PubMed Health⌕ Search

Biomedical subjects

T A Teoh

Publications and source records attributed to T A Teoh.

At least 19 recordsLinked to original sources
PubMed1996

Stimulated gracilis neosphincter operation. Initial experience, pitfalls, and complications.

PURPOSE: The stimulated gracilis neosphincter is accepted as a viable option in select patients with fecal incontinence. The aim of this study was to review the initial problems and complications. METHODS: A prospective analysis of all patients who underwent this procedure was undertaken. Stage I consisted of the distal vascular delay of the muscle and creation of a temporary stoma. Stage II was the transposition of the muscle and implantation of the stimulator and electrodes. Low frequency electrical stimulation was applied to the muscle for 12 weeks, after which Stage III (stoma closure) was undertaken. RESULTS: From March 1993 to December 1995, 17 patients (9 females and 8 males) with a mean age of 42.2 (range, 19-72) years underwent the procedure. One patient died from pancreatitis and another from small-bowel adenocarcinoma, three and six months after the procedure, respectively. Two patients (one with Crohn's disease) required permanent stomas. One additional patient required a permanent stoma because of lead fibrosis. Other complications noted during ascent of the learning curve included seroma of the thigh incision, excoriation of the skin above the stimulator, fecal impaction, anal fissure, parastomal hernia, rotation of the stimulator, premature battery discharge, fracture of the lead, perineal skin irritation, perineal sepsis, rupture of the tendon, tendon erosion, muscle fatigue during programming sessions, and electrode displacement from the nerve or fibrosis around the nerve. However, ultimately after rectification of these problems, 13 of the 15 eligible patients had stoma reversal. Manometric results showed an average basal pressure of 43 mmHg and an average maximum squeeze pressure that increased from 36 mmHg before surgery to 145 mmHg by stimulation (P < 0.01). Based on objective functional questionnaires, 9 of 15 (60 percent) evaluable patients reported improvement in continence, social interactions, and quality of life. Three of these nine patients require daily use of enemas. CONCLUSION: Although the stimulated gracilis operation is a feasible procedure for selected patients with severe incontinence, the learning curve is steep. Although the ultimate outcome in a selected group of patients can be very gratifying, major technical modifications are required before use beyond a research protocol setting. Furthermore, patients must have the psychological strength, emotional commitment, and financial resources that may be necessary for multiple revisional surgeries or ultimate device failure.

Adult↗
PubMed1996

The stimulated gracilis neosphincter for fecal incontinence: a new use for an old concept.

The stimulated gracilis neosphincter is a viable procedure in selected patients with fecal incontinence. The aim of this paper is to review the technique of this staged operative procedure and review the problems and complications. Stage 1 consists of the vascular "delay" of the gracilis muscle and the creation of a temporary stoma. Stage 2 consists of transposition of the muscle around the anus with implantation of the stimulator. Low-frequency electrical stimulation is applied to the muscle for 12 weeks, after which stage 3 (stoma closure) is undertaken. From March of 1993 to March of 1995, 14 patients (9 females and 5 males) with a mean age of 44 years (range 20 to 67 years) underwent the procedure. Two patients died within 1 year of the operation from unrelated causes. Two patients developed anal stenosis and required permanent stomas. Other complications noted during ascent of the learning curve included seroma, excoriation of the skin above the stimulator, transposition of the stimulator, premature battery discharge, wound infection, rupture of the gracilis tendon, fatigue during programming sessions, and electrode displacement or fibrosis from the nerve. However, 8 of the 10 eligible patients had stoma reversal; the manometric results showed an average mean squeeze pressure that increased from 43 mmHg prior to surgery to 151 mmHg after the operation (p < 0.01). Based on an objective functional questionnaire, 60 percent of the patients who could be evaluated reported improvement in continence, social interactions, and the quality of their life. In conclusion, despite a steep learning curve, the stimulated gracilis operation is a viable operation for selected patients with severe incontinence.

Adult↗
PubMed1996

Functional outcome of the double stapled ileoanal reservoir in patients more than 60 years of age.

