Biomedical subjects

V W Fazio

Publications and source records attributed to V W Fazio.

At least 91 records · Page 5Linked to original sources

PubMed1997

Guided imagery as a coping strategy for perioperative patients.

Patients who undergo surgery usually experience fear and apprehension about their surgical procedures. Guided imagery is a simple, low-cost therapeutic tool that can help counteract surgical patients' fear and anxiety. The authors randomly assigned 130 patients undergoing elective colorectal surgical procedures into two groups. Members of one group received routine perioperative care. Members of the other group listened to guided imagery tapes for three days before their surgical procedures, during anesthesia induction, intraoperatively, in the postanesthesia care unit, and for six days after surgery. The authors measured patients' anxiety levels, pain perceptions, and narcotic medication requirements. The patients in the guided imagery group experienced considerably less preoperative and postoperative anxiety and pain, and they required almost 50% less narcotic medications after their surgical procedures than patients in the control group.

Adaptation, Psychological↗

PubMed1997

Surgical approaches to low anovaginal fistula in Crohn's disease.

BACKGROUND: Anovaginal fistula due to Crohn's disease can be surgically repaired in some women. The purpose of this study was to analyze the types of fistula along with the features that point to success or failure in treating these patients. METHODS: Women with anovaginal fistula and Crohn's disease treated surgically by one surgeon from 1988 to 1992 were retrospectively studied. RESULTS: Forty-eight women underwent treatment for anovaginal fistula caused by Crohn's disease. This represented 55% of the total patients seen for anovaginal fistula from all causes. Nine patients had severe anorectal and/or colonic disease and underwent total proctocolectomy with ileostomy. Four other patients had seton placement only. The remaining 35 patients underwent transanal repair of their fistula and are the basis of this study. Three types of flap repairs were performed: curvilinear advancement rectal flap (n = 24), linear advancement rectal flap (n = 6), and advancement sleeve flap (n = 5). The type of surgery selected depended on the associated anal and colorectal disease. Diverting ileostomies were used in nine patients with a successful outcome in eight. Healing occurred with the initial repair in 19/35 (54%). An additional five patients underwent successful repeat procedures for an overall success rate of 24/35 (68%). CONCLUSION: Surgical closure of anovaginal can be offered to selected women with Crohn's disease, thus avoiding a permanent stoma in this group. The type of flap chosen for repair depends on the characteristics of the fistula.

Adult↗

PubMed1997

Chances of cure are not compromised with sphincter-saving procedures for cancer of the lower third of the rectum.

BACKGROUND: The goal of this study was to compare patterns of recurrence and long-term outcome after sphincter-saving procedures (SSPs) and abdominoperineal resection (APR) in patients with tumors located in the lower third of the rectum. METHODS: We reviewed the charts of 1001 patients operated on for primary rectal adenocarcinoma between 1980 and 1991. All patients with tumors located between 5 and 7 cm from the anal verge and treated with curative intent were included. RESULTS: Of the 261 patients who met our criteria, 162 had undergone SSP and 99 had undergone APR. The local recurrence rates for SSP and APR were 8% and 11%, respectively (p = 0.41), and the distant metastases rates were 23% and 28%, respectively (p = 0.35). Recurrence and distant metastases rates for SSP and APR, respectively, did not differ by TNM classification: state I, 10% versus 9% (p = 0.9); stage II, 25% versus 43% (p = 0.13); and stage III, 56% versus 57% (p = 0.92). Five-year disease-free survival rates for SSP and APR patients were 70.5% and 62.3%, respectively (p = 0.2). CONCLUSIONS: Tumors in the lower third of the rectum can be treated with sphincter-saving procedures without compromising the chance of cure.

Adenocarcinoma↗

PubMed1997

Surgical therapy for Crohn's disease of the colon and rectum.

