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Results for “Digestive System Fistula”

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At least 613 records · Page 34Linked to original sources
PubMed2004

Use of radiofrequency in the treatment of minor anal pathology.

BACKGROUND: Conventional approaches dealing with chronic anal fissures focus on relieving the anal spasm by manipulation of the internal sphincter. The concomitant pathologies like sentinel piles, anal papillae, or haemorrhoids, however, are often ignored for unknown reasons. MATERIAL AND METHODS: This study describes radiofrequency procedures to remove the above named associated pathologies after performing anal sphincterotomy. A separate, blinded and prospective study between conventional and radiofrequency excision of sentinel pile is described. The measured parameters included the procedure time, intraoperative blood loss, postoperative pain and wound healing time. RESULTS: This combined technique was found useful in treating anal fissures as well as the associated pathologies. The comparative study showed that the intraoperative bleeding was less (p < 0.0001) and wound healing was faster (p < 0.0001) in the radiofrequency group. CONCLUSION: Radiofrequency can be used as an alternative in treating pathologies like the sentinel tags, anal papillae, post fissure fistula or non prolapsing haemorrhoids found associated with anal fissures.

Anus Diseases↗
PubMed2006

Intraoperative physical diagnosis in the management of anal fistula.

This report reviews a prospective database applying a systematic fistulomy technique in 101 patients requiring surgery for fistula in ano at LAC+USC Medical Center during a 15-month period. Data were collected for the reliability of primary crypt palpation, success of tract injection with peroxide/methylene blue, and the accuracy of Goodsall's rule. Time to healing, recurrence, and incontinence according to type of procedure were also recorded. Palpation of the primary crypt was possible in 93 per cent. Hydrogen peroxide/methylene blue injection successfully delineated the tract in 83 per cent. Goodsall's rule was correct in 81 per cent. Each fistula was categorized as intersphincteric (n = 72), transphincteric (n = 33), extrasphincteric (n = 1), or submucosal (n = 6). At a mean follow-up period of 44 weeks, 89.2 per cent of patients were cured. Reasons for recurrence included wound bridging (n = 6), misdiagnosis of the tract (n = 3), and two blind-ended fistulae (n = 2). Time to healing in weeks was (mean, range): simple fistulotomy (12, 3-21), seton (16, 4-28), Hanley procedure (28, 8-48). Patients with a marsupialized tract healed at an average of 6 weeks (range 4-8). Four (3.9%) patients reported postoperative incontinence (1 gas, 3 liquid, 0 solids).

Diagnosis, Differential↗
PubMed2006

Primary anterior sagittal anorectoplasty for rectovestibular fistula.

OBJECTIVE: To reduce the morbidity and suffering of patients with rectovestibular fistula (RVF) and to lessen the cost of the staged management protocol. METHODS: A prospective study was carried out in the Department of Paediatric Surgery of Dhaka Shishu (Children) Hospital, Bangladesh, from January 2002 to February 2004. Twenty-three patients underwent primary anterior sagittal anorectoplasty (ASARP) for RVF, of whom 18 had congenital and five had acquired RVF. Patient age ranged from 15 days to 5 years. The diagnosis was made from history, clinical examination and ultrasonography. RESULTS: The mean operating time was 90 minutes. There were no major perioperative complications. Three patients developed partial wound disruption in the postoperative period. All patients started oral feeding on the 4th postoperative day and the mean hospital stay was 6 days. The average bowel movements per day were 3-5 motions, without any oral therapy or enema. Two patients had occasional perineal soiling. All patients are being followed-up and the early postoperative results seem acceptable. CONCLUSION: Primary ASARP is a good procedure for RVF as it is quick and cost-effective and requires no colostomy, laparotomy or laparoscopy.

Child, Preschool↗
PubMed2004

Can anal manometry predict anal incontinence after fistulectomy in males?

BACKGROUND: Disordered continence is frequently reported after operations for anal fistulae and pre-operative anorectal physiology may be carried out prior to surgery to improve functional outcome. Elderly patients and multiparous females are at higher risk for incontinence, whereas males under 60 have stronger sphincters. The aim of this study was to investigate the predictive role of anal manometry and the causes of postoperative soiling and its effect on the quality of life in males with intact sphincters undergoing excision of either trans or supra sphincteric fistulae. METHODS: Thirty-eight patients (median age 47 years) were analysed retrospectively. None had previous anal surgery and all were fully continent. Five had Crohn's disease. Anal pressures and rectal sensation were evaluated prior to fistulectomy by means of anal manometry in all cases and after surgery in those who had postoperative incontinence. A cutting seton was used in 17 patients, a rectal advancement flap in 15 and a double rectal-cutaneous flap in six. None had a lay-open. The intersphincteric plane was explored and drained in all cases. A previously described incontinence grading and score was used to assess postoperative soiling. The median follow-up was 22 (range 5-89) months. The patients with postoperative anal incontinence were evaluated with the Gastrointestinal quality of Life Index Questionnaire (0:poor, 4:good) at a median follow-up of 49 months. RESULTS: Twenty-nine (76%) patients were continent after surgery, whereas 9 (24%) complained of some degree of anal incontinence (minor in 4, severe in 1, the 1-6 incontinence score being 3.7 +/- 1.3 (mean +/- s.d.m.). Their Quality of life score was 3.8 +/- 0.5 (mean +/- sdm). None of them had Crohn's disease, five had frequent diarrhoea, four had a reintervention for either anal fissure or recurrent fistula (two), three had a postseton anal deformity. No difference was found between continent and incontinent patients as far as pre-operative anal pressures were concerned, but the maximum rectal volume threshold was significantly higher in incontinent patients, 165 +/- 67 vs. 123 +/- 49 ml of air (P = 0.04). CONCLUSIONS: Sphincter division, diarrhoea and anal deformity may cause soiling after fistulectomy in males and it does not severely affect quality of life. Surgery rather than manometry may predict it and rectal sensation may play a role which needs further investigation.