Total proctocolectomy with creation of an ileoanal reservoir (IAR) is currently the preferred surgical treatment of mucosal ulcerative colitis and familial adenomatous polyposis. However, the creation of an IAR on older patients is controversial and commonly avoided because of anticipated poor functional results and increased morbidity. We prospectively studied 140 consecutive patients who underwent a double stapled IAR (DSIAR) between 1988 and 1993. We compared the outcome of 14 patients (Group I) 60 years of age or older (mean 65, range 60-71 years; 10 males and 14 females), to 126 patients (Group II) under the age of 60 (mean 37, range 12-59 years; 80 males and 14 females). Mucosal ulcerative colitis and indeterminate colitis were noted, respectively, in 12 (93%) and 1 (7%) patients in Group I and in 94 (75%) and 5 (4%) patients in Group II. In Group II, 21 (16%) patients had familial adenomatous polyposis, and 6 (5%) had a postoperative diagnosis of Crohn's disease. Subjective functional results and anal manometry were assessed in all 14 patients in Group I (100%) and in 110 of the 117 patients in Group II (94%) whose stomas were closed at a mean followup of 24 (3-60) months. Manometry was per- formed before, and 2 and 12 months after surgery. Patients in Groups I and II reported a mean of 6.2 and 5.2 bowel movements during the day (P=NS), and 2 and 1.1 at night, respectively (P<0.05). A total of 12 (86%) patients in Group I and 104 (95%) in Group II reported perfect or almost perfect continence at night (P=NS), and 12 (93%) patients in Group I and 104 (95%) in Group II reported perfect or almost perfect continence during the day (P=NS). The preoperative mean and maximal resting pressures were similar in both groups (71.7 mmHg and 94 mmHG in Group I and 71.6 and 88 mmHg in Group II respectively; P=NS). Postoperative resting pressure changes were also similar in both groups P=NS), with a similar significant decline 2 months after surgery, which recovered by 12 months after surgery in both groups. There were no significant changes between the pre- and postoperative mean and maximal squeeze pressures in either group. The overall morbidity and mortality rates in Groups I and II were 21 and 0 per cent, and 21 and 0.8 per cent, respectively (P=NS). DSIAR in patients 60 years of age or older is as safe and is associated with as good functional and physiologic results as it is in younger patients. Thus, this procedure may be offered to older patients with expectation of good outcome.

Adenomatous Polyposis Coli↗
PubMed1996

Adhesion formation after laparoscopic anterior resection in a porcine model: a pilot study.

Although decreased adhesion formation is one of the accepted advantages of laparoscopic colorectal surgery, no prospective studies have been done to support this claim. Therefore, we prospectively assessed adhesion formation following laparoscopic anterior resection of the rectum in a porcine model. Five domestic female pigs underwent the procedure with a double-stapled intracorporeal anastomosis. After completion of the laparoscopic procedure, 50 cm of ileum was retrieved through the right lower port site. Controlled serosal abrasion of the antimesenteric surface was performed using a fresh knife. The abraded loop was returned into the peritoneal cavity and the fascia closed at all port sites. All animals underwent a midline laparotomy 3 weeks later to assess adhesions using a 0-3 score according to the density vascularity, and extent of adhesions. All animals survived the study period. The mean level of the anastomosis was 8 cm (range, 7-10) above the anal verge; all anastomoses were intact and completely healed. None of the animals had adhesions to the port sites. The anastomotic site was completely free of adhesions in four animals, and only one animal (20%) had grade 1 adhesions between the urine horns and the anastomosis. Conversely, all animals had adhesions of the abraded loop involving 60 cm (range, 40-75) of bowel and 7 cm (range, 4-9) of the abdominal wall (remote to the port sites); no other adhesions were noted. In this pilot study, serosal abrasion of the small bowel resulted in severe adhesion formation in the porcine model. However, laparoscopic anterior resection of the rectum in the same animals was associated with only minimal insignificant adhesions. Furthermore, unlike in laparotomy incisions, adhesions to port sites did not occur.

Abdomen↗
PubMed1996

Laparoscopic Nissen fundoplication for hiatus hernia: a case report.

Laparoscopic Nissen fundoplication has rapidly become an established technique in the management of severe or complicated reflux oesophagitis. We describe our initial experience with laparoscopic Nissen fundoplication in a 54-year-old man with intractable severe haemorrhagic oesophagitis and a large sliding hiatus hernia. The Rossetti modification of Nissen fundoplication was used as this is a surgical procedure eminently suited for the laparoscopic approach since minimal dissection is needed. The operative time taken was 260 minutes, there was minimal blood loss, minimal postoperative analgesia requirement and early return of bowel function.

Follow-Up Studies↗
PubMed1995

Enhancing cosmesis in laparoscopic colon and rectal surgery.