Crohn's disease remains incurable by either medical or surgical treatment. Both physician and surgeon must work together with the common objective of restoring health by eliminating or alleviating the complications of Crohn's disease. From the surgeon's viewpoint, operation is performed for complications of the disease or for failure of medical management. Although aggressive surgical excision of affected bowel rids the patient of disease for a period of time, the beneficial effects of operation have to be considered in the context that disease recurrence is always a possibility and that reoperation for such complications may be necessary. The aim of the surgeon is to deal with the current problem as simply as possible and to maintain a long-term, strategic view of the disease process with the understanding that what is done today may affect the patient for life.

Anastomosis, Surgical↗

PubMed1997

Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients.

BACKGROUND: Despite improvement in surgical techniques and stapling devices during the last 10 years, colorectal anastomoses are still prone to leakage. The purpose of this study was to assess the performance and safety of stapled anastomoses in rectal surgery and to identify factors that influence the occurrence of anastomotic leaks. STUDY DESIGN: A review was undertaken of 1,014 patients who underwent stapled anastomoses to the rectum or anal canal for colorectal cancer or benign disease between 1989 and 1995 in a tertiary care institution. Indications for operations, comorbidities at admission, preoperative bowel preparation, stapler size, intraoperative events, associated surgical procedures, and clinical outcomes were tested for any association with anastomotic leak. RESULTS: A double stapled technique was used in 154 patients and a conventional single stapler technique was used in 860. Postoperative mortality was 1.6%, and the overall morbidity was 18.4%. Clinically apparent anastomotic leak developed in 29 patients (2.9%). Anastomotic dehiscence occurred in 22 of 284 patients (7.7%) after low stapling (within 7 cm from the anal verge) and in 7 of 730 patients (1%) after high stapling (p < 0.001). Diabetes mellitus, use of pelvic drainage, and duration of surgery were significantly related to the occurrence of anastomotic leak by the univariate analysis. Multivariate regression analysis identified an anastomotic distance from the anal verge within 7 cm as the only variable related to the occurrence of postoperative leak (p < 0.001). CONCLUSION: Low anastomoses were associated with a leak rate greater than with high colorectal anastomoses. We conclude that anastomoses to the rectum using the circular stapler can be done with low mortality and morbidity.

Adolescent↗

PubMed1997

The risk of cancer and dysplasia among ulcerative colitis patients with primary sclerosing cholangitis.

BACKGROUND: Ulcerative colitis (UC) patients with primary sclerosing cholangitis (PSC) may have an increased risk for colonic dysplasia or cancer. They also may have higher levels of carcinogenic secondary bile acids and, thus, be more likely to develop cancer in the right side of the colon, where secondary bile acid concentrations are highest. METHODS: Since 1983, 1212 UC patients have undergone total proctocolectomy with ileal pouch-anal anastomosis at the Cleveland Clinic. All 27 patients with PSC were compared with the remaining 1185 patients in a historical cohort study. RESULTS: Dysplasia detected during cancer surveillance was the indication for surgery in 16 (59.5%) PSC patients and 136 (11.5%) controls [adjusted relative risk (RR), 6.9; 95% confidence interval (CI), 3.0-16.0]. Dysplasia or cancer was found in the resected specimen in 18 (66.7%) PSC patients and 145 (12.2%) controls (RR 10.4, CI 4.1-26.1). Right-sided cancers (proximal to the splenic flexure) were found in all four PSC patients with cancer and in 20 of 49 controls with cancer (RR 2.5, CI 1.3-5.4). CONCLUSIONS: UC patients with PSC are at a significantly increased risk for dysplasia or cancer. The high proportion of right-sided cancers supports the contention that secondary bile acids are carcinogenic and increase the likelihood of cancer in the proximal colon.

Adolescent↗

PubMed1996

Long-term analysis of the use of transanal rectal advancement flaps for complicated anorectal/vaginal fistulas.