Adult↗
PubMed2006

Foregut abnormalities.

Explore the source record for details and available documents.

Diagnostic Techniques, Digestive System↗
PubMed2001

Crohn's disease of the foregut.

Historically, Crohn's disease of the esophagus, stomach, and duodenum has been reported only rarely. With more frequent use of upper endoscopy, however, upper gastrointestinal involvement has been found to be more common than previously suspected. The surgeon with an interest in Crohn's disease needs to be familiar with all areas that are potentially affected in this perplexing and sometimes devastating disease. This article examines the literature on foregut Crohn's and discusses the incidence, clinical manifestations, diagnosis, medical management, surgical indications, and operative techniques.

Crohn Disease↗
PubMed1983

[Clinical evaluation of neocarzinostatin in digestive system cancer. 2. Clinical studies on the administration of neocarzinostatin in advanced and recurrent carcinoma of the pancreas].

The present study was designed to evaluate the efficacy of chemotherapy by NCS for advanced and/or recurrent carcinoma of the pancreas, mainly nonresectable cases in which exploratory laparotomy or construction of biliary fistula were performed. Three hundred fifty seven cases were available for the study. Of the 357 cases, 116 were treated with NCS alone 5-FU. In the former, the efficacy rate was higher in cases with 2,000 mu/body of NCS every day than in those with 4,000 mu/body of NCS intermittently 2-3 times for a week. 19.6% of the cases treated with more than 40,000 mu of NCS alone in total were interpreted as effective clinically by Karnofsky's criteria of I-A over. In the latter, the efficacy rate was higher in cases with 2,000 mu/body of NCS combined with 250 mg of 5-FU every day than in those with 4,000 mu of NCS combined with 500 mg of 5-FU intermittently, 22.5% of the cases given more than 40,000 mu of NCS in total were interpreted as effective clinically by Karnofsky's criteria of I-A over. The major adverse effects of NCS such as anorexia, vomiting and nausea were observed in 20% of total cases respectively, leucopenia in 10% and fever in 15% of them.

Antibiotics, Antineoplastic↗
PubMedDate not supplied

[Evaluation of late results in the children with anorectal anomalies].

UNLABELLED: Anorectal malformations constitute the most varied group of congenital defects. Constant challenge for the surgeon being engaged in this subject are the studies of new factors which could improve the functional results of treatment. AIM: The aim of the study was the evaluation of late results after surgical treatment in children with anorectal anomalies. Assessment of the qualification criteria for the kind of surgical repair: one-stage (OSR) or stage repair (SR), age of the patient at the end of treatment and accompanying sacral bone defects were taken into consideration as the factors of functional prognosis. MATERIAL AND METHODS: 93 children with different types of anorectal defects were operated on between 1990-2002 in Department of Pediatric Surgery in the Institute of Mother and Child. The evaluation was performed in 60 patients over 3 years old: in 30 after OSR (group I) and in 30 after SR proceeded by colostomy (group II). Anorectal malformations were classified according to Pena's division based on the place of fistula orifice. Most kinds of anorectal anomalies were operated on according to the principles of posterior sagital anorectoplasty (PSARP). In patients with congenital anal stenosis a modified cutback procedure was done. In long-term evaluation in every child precise diagnostics of sacral bone with definition of congenital sacral bone defects and sacral measurements were performed, in order to estimate their influence on the results of treatment of anorectal anomalies. In postoperative evaluation of functional results the following criteria were taken into consideration: physical examination, evaluation of fecal continence by using quantitative scoring method and manometric study. The control group included 20 children with constipation. RESULTS: Sacral bone defects were diagnosed in 10% of the OSR group (group I) and in 73% of patients of the SR group (group II). Sacral measurements showed significant differences in SR group compared with OSR and control group. In clinical examination postoperative appearance of perineal and anal region depended on congenital development of perineal structure. In ST group of patients symptoms of 'flat perineum' were seen with various degree of muscles hypodevelopement, lack of perineal raphe and weakly marked anal dimple. Results of fecal continence in OSR group (group I) were defined as normal in 93% of patients and good in 7% of cases. In SR group (group II) the results were as following: normal in 41%, good in 17%, fair in 38% and poor in 4% of cases. The worst results were obtained in the patients with sacral defects in SR group. In manometric study there were no significant differences except for one parameter (anal resting pressure) between OSR group (group I) and the control group. In group II manometric study was different in three parameters: anal resting pressure, squeezing pressure and presence of internal sphincter reflex. The presence of sacral bone defects had the most important influence on manometric study results. CONCLUSION: Functional results in the OSR group of patients were not different from the control group. Precise criteria for this kind of surgical treatment and lack of serious sacral defects were the most important factors for good prognosis. The results of late evaluation in SR group depended on coexisting sacral bone agenesis.

