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Biomedical subjects

W A Kmiot

Publications and source records attributed to W A Kmiot.

9 recordsLinked to original sources
PubMed1992

Estimation of small bowel transit time following colectomy and ileal reservoir construction.

A study was carried out to evaluate the breath hydrogen test as a method of estimating small bowel transit in patients with an ileal pouch and to determine whether gut transit time influenced functional outcome. Twelve patients with an ileal reservoir and ten control subjects ingested a test meal of 400 ml chicken soup, 20 g lactulose and 50 ml dilute barium solution. Concurrent breath hydrogen testing and radiological screening was carried out until the head of the test meal reached the ileal pouch or caecum. At the time that the test meal arrived in the pouch, faecal anaerobic bacterial counts were obtained. Pouch compliance, functional capacity and anal sphincter pressures were also measured. While there was an excellent correlation between radiological and breath hydrogen measures of orocaecal transit time in controls (P less than 0.001), no such relationship was found for oropouch transit. Four of the 12 patients with a pouch produced no hydrogen after test meal ingestion, while in two other such patients breath hydrogen peaks occurred when the head of the meal was in the jejunum. The magnitude of the breath hydrogen rise in patients with an ileal pouch correlated well with faecal anaerobic bacterial counts (P less than 0.01). The median (95 per cent confidence interval) radiological small bowel transit time was more rapid in patients with a pouch than in control subjects: 28 (23-33) versus 72 (46-86) min (P less than 0.01). Increased 24-h frequency of defaecation was associated with more rapid small bowel transit after ileal reservoir construction (P less than 0.01) but correlated with neither pouch capacity nor compliance. These data show that small bowel transit time may be a determinant of ileal pouch function but that breath hydrogen estimation of gut transit time in patients with an ileal reservoir is unreliable.

Breath Tests↗
PubMed1991

Prospective randomized trial of Nissen fundoplication and Angelchik prosthesis in the surgical treatment of medically refractory gastro-oesophageal reflux disease.

Fifty patients with gastro-oesophageal reflux disease refractory to multiple courses of medical therapy were entered into a prospective randomized trial comparing Nissen fundoplication with the Angelchick prosthesis as a primary surgical procedure. The two groups were matched for age, sex, duration of symptoms before surgery, type of medical therapy, pattern of symptom presentation, endoscopic grade of oesophageal inflammation, manometric lower oesophageal pressure and 24-h pH profile. Twenty-five patients were randomized to each of the Nissen fundoplication and Angelchik prosthesis groups. Operation time and hospital stay were similar in both groups. Persistent dysphagia was reported in five of the patients with an Angelchik prosthesis compared with none in the Nissen fundoplication group. Three prostheses were removed because of severe dysphagia while no Nissen fundoplication required revision. No patient with preoperative dysphagia because of stricture reported swallowing difficulties after operation. At clinical assessment at 3, 6, 12 and 24 months after operation, 85-88 per cent of the patients having a Nissen fundoplication were graded Visick 1 or 2 compared with 60-72 per cent of patients in the Angelchik group.

Adult↗
PubMed1990

Constipation: another indication for restorative proctocolectomy.

We have extended our experience of restorative proctocolectomy and ileoanal anastomosis to include 13 patients with functional bowel disorders. Eight had recurrent constipation after colectomy for slow transit constipation and five had constipation and overflow incontinence associated with megarectum and megacolon. In all cases the only alternative was a permanent stoma. Despite a high complication rate, 11 patients (85 per cent) felt that the operation had been worthwhile with improvement of their symptoms and quality of life. The operation led to a mean frequency of defaecation of 4.8 times (range 2-8) during the day, and 1.2 times (range 0-4) during the night. There was no frank incontinence and, while only one patient experienced soiling during the day, six patients suffered from night-time soiling. Two patients have had the pouch converted to an ileostomy due to persistent complications and a poor functional result.

Adolescent↗
PubMed1990

Videoproctographic assessment after restorative proctocolectomy.

Videoproctography was performed in 40 patients after restorative proctocolectomy to evaluate pouch emptying, anopouch angle, and pelvic floor movement in relationship to functional outcome. Results were compared between the two different pouch designs tested and a control group of 26 patients who had an intact rectum. There was no difference in emptying between the two pouch designs or compared with the control subjects. Emptying did not influence either the frequency of defecation or patient soiling rate. The presence of an anal stricture was associated with poor emptying in each case in the pouch group. Anorectal angle was no different between the different pouch designs or compared with the control group at rest, during pelvic floor contraction, or attempted defecation. A similar finding was obtained with anorectal angle position and movement during pelvic floor contraction and attempted defecation in both pouch design groups and when compared with normal rectum. This study shows that the only factor that is consistently associated with poor pouch emptying is the presence of an anal stricture.

Adult↗
PubMed1989

Totally stapled abdominal restorative proctocolectomy.

A technique of totally stapled abdominal restorative proctocolectomy is reported in 20 consecutive patients using a 20 x 20 cm J pouch and a stapled ileoanal anastomosis. The stapled ileoanal anastomosis had to be abandoned in three patients because of attempted mucosectomy in one and megarectum in two. One patient receiving steroids had a covering ileostomy. The remaining 16 patients had a totally stapled procedure without a covering ileostomy. Three patients developed serious postoperative morbidity but they were the only patients receiving steroids at the time of the operation. Of the remaining 13 patients none developed serious complications, the median hospital stay was 14 days and the median operating time was 150 min. The operation may be a technical advance particularly in allowing pouch construction without ileostomy in fit patients who are not receiving steroids at the time of operation.

Adolescent↗