UNLABELLED: Transanal rectal advancement flap (TRAF) is a surgical option in the management of rectovaginal and other complicated fistulas involving the anorectum. Most reported series have a short follow-up. PURPOSE: This study was undertaken to determine the long-term success, safety, applicability, and factors affecting recurrence in patients managed with TRAF, including patients with Crohn's disease. METHODS/MATERIALS: Retrospective analysis of all patients undergoing endorectal advancement flaps at a single institution between 1988 and 1993 was performed. One hundred one patients were identified (70 percent female; 30 percent male). Included were 52 patients with rectovaginal, 46 with anal perineal, and 3 with rectourethral fistulas. Causes were obstetric injury in 13 patients, Crohn's disease in 47, cryptoglandular in 19, mucosal ulcerative colitis in 7, and surgical trauma or undefined causes in 15 patients. RESULTS: No mortality occurred. Median follow-up was 31 (range, 1-79 months). Immediate failure (within one week of the repair) was seen in 6 percent of patients. Statistically (P<0.001) higher recurrence rates were observed in patients who had undergone previous repairs. Mean hospital stay was four days. Overall recurrence was seen in 29 patients (29 percent). Seventy-five percent of all recurrences occurred within the first 15 months; however, recurrence was noted for up to 55 months after repair. Etiology of fistula, use of constipating medications, antibiotic use, and most importantly associated Crohn's disease did not statistically affect recurrence rates. Failure rate was only influenced by previous number of repairs. CONCLUSION: TRAF is a safe technique for managing complicated anorectal and rectovaginal fistulas, including patients with Crohn's disease. Long-term follow-up is essential to accurately report recurrence rates.

Adolescent↗

PubMed1996

Laparoscopic techniques for fecal diversion.

UNLABELLED: Although the role of laparoscopic techniques in performing major colorectal resections is unclear, laparoscopy may be well suited for fecal diversion procedures because no resection and minimal tissue dissection is required. PURPOSE: This report reviews our initial experience with laparoscopic stoma procedures to assess safety and efficacy. METHODS: Using a simple two-cannula technique, 24 such procedures (16 loop ileostomies, 6 end sigmoid colostomies, 1 transverse, and 1 sigmoid loop colostomy) were attempted. Indications for diversion were rectovaginal fistula (7), perianal sepsis (7), incontinence (4), advanced rectal or colon carcinoma (4), and complicated pelvic infection (2). There were 15 females and 9 males with a median age of 44 (range, 25-88) years. RESULTS: Median operative time was 60 (range, 20-120) minutes, and median blood loss was 50 (range, 0-150) ml. There were no intraoperative complications. One case was converted to a laparotomy because of dense adhesions. Median time to passage of both flatus and stool was one (range, 1-3) day for ileostomy patients, two (range, 2-4) for flatus, and 3 (range, 2-6) days for stool after colostomy. Median time to discharge was 6 (range, 2-28) days and was often delayed by the primary disease process or ostomy teaching. One major postoperative complication, a pulmonary embolism, occurred eight days after operation in a patient with near obstructing, widely metastatic colon carcinoma. This patient later died of pulmonary failure. All stomas have functioned well, with no revisions required. CONCLUSIONS: Laparoscopic fecal diversion procedures can be performed safely, simply, and effectively. Apparent advantages over standard techniques are avoidance of a laparotomy, while maintaining the ability to precisely identify and orient the pertinent bowel segment and rapid return of bowel function.

Adult↗

PubMed1996

Intraoperative laparoscopic liver ultrasonography for staging of colorectal cancer. Initial experience.

