PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Colectomy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Subtotal colectomy with ceco-rectal anastomosis (Deloyers) for severe idiopathic constipation: an alternative to total colectomy reducing risks of digestive sequelae].

PURPOSE: Functional results of total colectomy (TC) and ileorectal anastomosis for colonic inertia are often impaired by postoperative obstruction and diarrhea. In order to avoid these postoperative complications, we propose a subtotal colectomy (STC) preserving the ileo-caecal junction. METHODS: Since 1989, 18 consecutive patients (17 F, 1 M; mean age: 54 years) with intractable constipation underwent TC (n = 6) or STC with caecorectal anastomosis (Deloyers Procedure) (n = 12). Mean preoperative bowel frequency was two movements every month. Colonic inertia was defined as diffuse marker delay during transit study without obstructed defecation on manometry or digitalised rectography. Rectocele (n = 10), rectal (n = 5) and genital prolapse (n = 6) were treated in the same operative time. RESULTS: Postoperative course was uneventful after STC but bowel obstruction, requiring laparotomy, occurred in 3 patients (50%) after TC: enterolysis (n = 2), bowel resection (n = 2). Mean postoperative day stool frequency of TC (4.2 +/- 1.2) was higher than STC (1.2 +/- 0.1). Half of patients after TC needed anti-diarrheal treatment and diet, 33% had rectal evacuation difficulties despite liquid stools, 17% had episodic incontinence, 66% had persistent abdominal pain. Compared to TC, the functional results of STC were significantly better: regular normal transit return without diet or treatment in 75% of cases, 25% had rectal emptying difficulties easily treated by mild laxatives, only 17% had persistent abdominal pain. Postoperative obstruction, diarrhea or fecal incontinence never occurred after STC. CONCLUSION: Compared to TC, STC with Deloyers procedure seems to reduce significantly the postoperative incidence of bowel obstruction, diarrhea and abdominal pain. Expected regular transit return after STC needs a careful selection of patients and simultaneous treatment of ano-rectal and pelvic floor abnormalities frequently associated with colonic inertia.

Adult↗
PubMed1986

Personality traits that can affect adaptation after colectomy. A study of 10 patients treated for ulcerative colitis either with proctocolectomy and ileostomy or with colectomy, proctomucosectomy, ileal pouch and ileoanal anastomosis.

The purpose of the present study was to examine how specific personality traits and/or conflicts could serve to predict nonadaptability after surgical treatment for ulcerative colitis. In order to define the scope of the study and to establish more specific hypotheses, retrospective studies were conducted by in depth interviews with 10 patients. Five of the patients had undergone colectomy with proctomucosectomy and ileal pouch ad modum Parks, and 5 had had a proctocolectomy with ileostomy ad modum Brooke. The interviews were recorded on tape and analyzed by the interviewer as well as by an independent evaluator. In addition, the operating surgeon provided an independent evaluation of the patients' post-operative adaptation. There was good consensus between both sets of assessments based on interviews as well as between the interview diagnoses and the surgeon's evaluation. There was no observed correlation between prevailing psychiatric diagnostic categories and postoperative adaptation. Psychological factors, such as a discrepancy between body image and body ideal, alexithymic characteristics, abnormal aggression patterns, extensive physical exercise and muscular training, showed varying degrees of negative correlation with postoperative adaptation.

Adaptation, Psychological↗
PubMed1993

Open colectomy versus laparoscopic colectomy: are there differences?

Laparoscopic colectomy has been increasingly reported as an option for the treatment of colonic pathology. However, there is very little information regarding perioperative morbidity and the cost effectiveness of this technique. The purpose of this study is to review our first year of experience with laparoscopic colon resection. Data collected includes: age, technique (open laparotomy, laparoscopic, laparoscopic/converted open), Karnofsky score, complications, specimen size/nodes, OR time, hospital stay, and cost. This is a consecutive series of 140 elective colonic resections including 102 open laparotomies (O) and 38 laparoscopic (L) cases. The indications for surgery have included adenocarcinoma col/rect (O = 59, L = 9), diverticular disease (O = 10, L = 10), adenomatous polyp (O = 3, L = 7), IBD (Crohn's, CUC) (O = 15, L = 4), rectal prolapse (O = 3, L = 4), and other (O = 12, L = 4). There were no significant differences with respect to age (O = 60.7 +/- 1.5; L = 54.8 +/- 3.8; C = 66.1 +/- 3.1), perioperative morbidity (O = 11%; L = 15%; C = 17%). The laparoscopic and laparoscopic converted cases required significantly more time compared to the open laparotomy group (O = 2.1 +/- 0.2 hours; L = 2.9 +/- 0.2; C = 3.4 +/- 0.2). There were significantly less intraoperative blood loss associated with laparoscopic procedures compared with either open or converted groups of patients (O = 687 +/- 54 cc; L = 157 +/- 19; C = 491 +/- 50).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed2006

Review article: colon-saving medical therapy vs. colectomy in ulcerative colitis - the case for colectomy.

