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At least 19 recordsLinked to original sources

PubMed1992

Prospective evaluation of laparoscopic-assisted colectomy in an unselected group of patients.

Laparoscopic technology is likely to have an increasing impact on surgical procedures that have previously required an open approach. We have prospectively evaluated laparoscopic colectomy in 40 patients requiring elective colonic excision mainly for malignant disease. 33 of 40 patients had a successfully completed laparoscopic colectomy, although there was one postoperative death. Seven operations were unsuccessful and required conversion to conventional open laparotomy. Morbidity was low with no wound infections and only two chest infections in the 32 survivors. Early mobilisation and discharge from hospital (mean 8 days) was a notable feature. Previous abdominal surgery was not an absolute contraindication to laparoscopic colectomy. However, the inability to palpate the colon directly to confirm the site of laparoscopically impalpable lesions leads us to recommend contrast radiology to confirm the location of colonoscopically diagnosed lesions before laparoscopically assisted colectomy. Preliminary pathological assessment of resected tumour specimens revealed a satisfactory tumour clearance. We conclude that laparoscopic colectomy is a feasible operation in most patients and leads to a substantial patient benefit without compromising the chance of a surgical cure of cancer.

Adult↗

PubMed1992

Changes in rectal epithelial cell proliferation and intestinal bile acids after subtotal colectomy in familial adenomatous polyposis.

Subtotal colectomy and ileorectal anastomosis in familial adenomatous polyposis patients can induce temporary regression of adenomas in the rectum. The mechanism for this phenomenon is unclear. We evaluated the effect of colectomy on rectal mucosal proliferation, in relation to changes in bile acid metabolism. Four familial adenomatous polyposis patients were studied before and 3-6 months after surgery, and eight others 7-22 years postoperatively. Within 6 months after surgery, the size of the proliferative zone of the colonic crypts was found to be reduced (P less than 0.05). The proliferative activity of total colonic crypts was not affected within this period. More than 7 years postoperatively, increased cell proliferation of total crypts (P less than 0.02), as well as mid (P less than 0.05) and basal (P less than 0.05) crypt compartments, were observed compared to shortly after colectomy. In duodenal bile, deoxycholic acid was absent shortly after operation, whereas several years after operation only a small fraction (2%) was present. Fecal secondary bile acid excretion diminished after colectomy and did not change several years postoperatively. In postoperative stools only, small proportions of ursocholic and ursodeoxycholic acids (about 5% each) were consistently found. As subtotal colectomy causes a temporary decrease in the length of the proliferative zone of rectal crypts toward a normal pattern, this may explain regression of rectal polyps. This temporary effect may be mediated, at least in part, by decreased amounts of cytotoxic secondary bile acids in the rectal lumen.

Adenomatous Polyposis Coli↗

PubMed1992

Laparoscopic colectomy.

Fifty-one laparoscopic colectomies were attempted at two institutions. The clinical results and methods are presented. Seven cases (14%) were converted to facilitated procedures, and four cases (8%) were converted to "open." Cases of cancer, diverticulitis, endometriosis, regional enteritis, villous adenomas, and sessile polyps were operated. Right, transverse, left, low anterior, and abdominoperineal colectomies were performed. Colotomies and wedge resections were also performed. Laparoscopic suturing was required in five cases of incomplete anastomosis by circular stapler (18%). Suturing was required in all right, transverse colectomies and colotomies. Operative time averaged 2.3 hours. Hospitalization averaged 4.6 days. Four patients had complications (8%), and one 95-year-old died of pneumonia (2%). Laparoscopic colectomies can be performed safely, but require two-handed laparoscopic coordination, as well as suturing and knot-tying skills.

Adult↗

PubMed1992

Selection of constipated patients as subtotal colectomy candidates.

We evaluated 224 consecutive patients referred for severe constipation prospectively by strict criteria to determine their candidacy for subtotal colectomy. Eighteen patients had insufficient symptoms to warrant evaluation. Two hundred six patients had anorectal manometry and defecography, and 182 had colonic transit measurement. Forty-nine patients had normal or minimally abnormal studies. One-hundred twenty-nine patients had abnormalities such as outlet obstruction, mild colonic inertia, diffuse gut dysfunction, or combinations of factors not favoring subtotal colectomy. Twenty-eight patients had colonic inertia without outlet obstruction and with disabling symptoms; 19 of these patients underwent subtotal colectomy. Follow-up > or = 12 months was available in 14 patients from this group. Of these patients, 12 (86%) were clinically improved. Preoperative evaluation accurately predicted postoperative fecal incontinence and likely reduced postoperative constipation. Small-bowel obstruction occurred postoperatively in 4 patients (29%), and remains a major risk of subtotal colectomy even in carefully selected candidates.

Adult↗

PubMed1976

Postoperative mortality and complications after colectomy for ulcerative colitis.