PURPOSE: This study was undertaken to evaluate the feasibility of intraoperative laparoscopic ultrasonography (ILUS) to completely scan all anatomic segments of the liver through a single port site during laparoscopic resection for colorectal cancer. METHODS: ILUS was performed in patients who were undergoing laparoscopic colorectal cancer surgery using the following approach: 1) presence of a radiologist in the operating room; 2) introduction of the probe through a single cannula site; 3) standardized sequence of four probe positions on liver surface; 4) identification of all major vascular/biliary hepatic structures as a guideline to scan all parenchymal segments of the liver. RESULTS: Twenty-two patients who were undergoing laparoscopic colorectal cancer surgery were prospectively enrolled. Computed tomography (CT) scan films were available for an immediate comparative analysis in the first 12 cases. Mean duration of the procedure was 10 (range, 5-15) minutes. All major vascular and biliary structures were identified in all patients. Sixteen focal abnormalities were identified by ILUS, and ten focal abnormalities were identified by CT scan in the same seven patients. In one patient, detection of a suspected metastasis not seen by preoperative CT scan led to conversion of the surgical procedure to a laparotomy. CONCLUSIONS: ILUS is a safe and expeditious technique that permits scanning of all anatomic liver parenchyma segments through a single cannula site. Because intraoperative palpation of the liver is not possible during laparoscopic colorectal cancer surgery, ILUS should probably be a standard component of the curative laparoscopic colorectal cancer operation.

Adult↗

PubMed1996

Quality of life after prophylactic colectomy and ileorectal anastomosis in patients with familial adenomatous polyposis.

BACKGROUND: Prophylactic colectomy or proctocolectomy is standard treatment for colorectal manifestation of familial adenomatous polyposis (FAP), a dominantly inherited disorder for which the risk of developing colorectal cancer in an untreated patient is close to 100 percent. Hereditary nonpolyposis colorectal cancer (HNPCC) is also dominantly inherited but has a lower risk of colorectal cancer than FAP and does not have a clinically obvious phenotype. The role of prophylactic colectomy in patients with HNPCC is controversial. PURPOSE: This study was performed to examine the outcome of colectomy and ileorectal anastomosis (IRA) so its use as a prophylactic procedure can be better evaluated. METHODS: Records of all patients undergoing IRA for FAP between 1985 and 1993 were reviewed. Demographic data and data about the operation were collected. Surgical outcome data included length of hospital stay, complications, bowel function, quality of life, and patient satisfaction. RESULTS: There were 51 patients with a median age of 28 years; 24 were male. All but eight patients were asymptomatic, and all had less than 1,000 polyps in the resected specimen. Mean surgery time was 3.5 hours, mean blood loss was 406 ml, and median length of hospital stay was seven days. There were no deaths, and eight patients (16 percent) had complications. Mean number of stools per day after median follow-up of 4.2 years was 3.6. Only 11 patients had nighttime stooling. Four patients reported seepage, 9 had some incontinence, and 16 had urgency. Quality of life, rated on a scale of 0 to 10, was 7 or above in 44 of 48 assessed patients. Quality of health was rated 7 or higher in all 48 patients, energy level was 7 or higher in 39 patients, and overall happiness with surgery was 7 or higher in 47 patients. CONCLUSIONS: Colectomy and IRA is a relatively safe operation that results in minimum disturbance of bowel function. Patient satisfaction is usually high. Prophylactic colectomy can be offered to HNPCC gene carriers with a greater understanding of the likely outcome of surgery.

Adenomatous Polyposis Coli↗

PubMed1996

Reoperative rates for Crohn's disease following strictureplasty. Long-term analysis.