In the era of expanding medical therapy for ulcerative colitis, surgery is still a very valid option in those patients, where medicine is not able to control symptoms, both in the acute and chronic stages, and also for those at risk of developing a cancer. The ileal pouch-anal anastomosis (IPAA) will, for the vast majority of patients, give a very acceptable functional outcome. There is a risk of surgical complications and pouchitis; however, mortality is very low and compares well with medical therapy. Reduced female fertility is a concern but compared with the preoperative state, overall sexual function is largely improved. The ileorectal anastomosis is undergoing a revival and can be used especially in the case of female fertility concerns. Either the continent ileostomy or a conventional ileostomy is an option for those 10-15% of patients who will eventually experience pouch failure, usually either because of septic complications or an unacceptable bowel function. Quality of life following both these options, and IPAA, is excellent and does not differ from that of the matched background population.

Colectomy↗
PubMed2000

Safety and advantages of laparoscopic vs. open colectomy in the elderly: matched-control study.

PURPOSE: The aim of this study was to determine rates of complications and extent of benefits for laparoscopic-assisted colectomy compared with open colectomy in patients older than age 75. METHODS: Forty-two patients undergoing laparoscopic-assisted colectomy (1992-1998) were matched to 42 open colectomy patients for gender, age, year of surgery, operating surgeon, and procedure. Health status (American Society of Anesthesiology score), previous abdominal surgery, conversion rate, surgical outcome, and need for assistance at admission and dismissal (independence vs. home with assistance vs. nursing facilities) were reviewed. RESULTS: Mean ages were 81.2 and 80.5 years for laparoscopic-assisted colectomy and open colectomy, respectively (P = not significant). Twenty-one laparoscopic-assisted colectomy and 23 open colectomy patients were females. American Society of Anesthesiology scores were comparable, as were rates of previous abdominal surgery (57 percent for laparoscopic-assisted colectomy vs. 62 percent for open colectomy; P = not significant). Mean operative times were longer for laparoscopic-assisted colectomy (190 minutes for laparoscopic-assisted colectomy vs. 142 minutes for open colectomy; P < 0.001); operating room times progressively decreased from 221 minutes in 1992 to 1995 to 147 in 1998 for laparoscopic right hemicolectomy (P < 0.001). The conversion rate for laparoscopic-assisted colectomy was 14.3 percent. There were no deaths in either group, and laparoscopic-assisted colectomy was associated with fewer morbidities (14.3 percent for laparoscopic-assisted colectomy vs. 33.3 percent for open colectomy; P = 0.04), narcotic usage (2.7 vs. 4.8 days; P < 0.001), time to return to bowel movements (3.9 vs. 5.9 days; P < 0.001), and length of hospital stay (6.5 vs. 10.2 days; P < 0.001). Independent status at admission in 37 laparoscopic-assisted colectomy and 38 open colectomy patients was maintained at discharge by 35 laparoscopic-assisted colectomy vs. 29 open colectomy patients (P = 0.025). CONCLUSIONS: Laparoscopic-assisted colectomy is safe and beneficial, including preservation of postoperative independence, to the elderly when compared with open colectomy.

Aged↗
PubMed1995

Levels of portal and systemic blood cytokines after colectomy in patients with carcinoma or Crohn's disease.

BACKGROUND: Cytokine overproduction has been observed in different pathophysiologic conditions, including sepsis, carcinoma, inflammatory disease, and tissue injury induced by operation. Colectomy is a procedure that may result in excessive cytokine release through the portal vein. The respective effects of an operative procedure, perioperative septic complications, and of the disease itself on cytokine production are still not known. STUDY DESIGN: This study was done to investigate the variations in the levels of interleukin-1 beta (IL-1), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) and C-reactive protein (CRP) in portal and systemic blood during and after colectomy in patients with malignancy or with Crohn's disease. Blood samples were collected intraoperatively from portal and systemic veins of 24 patients undergoing colectomy for either Crohn's disease (n = 13) or carcinoma (n = 11), and postoperatively (from days 1 to 5) from systemic veins. The changes in blood levels of cytokines and CRP in patients with an uneventful colectomy (n = 19) were compared to changes in patients whose colectomy was complicated by sepsis (n = 5). Similar changes in cytokines and CRP levels were compared between patients with malignancy and those with Crohn's disease. RESULTS: The portal and systemic blood levels of IL-1, IL-6, TNF-alpha, and CRP were significantly correlated before and after colectomy. In portal blood, the level of IL-6 was significantly higher after colectomy than before. In systemic blood, the levels of CRP, TNF-alpha, and IL-6 before colectomy were significantly higher in patients with Crohn's disease than in patients with malignancy. After uneventful colectomy, a temporary increase in CRP, TNF-alpha, and IL-6 was noted in systemic blood, followed by a rapid decrease, although systemic blood cytokine levels remained significantly higher after colectomy complicated by sepsis. Interleukin-1 beta levels in both portal and systemic blood remained unchanged during and after colectomy, regardless of the indication for operation and its outcome. CONCLUSIONS: Colectomy causes acute release of cytokines and CRP in both the portal and systemic circulation. The increase in IL-6 observed after colectomy in portal blood and subsequently in systemic blood suggests local production from the resected specimen, or at least from the area of resection. Cytokine production, especially of IL-6, was modified not only by the underlying disease itself, as higher levels were observed in Crohn's disease before colectomy, but also by the presence of perioperative septic complications.

