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Yik-Hong Ho

Publications and source records attributed to Yik-Hong Ho.

8 recordsLinked to original sources
PubMed2006

Techniques for restoring bowel continuity and function after rectal cancer surgery.

A very low local recurrence rate of 3%-6% (associated with improved 5 year survival) is possible when proper oncological surgery is performed of mid and distal rectal adenocarcinoma. Restoration of bowel continuity is possible in most cases, without compromise of cancer clearance. Re-anastomosis can be performed with stapled, transabdominal hand-sewn or coloanal pull-through techniques. However after a direct (straight) anastomosis of the colon to the distal rectum/anus, up to 33% of patients have 3 or more bowel movements/d; some can be troubled with up to 14 stools a day. Construction of a 6-cm colonic J-pouch is likely to cause some reversed peristalsis which improves postoperative bowel frequency without causing neo-rectum evacuation problems. Colonic J-pouch-anal anastomosis patients have a median of 3 bowel movements a day compared with a median of 6 a day for straight anastomoses, at 1 year after surgery. In the longer term, bowel adaptation may enable the function after a straight anastomosis to approximate that of a colonic J-pouch-anal anastomosis. This probably depends in the former, upon whether the more rigid sigmoid colon or more distensible descending colon is used. An additional advantage of the colonic J-pouch-anal anastomosis is the lower risk of anastomotic complications. A more vascularized side-to-end (colonic J-pouch-anal) anastomosis is likely to heal better than an end-to-end (straight) anastomosis. Where the pelvis is too narrow for a bulky colonic J-pouch anal anastomosis, a coloplasty-anal-anastomosis is an option. The latter results in postoperative bowel function comparable with the colonic J-pouch. However, the risk of anastomotic complications is higher possibly related to its end-to-end anastomotic configuration. Laparoscopic techniques for accomplishing all the above are being proven to be effective. Restorative surgery for rectal cancer can be safely and effectively performed with methods to improve bowel function very acceptably; the future advances are likely in laparoscopy.

Adenocarcinoma↗
PubMed2006

Colorectal mucinous adenocarcinoma: the clinicopathologic features and significance of p16 and p53 expression.

PURPOSE: This study was designed to examine the clinicopathologic features and p53 and p16 expressions in colorectal mucinous adenocarcinoma and colorectal signet-ring cell carcinoma. METHODS: The clinicopathologic features of 36 patients with colorectal mucinous adenocarcinoma and colorectal signet-ring cell carcinoma were analyzed and compared with 228 patients with colorectal adenocarcinomas. The p53 and p16 expressions in the colorectal mucinous adenocarcinoma and colorectal signet-ring cell carcinoma were studied by immunohistochemistry. RESULTS: Colorectal mucinous adenocarcinoma and colorectal signet-ring cell carcinoma accounted for 14 percent of colorectal cancer. The median age at presentation was 67 years. Family history of colorectal cancer in their first-degree relatives was seen in 14 percent of these patients. Fifty-six percent of the carcinomas were located in the proximal colorectum, most commonly in the transverse colon. Two patients had ulcerative colitis. Compared with the usual colorectal adenocarcinoma, colorectal mucinous adenocarcinoma and colorectal signet-ring cell carcinoma was found more often in proximal colorectum (P = 0.002), larger (P = 0.05), and in advanced stages (P = 0.018). Forty-four percent (n = 16) of the colorectal mucinous adenocarcinoma and colorectal signet-ring cell carcinoma showed p53 expression. All the patients with colorectal mucinous adenocarcinoma and colorectal signet-ring cell carcinoma with a positive family history of colorectal adenocarcinoma had tumors that showed p53 expression (P = 0.012). Seventy-eight percent (n = 28) of the tumors showed p16 expression. The median survival of the patients with these tumors was 23 months. The survival of these patients with colorectal mucinous adenocarcinoma and colorectal signet-ring cell carcinoma was poorer if the lesions were of advanced stages (P = 0.023) or with family history of colorectal cancer (P = 0.0015). Also, patients with colorectal mucinous adenocarcinoma and colorectal signet-ring cell carcinoma that did not express p16 and p53 had better survival than other patients (P = 0.04). CONCLUSIONS: Colorectal mucinous adenocarcinoma and colorectal signet-ring cell carcinoma had distinctive clinicopathologic features. Tumor staging, family history of colorectal cancer, and status of p53 and p16 expressions might predict prognosis in these patients.