During a 10-year period colectomy was performed on 101 patients. The postoperative mortality of 12 per cent was influenced decisively by duration and severity of the disease. Seventy-eight per cent of the patients were severly ill during the attack leading to colectomy, and 15 per cent of them died. One-third of the patients with toxic megacolon and general intoxication died. One-quarter of the patients with a history of less than 3 months died. The causes of death were peritonitis and pulmonary complications. Half of the patients developed postoperative complications of varying severity. Preoperative steroid medication did not influence the mortality or the postoperative complications. It is concluded that only close medical and surgical cooperation, careful selection of patients, and skillful timing of operations may reduce the mortality in ulcerative colitis. The paper supports that total colectomy in suitable cases may be performed without higher mortality than subtotal colectomy.

Acute Disease↗

PubMed1992

[Right and left laparoscopic colectomy. Apropos of 10 cases].

Ten successive cases of celioscopic colectomy are reported (5 right and 5 left colons). Colectomies were made for diverticular disease in 6 case and for cancer in the remaining cases. The patients ages range from 52 to 80 years, with an average of 72 years. The average duration of surgery is 92 minutes. The stay in hospital lasted from 5 to 7 days with an average of 6 days. All patients resumed fluid feeding on the 3rd postoperative day and solid feeding on the 4th to 6th day. None of them received analgesics later than 48 hours postoperatively. There was no mortality. Only one complication was noted in the form of urinary retention. In our opinion, colectomy with celioscopic video surgery currently has a definite role to play and, owing to technical and instrumental progress, colectomy can be performed without complementary laparotomy, at least for the left colon.

Aged↗

PubMed1978

Familial polyposis coli. Management by total colectomy with preservation of continence.

Two cases of familial polyposis coli were managed by total colectomy and endorectal pull-through with excellent long-term results. The performance of a temporary loop ileostomy is advisable to prevent anastomotic complications. In addition, it avoids the excessive diarrhea and perianal excoriation that frequently occur in the early postoperative period until full continence is regained. This is the only method that allows the preservation of rectal function and prevents the occurrence of rectal cancer. It should be considered as a real alternative to either subtotal colectomy and ileorectal anastomosis or total colectomy with construction of an ileostomy.

Adolescent↗

PubMed1977

[Reversal of small bowel segments to delay intestinal passage after total colectomy (author's transl)].

Five female mini-pigs underwent total colectomy including resection of the ileocecal valve. Sparing the terminal rectum, we reformed an end-to-end anastomosis between terminal ileum and remaining rectal cuff. In a second series 8 female mini-pigs have been colectomized using the same model. To delay intestinal passage, in addition a 10-12 cm long reversed segment of terminal ileum has been inserted between small bowel and rectal stump. Both groups were compared with a group of normal unoperated mini-pigs in a study up to 1 year, observing intestinal transit time, blood chemistry and general development of the animals. It could be proved that the reversal of a small bowel segment in colectomized animals leads to a prolongation of the intestinal transit time, to normalization of electrolytes and general appearance. Colectomy was only survived by animals with a reversed segment. The clinical application of a reversed small bowel segment following total colectomy in 1 patient was successful.

Adult↗

PubMed1992

Surgery after colectomy for ulcerative colitis.

The need for surgery after colectomy in patients with ulcerative colitis in Stockholm County over a 30-year period, 1955 to 1984, was investigated. During this time 483 patients were discharged from the hospital after colectomy. The mean period of observation from colectomy was 11.6 years. In 325 (67 percent) of the 483 patients there was need for further surgery (932 surgical procedures) during the period of observation. In 95 (20 percent) patients 115 small intestinal obstructions requiring surgery developed. The 2-year and 15-year cumulative probabilities of a first small intestinal obstruction were 11 percent (confidence intervals [CI] 8-14 percent) and 23 percent (CI 19-27 percent), respectively. In 42 (16 percent) of 255 patients treated by proctocolectomy and ileostomy there was need for 64 ileostomy revisions. The 2-year and 15-year cumulative probabilities of a first ileostomy revision were 9 percent (CI 6-12 percent) and 19 percent (CI 14-24 percent), respectively. Ninety-one Kock's pouches were constructed and a total of 125 revisions of Kock's pouch were performed. The 2-year and 15-year cumulative probabilities of a first Kock's pouch revision were 52 percent (CI 41-63 percent) and 57 percent (CI 46-68 percent), respectively. In 75 patients a pelvic pouch and ileoanal anastomosis was constructed. In 32 patients 73 surgical procedures due to pouch-related dysfunction were performed. Alterations in ileoanal pouch technique and increasing surgical experience has resulted in a markedly decreasing frequency of complications during the last years. There was no need for further surgery in 116 (45 percent) of the 255 patients treated by proctocolectomy and ileostomy, in 31 (34 percent) of the 91 patients with Kock's pouch, in 20 (39 percent) of the 51 patients with ileorectal anastomosis, and in 43 (57 percent) of the 75 patients with pelvic pouch and ileoanal anastomosis (closure of loop ileostomy excluded).

Colectomy↗

PubMed1992

Management of the rectum following colectomy for acute colitis.