Adult↗
PubMedDate not supplied

Previous abdominal colectomy affects functional results after ileal pouch-anal anastomosis.

We assessed the effect of previous abdominal colectomy on functional results after ileal "J" pouch-anal anastomosis (IPAA) in patients with ulcerative colitis. Twenty-five patients with colectomy prior to IPAA were compared with 22 patients who underwent noncolonic abdominal operations prior to IPAA. No differences were observed in pre- or postoperative resting anal sphincter pressure, squeeze pressure, or rectal inhibitory reflex. Previous colectomy was associated with a greater incidence of postoperative small bowel obstruction. Mean +/- SEM daily stool frequency at 1 and 12 months postoperatively, respectively, was 8.9 +/- 0.8 and 5.7 +/- 0.3 for patients who had undergone previous colectomy, and 8.2 +/- 0.7 and 6.0 +/- 0.5 for the no-previous colectomy group (p = not significant). At the same postoperative intervals, nocturnal stool frequency was 1.9 +/- 0.3 and 1.1 +/- 0.2 for the colectomy group and 1.5 +/- 0.3 and 0.6 +/- 0.1 for the no colectomy group (p = 0.05 at 1 year). More patients in the previous colectomy group had greater than or equal to 1 nocturnal stool after 1 year (71% versus 33%, p = 0.03). Although pouch capacity at 1 year was not different in the 2 groups, pouch capacity was directly related to stool frequency in the no colectomy group (r2 = 0.48, p = 0.01), but not in the previous colectomy group (r2 = 0.08, p = not significant). We conclude that previous abdominal colectomy may be associated with a higher overall incidence of small bowel obstruction. Moreover, previous colectomy is a determinant of postoperative nocturnal stool frequency after IPAA, most likely due to altered ileal pouch function.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Factors affecting intravenous analgesic requirements after colectomy.

BACKGROUND: The purpose of this study was to determine factors that influence postoperative IV analgesic use after colectomy. STUDY DESIGN: We retrospectively evaluated patients who underwent colectomy between January 1997 and December 2000 at our medical center and calculated the amount of postoperative IV narcotics needed in morphine equivalents. Statistical differences (p < 0.05 considered significant) were measured using the Wilcoxon rank-sum test. Correlations were performed using Spearman correlation coefficients, and linear regression analysis was also performed. RESULTS: Four hundred eighty-one patients (235 men, 246 women) underwent colectomy; patients had a mean age of 60.6 years (range, 17 to 96 years). Procedures performed included total/subtotal colectomy (10%, n = 49), right colectomy (42%, n = 200), transverse colectomy (3%, n = 12), left/sigmoid colectomy (40%, n = 195), and low anterior resection (4%, n = 17). Laparoscopic colectomy was performed in 53 (11%) patients. Mean postoperative morphine equivalent use was 160.2 mg. Narcotic analgesic use was significantly less for women (p = 0.02), diagnosis of cancer (p = 0.02), and laparoscopic colectomy (p = 0.0001). Patients undergoing a right colectomy required less postoperative narcotics than patients having other types of colectomies (p < 0.02). There was a positive correlation between postoperative narcotic use and operative time (r = 0.14, p = 0.007) and a negative correlation with patient age (r = -0.37, p = 0.0001). Linear regression analysis demonstrated that age (p = 0.0001), female gender (p = 0.04), and laparoscopy (p = 0.001) were independent predictors for decreased narcotic use. CONCLUSIONS: Postoperative IV narcotic analgesic use is affected by gender, patient age, indication for colectomy, operative time, type of procedure, and operative technique.

Adolescent↗
PubMed1990

Factors affecting colectomy rate in ulcerative colitis: an epidemiologic study.

Factors affecting colectomy rate were studied in a retrospective population based series of 1586 patients with ulcerative colitis, in Stockholm County during 1955-84. Five hundred and sixty eight patients (36%) had total colitis at diagnosis, 603 patients (38%) left sided colitis, and 397 patients (25%) proctitis. During a median period of observation of 13 years 514 patients were treated by colectomy. The five, 10, and 25 year cumulative colectomy rate were 20% (CI 18-22%), 28% (CI 26-30%), and 45% (CI 41-49%) respectively. The main factor affecting the colectomy rate was the extent of disease at diagnosis. Patients with total colitis showed a five, 10, and 25 year cumulative colectomy rate of 32% (CI 28-36%), 42% (CI 38-46%), and 65% (CI 58-72%) respectively. Ten per cent of the 1586 patients had a colectomy during the first year after diagnosis, 4% during the second year and 1% during subsequent years. The age at diagnosis and sex did not affect the cumulative colectomy rate. Elective colectomy was performed in 322 cases (63%) and acute colectomy in 192. The duration of disease before colectomy fell during the study period due to a more standardised criteria for colectomy in severe attacks. One hundred and twenty nine (66%) of the acute colectomies were performed within two years from diagnosis.

Adult↗