Adenocarcinoma, Mucinous↗
PubMed2005

Faecal incontinence: an unrecognised epidemic in rural North Queensland? Results of a hospital-based outpatient study.

OBJECTIVES: We explored the prevalence of faecal incontinence (FI) in a referral hospital outpatient population, to explore suspicions that FI is inadequately studied, underestimated and poorly appreciated in the rural North Queensland (NQ) community. DESIGN: Prospective cross-sectional study using a specifically designed questionnaire. SETTING: The Townsville Hospital, a referral centre serving rural NQ. SUBJECTS: A total of 435 consecutive patients attending the gynaecology (n = 261) and colorectal clinics (n = 174) between 31 January and 12 June 2003 were enrolled (participating proportion 96.5%). MAIN OUTCOME MEASURES: FI prevalence, severity, impact on patients' lives, and risk factors. RESULTS: The prevalence of FI in the study population (median age 53 years) was 20.7%. Amongst affected patients (n = 90) the median duration of FI was 2 years with more than half of those affected soiling themselves at least once a month. Many patients with FI (42%) reported feeling hopeless at least some of the time. Rectal prolapse, chronic constipation, psychiatric problems, colon disease, and urinary incontinence were all significantly associated with FI. A CART analysis revealed that many patients (45%) with urinary incontinence and chronic constipation also experienced FI. CONCLUSIONS: This FI prevalence in a clinical setting in NQ is, apart from nursing home studies, the highest reported in the literature. FI negatively impacted on affected persons' lives. In patients presenting with urinary incontinence and chronic constipation, physicians should specifically enquire whether FI is also present. Definitive community studies to determine the scale of this 'silent epidemic' in northern Australia are now required.

Adaptation, Psychological↗
PubMed2005

Colorectal carcinoma among Indigenous people: a public hospital-based study in Townsville and Cairns, North Queensland, Australia.

INTRODUCTION: There are very little clinical and pathological data on colorectal cancer among Indigenous people in Australia. METHODS: A retrospective study on Indigenous patients treated for colorectal cancer at the Townsville and Cairns Base Hospitals from 1999 to 2004 was carried out in order to better characterise this disease in the Indigenous population. RESULTS: There were 25 patients (12 M, 13 F) with a median age of 57.3 years. The majority (56%) of the tumours were left-sided, being in the sigmoid colon, rectosigmoid junction and rectum. Of the patients, 60% had American Joint Committee on Cancer (AJCC) staging system Stage I and II disease at presentation. There was a relatively high proportion of poorly differentiated adenocarcinomas (40%). Six patients died of the disease. The median follow-up was 20.5 months (range 2-51). CONCLUSIONS: Comparisons were made with available data on colorectal cancer in the general Australian population. The limitations and deficiencies of the study, as well as problems of data collection on Indigenous people were discussed.

Adult↗
PubMed2003

Randomized trial of rubber band ligation vs. stapled hemorrhoidectomy for prolapsed piles.

PURPOSE: The introduction of stapled hemorrhoidectomy may replace local techniques such as rubber band ligation as a first-line treatment for Grade III and small Grade IV piles. We conducted a randomized trial to determine the role of rubber band ligation in the era of stapled hemorrhoidectomy. METHODS: Fifty-five patients with Grade III or small Grade IV hemorrhoids were randomly allocated to either rubber band ligation or stapled hemorrhoidectomy. Patient demographics and procedure-related details were recorded. Follow-up was at two weeks and two and six months to assess complications, symptom relief, incontinence scores, quality of life, and patient satisfaction. RESULTS: Twenty-five patients were randomly assigned to rubber band ligation and 30 to stapled hemorrhoidectomy. The groups were equally matched for age, gender, grade of piles, continence scores, and quality of life. Stapled hemorrhoidectomy was associated with increased pain and analgesia usage at both 2-week and 2-month follow-up (P < 0.001). Rubber band ligation and stapled hemorrhoidectomy were equally effective in controlling symptomatic prolapse, but rubber band ligation was associated with an increased incidence of recurrent bleeding (P = 0.002). There were 6 procedure-related complications in the stapled hemorrhoidectomy group compared with none in the rubber band ligation group (P = 0.027). There was no difference between the two groups in terms of continence scores, patient satisfaction, or quality of life. CONCLUSION: Stapled hemorrhoidectomy is associated with more pain and minor morbidity than rubber band ligation in the treatment of Grade III and small Grade IV piles. However, for those patients who do not want the risk of further intervention procedures, stapled hemorrhoidectomy offers the better chance of a symptomatic cure.

