mRNA were increased in adhesions compared to uninjured peritoneum (p < 0.05 for both). The temporal expression pattern depicted delayed peak levels of collagen-I mRNA with increasing tendency for both transcripts at the end of the observation period. Fibrosis within adhesions correlated positively with time after surgery (r = 0.85; p < 0.001) and showed typical signs of chronic tissue fibrosis at later time points. Angiogenesis was detected in adhesions but not in uninjured peritoneum (p = 0.001) and coincided with the spatial and temporal expression of CTGF protein in fibroblasts and vascular endothelial cells. CONCLUSIONS: The co-expression of CTGF with increasing fibrosis and angiogenesis in postoperative peritoneal adhesions suggests a role for CTGF as critical molecule in fibrous adhesive disease and target for future adhesion prevention.

Animals↗
PubMedDate not supplied

Local resection of rectal cancer.

Stringent patient selection and careful preoperative evaluation are important factors for the successful treatment of all rectal cancers. The lack of histopathologic evaluation is the parameter that even in the best scenario, allows for a 5% risk of nodal involvement that cannot be assessed and therefore treated. However, in appropriately selected situations, local treatment of rectal cancer allows for effective and safe curative therapy.

Chemotherapy, Adjuvant↗
PubMedDate not supplied

Laparoscopic surgery for anorectal malignancies other than carcinoma.

OBJECTIVE: Numerous concerns have been raised relative to the appropriateness of laparoscopic surgery for cure of rectal adenocarcinomas. However, because of their rarity, little information exists about the role of laparoscopy for other anorectal malignancies. We report the outcome of five patients who underwent laparoscopic surgery for other anorectal malignancies. METHODS: All patients who underwent laparoscopic surgery for treatment of non-carcinomatous anorectal malignancy were assessed by means of endoscopic, radiological and histopathologic diagnostic tests. RESULTS: Two patients with anorectal melanoma and one with anal leiomyosarcoma underwent laparoscopic abdominoperineal resection. A laparoscopic loop ileostomy was performed for an HIV-positive patient with rectal Kaposi's sarcoma. Another patient with anorectal melanoma had intraoperative identification of distant liver metastasis and therefore underwent diagnostic laparoscopy instead of an intended abdominoperineal resection. There were no intraoperative laparoscopic complications. During the follow-up period three patients who underwent abdominoperineal resection were alive, one of whom had rectal melanoma and developed liver metastasis without local recurrence. The two patients with distant liver metastasis and rectal Kaposi's sarcoma died 46 days and five months after surgery, respectively. There were no port-site or local recurrences. CONCLUSION: Laparoscopic abdominoperineal resection for non-carcinomatous anorectal malignancies is technically feasible and avoids many of the concerns associated with attempted curative laparoscopic resection of carcinoma.

Adult↗