PURPOSE: The only unanimously accepted advantage of laparoscopic colon and rectal surgery, at present, is cosmesis. Techniques to enhance cosmesis in laparoscopic surgery are presented. METHOD: Careful and meticulous placement of laparoscopic ports and incisions enhance the cosmetic effect of the procedure. Determination of port sites is aided, in part, by preoperative assessment of natural skin folds and creases by a stomatherapist. Intraoperative techniques include placement of ports directly through the umbilicus, previous incisions, and natural skin folds and creases. RESULTS: These techniques have been practiced with no complications or added morbidity. Safety and good access during the procedure is not compromised. The cosmetic effect in laparoscopic surgery is enhanced. CONCLUSION: Techniques to enhance cosmesis in laparoscopic surgery can be practiced safely and efficiently. Surgeons should make an effort to focus on this benefit, when possible.

Cicatrix↗
PubMed1995

Pudendal neuropathy is not related to physiologic pelvic outlet obstruction.

UNLABELLED: Chronic straining because of pelvic outlet obstruction is hypothesized to cause pudendal neuropathy (PN) by stretch injury. PURPOSE: The aim of this study was to determine any association between PN and pelvic outlet obstruction. METHODS: One hundred forty-seven constipated patients were evaluated by cinedefecography and pudendal nerve terminal motor latency assessment. PN was defined as a latency longer than 2.2 ms. Pelvic outlet obstructive patterns of evacuation included paradoxic contraction, nonrelaxation of the puborectalis muscle, or failure of opening of the anal canal. RESULTS: Median length of constipation including straining during evacuation was eight (range, 1-47) years. Ninety-one (62 percent) subjects had a normal pattern of evacuation, and 56 (38 percent) had an obstructed pattern. Both groups had a similar median age (68 vs. 69 years, respectively; P > 0.05) and same median length of symptoms. Overall incidence of PN was 23.8 percent (10.9 percent unilateral and 12.9 percent bilateral). There was no difference in the incidence of PN between patients with normal evacuation and patients with obstructed evacuation (24.2 percent vs. 23.2 percent, respectively; P > 0.05). Patients with PN had a similar incidence of physiologic pelvic outlet obstruction as did patients without PN. However, median age of patients with PN was higher than those without PN (73 vs. 66 years, respectively; P > 0.05). CONCLUSION: There was a difference in the incidence of PN between normal and obstructed patterns of evacuation. Therefore, the espoused theory that obstructed defecation causes PN appears flawed.

Adolescent↗
PubMed1995

Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial.

INTRODUCTION: The routine use of a nasogastric tube after elective colorectal surgery is no longer mandatory. More recently, early feeding after laparoscopic colectomy has been shown to be safe and well tolerated. Therefore, the aim of our study was to prospectively assess the safety and tolerability of early oral feeding after elective "open" abdominal colorectal operations. MATERIALS AND METHODS: All patients who underwent elective laparotomy with either colon or small bowel resection between November 1992 and April 1994 were prospectively randomized to one of the following two groups: group 1: early oral feeding--all patients received a clear liquid diet on the first postoperative day followed by a regular diet as tolerated; group 2: regular feeding--all patients were treated in the "traditional" way, with feeding only after the resolution of their postoperative ileus. The nasogastric tube was removed from all patients in both groups immediately after surgery. The patients were monitored for vomiting, bowel movements, nasogastric tube reinsertion, time of regular diet consumption, complications, and length of hospitalization. The nasogastric tube was reinserted if two or more episodes of vomiting of more than 100 mL occurred in the absence of bowel movement. Ileus was considered resolved after a bowel movement in the absence of abdominal distention or vomiting. RESULTS: One hundred sixty-one consecutive patients were studied, 80 patients in group 1 (34 males and 46 females, mean age 51 years [range 16-82 years]), and 81 patients in group 2 (43 males and 38 females, mean age 56 years [range 20-90 years]). Sixty-three patients (79%) in the early feeding group tolerated the early feeding schedule and were advanced to regular diet within the next 24 to 48 hours. There were no significant differences between the early and regular feeding groups in the rate of vomiting (21% vs. 14%), nasogastric tube reinsertion (11% vs. 10%), length of ileus (3.8 +/- 0.1 days vs. 4.1 +/- 0.1 days), length of hospitalization (6.2 +/- 0.2 days vs. 6.8 +/- 0.2 days), or overall complications (7.5% vs. 6.1%), respectively, (p = NS for all). However, the patients in the early feeding group tolerated a regular diet significantly earlier than did the patients in the regular feeding group (2.6 +/- 0.1 days vs. 5 +/- 0.1 days; p < 0.001). CONCLUSION: Early oral feeding after elective colorectal surgery is safe and can be tolerated by the majority of patients. Thus, it may become a routine feature of postoperative management in these patients.