Adult↗
PubMed2002

Small colonic J-pouch improves colonic retention of liquids--randomized, controlled trial with scintigraphy.

PURPOSE: A small 6-cm colonic J-pouch improves stool frequency and continence, without stool evacuation problems. However, the reservoir function is not improved on physiologic studies. Hence, a scintigraphy technique was devised to study the transit of solid and liquid colonic contents in these patients. METHODS: Patients were randomly assigned to straight or colonic J-pouch anal anastomoses after ultralow anterior resection. At 1 year after surgery, they were studied by bowel questionnaire, anorectal manometry, and technetium TC 99m tin-colloid liquid test meal/I-131 microcapsule scintigraphy. In the latter, technetium TC 99m tin-colloid was ingested orally to image the colonic liquids. I-131 microcapsules taken simultaneously imaged the solid stools. After ingestion of the radioisotopes, imaging was performed at intervals of 7 to 8, 24, and 56 hours later. Two independent observers noted the presence of technetium TC 99m tin-colloid liquid and I-131 microcapsules in various areas of interest drawn over the colon. RESULTS: There were six patients (5 males, mean age, 61.5 (SE mean, 1.9) years) in the straight, and six patients (5 males, mean age, 63.2 (4.5) years) in the colonic J-pouch group. Stool frequency was more in the straight group (4.8 (0.4) vs. 3 (0.2) stools/day; P <.001). Continence, evacuation problems, and anorectal physiologic findings were not different. Technetium TC 99m tin-colloid (imaging liquids) transited significantly faster than I-131 microcapsules (imaging solids), at various areas of interest in the colon. In the colonic J-pouch patients, technetium TC 99m tin-colloid liquid was retained significantly longer in the descending colon at 24 hours (P <.05). Stool frequency was higher when technetium TC 99m tin-colloid was not retained in the descending colon at 56 hours (3.3 (0.5) vs. 4.3 (0.4) stools/day) but this did not reach statistical significance. There were no significant differences in the distribution of the ingested I-131 microcapsules between colonic J-pouch and straight groups. CONCLUSIONS: Reduced stool frequency after colonic J-pouch may be related to factors causing better retention of liquid stools in the distal colon. No difference in solid stool transit could possibly account for minimal evacuation problems in small pouches.

Aged↗
PubMed2002

Comparison of J-pouch and coloplasty pouch for low rectal cancers: a randomized, controlled trial investigating functional results and comparative anastomotic leak rates.

OBJECTIVE: To assess the efficacy of a novel coloplasty colonic pouch design in optimizing bowel function after ultralow anterior resection. SUMMARY BACKGROUND DATA: A colonic J-pouch may reduce excessive stool frequency and incontinence after anterior resection, but at the risk of evacuation problems. Experimental surgery on pigs has suggested that a coloplasty pouch (CP) may be a useful alternative. Although CP has recently been shown to be feasible in patients, there is no randomized controlled trial comparing bowel function with the J-pouch. METHODS: After anterior resection for cancer, patients were allocated to either J-pouch or CP-anal anastomoses. Continence scoring, anorectal manometry, and endoanal ultrasound assessments were made before surgery. All complications were recorded, and these preoperative assessments were repeated at 4 months. The assessments were repeated again at 1 year, and a quality of life questionnaire was added. RESULTS: Eighty-eight patients were recruited from October 1998 to April 2000. Both groups were well matched for age, gender, staging, adjuvant therapy, and mean follow-up. There were no differences in the intraoperative time and hospital stay. CP resulted in more anastomotic leaks. At 4 months, J-pouch patients had 10.3% less stool fragmentation but poorer stool deferment and more nocturnal leakage. However, there were no differences in the bowel function, continence score, and quality of life at 1 year. There were no differences in the anorectal manometry and endoanal ultrasound findings. CONCLUSIONS: Coloplasty pouches resulted in more anastomotic leaks and minimal differences in bowel function. At present, the J-pouch remains the benchmark for routine clinical practice, and due care (including defunctioning stoma) should be exercised in situations requiring CP.

Adenocarcinoma↗