BACKGROUND: In Crohn's disease, ten-year reoperative recurrence rates after resection range from 30 to 53 percent. To determine the effect of strictureplasty on reoperative "recurrence" rates, experience at a single tertiary care institution was reviewed. PATIENTS AND MATERIALS: Records of all patients who underwent strictureplasty for Crohn's disease from June 1984 to July 1994 at a tertiary care institution were reviewed. Data collected included duration of disease, medical and surgical history related to Crohn's disease, indications for strictureplasty, and longterm outcome. RESULTS: One hundred sixty-two patients (87 male) underwent 191 operations for a total of 698 strictureplasties (Heineke-Mikulicz, 617; Finney's, 81). Mean number of strictureplasties was three, and mean patient age was 36 years. No mortality occurred. Cumulative five-year incidence of reoperative recurrence was 28 percent (95 percent confidence interval, 18.8-37.2 percent), with a median follow-up of 42 (range, 1-120) months. Obstructive symptoms were relieved in 98 percent of patients. To determine whether any difference in reoperative rates exists between patients who have strictureplasty alone and those who have strictureplasty with bowel resection, we divided patients in two groups, those receiving strictureplasty alone and those undergoing stricutreplasty plus resection. For patients treated by strictureplasty alone (Group A, n = 52; 32 percent), cumulative reoperative rate at five years was 31 +/- 9.6 (+/-standard error) and for patients with concomitant bowel resection (Group B, n = 110; 68 percent), it was 27.2 +/- 5.4 (+/-standard error). No statistical difference was present between these two groups. Of patients undergoing strictureplasty alone (Group A), operative recurrence was managed by new stricutreplasty in seven, by restricutreplasty in two, and by bowel resection in one. Among patients in Group B (strictureplasty and concomitant bowel resection), new strictureplasty was performed in 11, restrictureplasty in 6, and bowel resection in 9. CONCLUSION: Strictureplasty is a safe and effective procedure for Crohn's disease in selected patients. Reoperative rates are comparable with resective surgery, and most recurrences occur at new sites.

Adolescent↗

PubMed1996

Adenocarcinoma arising from a strictureplasty site in Crohn's disease. Report of a case.

The occurrence of small-bowel cancer in Crohn's disease (CD) is a rare event. The risk seems to be greatest in patients with long-standing disease. Strictureplasty has proved to be a valuable alternative in the management of Crohn's strictures of the small-bowel. Critics and proponents of strictureplasty for selected patients with small-bowel Crohn's disease have voiced their concerns about cancer risk in the strictured or strictureplasty site. To date, there has been no clear or detailed report of such an occurrence. The authors report the first case of small-bowel adenocarcinoma arising at the site of a previous strictureplasty. In this patient, biopsies of the strictures at the original operation confirmed CD and excluded both cancer and dysplasia. Malignancy occurred seven years later at a strictureplasty site. The main clinical sign associated with the adenocarcinoma was severe, persistent anemia. The authors conclude that the risk of adenocarcinoma developing at the site of a previous strictureplasty for CD, although small, is real.

Adenocarcinoma, Mucinous↗

PubMed1996

Sexual function following restorative proctocolectomy in women.

PURPOSE: This study was undertaken to identify the incidence and type of sexual dysfunction experienced by women after undergoing restorative proctocolectomy. METHODS: A questionnaire was sent to 262 females who underwent restorative proctocolectomy by a single surgeon from 1984 to 1993. The response rate was 35 percent (92/262). Additional information was gained from our pelvic pouch data base. Mean follow-up was 43 (6-130) months. RESULTS: Following surgery, a significant increase was found in vaginal dryness, dyspareunia, pain interfering with sexual pleasure, and limiting of sexual activity because of concerns of stool leakage. There was no significant change in sexual desire, arousal, sensitivity, frequency of intercourse, or satisfaction with sexual relationship. CONCLUSION: Potential sexual dysfunction following restorative proctocolectomy in women merits discussion in preoperative counseling with the patient.

Adult↗

PubMed1996

Effect of systemic steroids on ileal pouch-anal anastomosis in patients with ulcerative colitis.