Anal Canal↗
PubMed2001

Analysis of the development of normal foregut and tracheoesophageal fistula in an adriamycin rat model using three-dimensional image reconstruction.

To examine the developmental process of the normal trachea and esophagus and their maldevelopment leading to tracheoesophageal fistula (TEF), we performed three-dimensional (3-D) image reconstruction of the developing foregut in normal and adriamycin (ADM)-induced TEF rats. Microscopic images of serial sections of embryos from seven normal and 14 ADM-treated rats killed every half a day after 11-14 days' gestation were traced and reconstructed using a 3-D construction imaging system (TRI, RATOC System Engineering, Tokyo, Japan). In the normal embryos, the lung bud appeared just below the pharyngeal foregut on day 11 and it elongated caudally to shape into the trachea as they grew. A 'tracheoesophageal septum" did not emerge. In the TEF embryos, although the lung bud appeared in a similar position on day 11, the trachea and esophagus did not separate and only a common foregut tube elongated caudally, then bilateral bronchial primordia emerged directly from it. Furthermore, abnormal development of the notochord was evident, being retarded in separation from the foregut, finally descending along a more ventral course and bending sharply around the level of the bifurcation. Microscopically, less mesenchymal cellularity around the foregut was noted in the TEF embryos. The trachea seemed to be formed only by caudal elongation of the lung bud in the normal embryos. In the ADM-induced TEF embryos, the upper foregut appeared to develop only into the trachea, and this maldevelopment may be implicated in the abnormal interaction between the foregut and the surrounding mesenchyme.

Animals↗
PubMed2004

Manometric evaluation of the intrathoracic stomach after gastric transposition in children.

Gastric transposition (GT) is one of the options for the esophageal replacement in children with esophageal atresia with or without tracheoesophageal fistula (EATEF). To date, no manometric studies have been conducted on the intrathoracic stomach after GT in EATEF patients; hence, this study was designed. Babies ( n=18) of EATEF who underwent esophageal replacement by GT were studied and manometry was correlated with the clinical outcome, age at surgery, and route of GT. The mean age at evaluation was 30.5 months (range 4-84 months). These cases were sub-stratified into group I (GT during neonatal period) and group II (GT during post-neonatal period). Mean age at surgery was 6 days and 7.8 months in groups I and II, respectively. There was no propulsive antegrade propagated peristaltic waves in any of the patients. Mean resting pressure and mean peak pressures were 19.5 and 50.4 mm Hg in groups I and II, respectively. Mass contractions to liquid swallow was noted in 77 and 55% of patients in groups I and II, respectively. There was no significant difference in the pressure parameters or appearance of mass contractions between group-I and group-II patients. Similarly, there was no significant difference in pressure parameters or appearance of mass contractions between the children who had transhiatal vs retrosternal GT. It needs to be determined whether the mass contractions noted in GT ever progress to a coordinated propulsive rhythmic contractions and whether this has a final bearing on the long-term functional outcome of GT patients.

Age Factors↗
PubMed1991

[Preventive operations in intestinal abnormalities].

In intestinal anomalies, preventive surgical procedures include gastrostomies and enterostomies as well as some special operations such as ligature of the cardia and associated appendectomies. General indications for enterostomies are seen in life-threatening circumstances, i.e. prematurity, surfactant deficiency, major associated malformations and complications. Preventive surgical procedures are necessary in certain cases of esophageal atresia, complicated small bowel atresia, meconium ileus, anorectal malformations, Hirschsprung disease, neuronal intestinal dysplasia and necrotizing enterocolitis. Prophylactic surgery requires detailed knowledge of the definitive therapeutic procedure.

Abnormalities, Multiple↗
PubMed1994

[Artificial (parenteral and enteral) nutrition in postoperative rehabilitation].

Post-surgical rehabilitation requires a full knowledge of the physiopathological basis and a great capacity to evaluate with specific tools, essential function and variations of digestive system. These problems have been underlined by the Authors specifically for gastric surgery in general, for movement factors of intestinal surgery and related nutritional implications for Crohn's disease, chronic intestinal insufficiency, enteric fistulas, severe exocrine pancreatic insufficiency, related to resective pancreatic surgery and for external pancreatic fistulas. The last words have been devoted to peri-operative parenteral nutrition.

Enteral Nutrition↗