Adolescent↗
PubMed1995

Anal stricture following haemorrhoidectomy: early diagnosis and treatment.

Anal stricture is an uncommon but well recognized complication following haemorrhoidectomy. Twenty-seven (3.8%) out of 704 (500 elective and 204 emergency) cases of haemorrhoidectomy performed at the Singapore General Hospital over a 24 month period had clinical evidence of anal stricture post-haemorrhoidectomy. Of the 27 cases, 15 had haemorrhoidectomy as an elective procedure while 12 had it performed as an emergency procedure (chi 2 = 3.26, 1 d.f., P > 0.05, not significant). The mean interval between surgery and presentation of anal stricture was 6 weeks (range 3-12 weeks). Eighteen of the patients were managed by anal dilatation in the outpatient clinic combined with bulk laxatives and a local anaesthetic agent. The other nine patients required a minor surgical procedure comprising either a lateral internal sphincterotomy (five) or an anoplasty (four) procedure. All patients were well, following treatment. None of these patients developed a recurrent stricture at follow up 3 months after treatment. It was concluded that although anal stricture following haemorrhoidectomy is rare, it should be detected and treated early in order to avoid pain and suffering, and treatment is usually successful.

Adolescent↗
PubMed1995

Laparoscopic-assisted perineal rectosigmoidectomy for rectal prolapse.

One of the important surgical principles in perineal rectosigmoidectomy (Altemeier's procedure) for full-thickness rectal prolapse is to ensure the complete resection of the redundant rectosigmoid colon to avoid recurrence of the prolapse. We present a new technique of laparoscopic assistance during this procedure, which helps achieve maximal mobilization and resection of the prolapsed portion.

Anastomosis, Surgical↗
PubMed1994

Colonoscopic-assisted laparoscopic colectomy.

One of the technical difficulties during laparoscopic and laparoscopic-assisted resection of the right, transverse, and left colon is the mobilization of the splenic and hepatic flexures. We present a simple technique of colonoscopic traction of the splenic or hepatic flexure. This technique enables good exposure and facilitates dissection while laparoscopic mobilization of these segments of the colon is performed.

Colectomy↗
PubMed1994

The laparoscope: an excellent illumination tool for deep pelvic dissection.

Adequate illumination during deep pelvic dissection in low anterior resection and abdominoperineal resection is sometimes difficult and frustrating, especially in deep narrow pelvises. Various methods of illumination are being used to overcome this problem. We present our technique of using the laparoscope as an excellent illumination tool for deep pelvic dissection in conventional surgery.

Colon↗
PubMed1994

Emergency surgery for bleeding oesophageal varices.

PURPOSE OF STUDY--This case-series reviews patients who underwent emergency transgastric ligation or oesophageal transection for uncontrolled bleeding oesophageal varices despite initial conservative therapy with vasoactive drugs, balloon tamponade and injection sclerotherapy. The study seeks to identify factors determining outcome of surgery and the problems of transection surgery following endoscopic sclerotherapy. SELECTION OF STUDY SUBJECTS--One hundred and ninety-eight patients (median age 54.6 years) were treated for bleeding varices between 1981 and 1991. Of these, 36 (18%) required emergency surgery and they formed the cohort under study. OBSERVATIONAL METHODS AND MAIN FINDINGS--Twenty-three patients underwent transabdominal oesophageal devascularisation and oesophageal transection while 13 had transgastric ligation. Nine patients were graded Child-Pugh's A, 20 Child-Pugh's B and 7 Child-Pugh's C-mortality was 11%, 25% and 100% respectively. Of all the risk factors, the Child-Pugh's grade was the single most important factor determining outcome (Chi-square test; 2 degrees of freedom, p < 0.0005). The data also showed that patients who were transfused less than 3 litres of blood had a mortality of 18% compared to 55% for those requiring 3 or more liters (Fisher's exact test p = 0.0155). There was no difference in mortality between transgastric ligation and oesophageal transection when patients were evaluated according to the Child-Pugh's grade. The results indicate that oesophageal transection is to be recommended for better control of bleeding (0% vs 23% post procedure) but conversely is associated with higher anastomotic leakage rate (8.7% vs 0%). PRINCIPAL CONCLUSIONS--We conclude that the decision to operate on bleeding variceal patients should be made early as procrastination is detrimental to their surgical outcome. In view of the extremely poor results with Child-Pugh's C patients, emergency surgery is best offered to the Child's A and B cases.

Adolescent↗