BACKGROUND: Long-term steroid therapy predisposes to postsurgical complications, especially in patients with inflammatory bowel disease. PURPOSE: This study was undertaken to determine incidence of early septic complications after ileal pouch-anal anastomosis (IPAA) in patients who are undergoing prolonged steroid therapy. METHODS: We reviewed charts of 692 patients undergoing restorative proctocolectomy and IPAA to treat ulcerative colitis. Incidence of early (within 30 days) septic complications and sepsis-related reoperations, in patients who were having high-dose (>20 mg of prednisone per day) and low-dose steroid therapy (<20 mg of prednisone per day) for more than one month before surgery, was compared with patients who were not receiving steroid therapy. Follow-up included an annual questionnaire and physical examination. RESULTS: Patients without steroid dose data recorded were excluded (n = 21). Of the 671 remaining patients, 310 received no steroids, 169 received low-dose steroids, and 192 received high-dose steroids. These three groups were similar in gender composition, age at surgery, types of anastomosis (stapled or handsewn), and incidence of diabetes mellitus, peripheral vascular disease, and obesity. Early septic complications were found in 18 (6 percent), 14 (8 percent), and 12 (6 percent) patients without steroid therapy, those having low-dose steroid therapy, and those having high-dose steroid therapy (P = 0.57), respectively. Sepsis- related reoperation rate (P = 0.73) and number of sepsis-related pouch excisions (P = 0.79) did not differ between groups. In patients undergoing IPAA without ileostomy, early septic complications were found in one (3.8 percent), two (20 percent), and five (50 percent) patients without steroid treatment, low-dose steroid therapy, and high-dose steroid therapy (P = 0.004), respectively. CONCLUSION: In patients who are undergoing IPAA with diversion for ulcerative colitis, prolonged systemic steroid therapy before surgery is not associated with increased septic complications.

Adolescent↗

PubMed1996

Comparison of handsewn with stapled loop ileostomy closures.

PURPOSE: The aim of this study was to determine if a stapled side-to-side closure of an ileostomy results in decreased length of hospital stay compared with a handsewn closure. METHODS: From March 1993 to August 1994, patients who had previously undergone total proctocolectomy with pelvic pouch formation and loop ileostomy were studied. At the time of ileostomy closure, patients were randomized to have their stoma closed by a handsewn technique or stapled closure. Data were prospectively gathered. RESULTS: During 17 months, 61 consecutive patients (38 male, 23 female) with a mean age of 37.8 (range, 16-69) years had their ileostomy closed and were entered into this study. There were 31 patients in the stapled group and 30 in the handsewn group. Mean operative time was 55 (range, 32-97) minutes in the stapled group and 67 (range, 42-128) minutes in the handsewn group (P = 0.01 Wilcoxon's test). Average length of stay was three (range, 2-5) days in the stapled group and 2.5 (range, 1-19) days in the handsewn group. One patient from the stapled group and two patients from the handsewn group were readmitted because of small-bowel obstruction. One patient from the stapled group underwent additional surgery for a leaking enterotomy with no defect in staple closure. Two patients from the handsewn group underwent additional surgery for small-bowel obstruction. There was no significant difference in day of first stool or day of solid diet for the two groups. CONCLUSION: Handsewn and stapled closures of loop ileostomy are not significantly different with respect to day of first stool, day until solid diet, or discharge day. Complications were similar in the two groups. Stapled closure is significantly quicker than handsewn closure.

Adolescent↗

PubMed1996

Stapled ileal pouch anal anastomoses are safer than handsewn anastomoses in patients with ulcerative colitis.

BACKGROUND: One of the theoretic advantages of using a stapled versus handsewn ileal pouch anal anastomosis (IPAA) in restorative proctocolectomy is a reduction in septic complications. We performed this study to compare the incidence of early septic complications in patients undergoing restorative proctocolectomy with stapled or handsewn IPAA. PATIENTS AND METHODS: A chart review of 692 patients undergoing restorative proctocolectomy for treatment of ulcerative colitis was performed. The incidence of early septic complications in patients having stapled IPAA was compared to that in patients having handsewn IPAA. Follow-up studies included an annual questionnaire and physical examination. RESULTS: Of the 692 patients, 238 had handsewn IPAA and 454 had stapled IPAA; these two groups were similar in sex, duration of disease, age at surgery, and type of surgical procedure performed. In the handsewn IPAA group, 25 patients (10.5%) had 32 septic complications, and 24 required 89 reparations. In 7 patients, the pouch was excised. In the stapled IPAA group, 21 patients (4.6%) had 23 septic complications, and 14 required 40 reparations. One patient needed pouch excision. There were more patients (P=0.0001) with early septic complications, and more (P<0.0001) pouch excisions because of these complications, in patients with handsewn IPAA than in patients with stapled IPAA. The sepsis-related reoperation rates did not differ significantly. CONCLUSIONS: The stapled technique for IPAA has fewer septic complications and results in fewer sepsis-related pouch excisions, in our hands, than the handsewn technique technique, for treating patients with ulcerative colitis.

Adolescent↗

PubMed1996

Preliminary experience with laparoscopic intestinal surgery for Crohn's disease.

BACKGROUND: Laparoscopic techniques are being applied to the surgical management of various intestinal conditions, but few reports describe their use with Crohn's disease. PATIENTS AND METHODS: Over a 2-year period, 31 selected patients with Crohn's disease underwent laparoscopic intestinal surgery: 18 women and 13 men, with a median age of 39 years (range 22 to 79). Indications for operation included: primary terminal ileitis (13); recurrent ileitis (2); Crohn's colitis (3); rectovaginal fistula (6); and severe perianal disease (7). Resections were laparoscopically assisted with division of mesentery and anastomosis performed extracorporeally. Diversion procedures were performed using a two-cannula technique. RESULTS: Twenty-five of 31 procedures were completed laparoscopically: loop ileostomy or colostomy (12); ileocecectomy (10); segmental colon resection (2); and total abdominal colectomy with ileorectal anastomosis (1). Six cases were converted to conventional surgery secondary to extensive adhesions from prior surgery (2) or severe inflammation (4). No case was converted because of intraoperative complication. Median operative time for diversion procedures was 53 minutes (range 20 to 90) and for resections 195 minutes (range 90 to 380). Median blood loss was 100 mL (range 10 to 500), and there were no intraoperative complications. Only 1 postoperative complication occurred: a myocardial infarction. Median times to passage of flatus and bowel movement were both 3 days (range 1 to 6). Median time to discharge was 6 days (2 to 21) for diversion patients, and 6 days (3 to 7) for resected patients. CONCLUSIONS: Laparoscopic intestinal surgery, both for resection and diversion, is feasible and safe for the management of selected patients with Crohn's disease. To determine if real advantages exist for laparoscopy in the surgical treatment of Crohn's disease, further study is needed.

Adult↗

PubMed1996

How safe is strictureplasty in the management of Crohn's disease?

BACKGROUND: Strictureplasty is a well-accepted technique in the management of selected patients with Crohn's disease. To determine the safety and optimal clinical setting for performing strictureplasty, perioperative complications and long-term outcomes need to be analyzed. PATIENTS AND MATERIALS: We retrospectively reviewed the charts of 162 patients (87 men, 75 women) with Crohn's disease who underwent strictureplasty between June 1984 and July 1994. Medical and surgical history, including medications and laboratory data, intraoperative findings, perioperative complications, and long-term follow-up data were recorded. RESULTS: These patients underwent 698 strictureplasties (Heineke-Mikulicz procedures, 617; Finney procedures, 81). Median hospital stay was 8 days. Perioperative septic complications were noted in 8 patients (5%); however, reoperation for sepsis was needed only in 5 patients. Five percent of patients developed prolonged ileus after strictureplasty. Symptomatic improvement after strictureplasty was achieved in 98% of patients. Restricture or new stricture or perforative disease was seen in 5% and 17% of patients, respectively, during a 42-month median follow-up period. CONCLUSIONS: Our findings show that strictureplasty is a good surgical option for stenosing small-bowel Crohn's disease, particularly in patients with multiple obstruction and in those vulnerable to short-bowel syndrome. Perioperative complications are few, and long-term results are gratifying.

Crohn Disease↗