During a 6 year period, 31 consecutive patients under the care of one surgeon had emergency colectomies for complicated colitis. A selective policy of closing the rectum intraperitoneally to minimize the length of retained diseased bowel and to avoid a mucus fistula was used during the study period. One patient underwent proctocolectomy, 7 subtotal colectomy with mucus fistula and 23 total colectomies with intraperitoneal closure of the rectum. Two patients (8.9%) developed pelvic sepsis. Both had intraperitoneal closure of the rectal stump and were readily managed by drainage into the stump. Subsequent surgery in the 18 patients having rectal excision has been uncomplicated. Intraperitoneal closure of the rectal stump in emergency surgery for complicated colitis can be performed safely in most of these patients.

Acute Disease↗

PubMed1992

Subtotal colectomy as a last resort for unrelenting, unlocalized, lower gastrointestinal hemorrhage: experience with 12 cases.

A 7-year experience involving 12 cases of massive, unrelenting lower gastrointestinal hemorrhage is presented. In these patients, the bleeding could not be localized by multiple diagnostic modalities and was managed by blind subtotal colectomy. While the procedure was efficacious in arresting bleeding in all cases, a resultant mortality of four cases (33%) ensued. Morbidity among the survivors was significant. Only three patients (25%) survived without complications, which enabled an early discharge from the hospital. Diverticulosis was the most common cause (83%) of uncontrollable and preoperatively undiagnosed bleeding in this group of patients. These 12 cases of blind subtotal colectomy for massive lower gastrointestinal bleeding represent one of the larger series in the literature. These data are consistent with more recent reports that indicate that subtotal colectomy for lower gastrointestinal bleeding is an effective but a formidable procedure. This is contrary to the earlier published results.

Aged↗

PubMed1979

Ileal adenomas after colectomy in nine patients with adenomatous polyposis coli/Gardner's syndrome.

Adenomas of the ileal mucosa are an uncommon finding in adenomatous polyposis coli/Gardner's syndrome. We report 9 patients who were found to have ileal adenomas 1 yr 11 mo to 25 yr 11 mo after colectomy. The ileal adenomas occurred proximal to an ileorectal anastomosis in 7 patients, both proximal to a cecoproctostomy and later proximal to an ileostomy in 1 patient, and in an ileostomy in 1 patient. The cases confirm that ileal mucosa is susceptible to adenoma formation in adenomatous polyposis coli/Gardner's syndrome and thus provide additional evidence that adenomas are not confined to the colon in these patients. In addition, the findings in the cases suggest that the ileal adenomas developed after colectomy. Thus, our cases suggest that the small intestine should be studied for the presence of adenomas after colectomy with either ileoproctostomy or ileostomy, as well as before resection. On the other hand, aggressive management does not seem warranted as carcinoma of the jejunum and ileum has been reported only rarely.

Adult↗

PubMed1977

Ulcerative colitis and Crohn's disease: results after colectomy and ileorectal anastomosis.

Eighty-one patients who had had colectomy and ileorectal anastomosis for ulcerative colitis or Crohn's disease of the colon from 1 to 13 years previously were interviewed and examined by a surgeon with whom they had had no previous contact. Sixty-four patients (79 per cent) had a satisfactory result. In 12 patients the operation had failed and an ileostomy had been established, and in a further 5 patients the result was considered unsatisfactory. Despite a high incidence of frequent loose stools and minor anorectal complications, most of the patients were satisfied with the result and would not contemplate the alternative of an ileostomy. No patient had developed rectal cancer. Provided that the rectum is examined regularly for pre-malignant or malignant change, colectomy and ileorectal anastomosis offer a satisfactory alternative to proctocolectomy and ileostomy for many patients with ulcerative colitis or Crohn's disease.

Adolescent↗

PubMed1992

The value of age of onset and rectal emptying in predicting the outcome of colectomy for severe idiopathic constipation.

We have evaluated the predictive value of pelvic floor dysfunction (as characterized by abnormal contraction during defaecation straining or absent balloon expulsion) and evacuation proctography on symptomatic severe idiopathic constipation after colectomy with ileorectal or colorectal anastomoses for improvement and the use of laxatives. We also determined whether there was a relationship between the age of onset of symptoms and the symptomatic outcome after surgery. Forty-four women (mean age 34 years) were studied. Twenty patients had had a preoperative evacuation proctogram. Of these, 8 evacuated completely and 12 incompletely. Of the 29 patients in whom puborectalis electromyography was performed, 19 had paradoxal contraction on straining. There was no statistical relationship between symptomatic outcome and complete or incomplete evacuation on proctography, the presence or absence of puborectalis paradox or the age of onset of constipation (before or after the age of 10 years). Twenty-five patients had a preoperative balloon expulsion test. Of these, 14 were not able to expel a 50 ml water-filled balloon, and all 14 (100%) still experienced postoperative pain; 8 (57%) were still using laxatives. Of the 11 patients who were able to expel a balloon, 6 (55%) experienced pain and 1 (11%) still required laxatives postoperatively. The differences in postoperative pain and laxative requirements between those unable and those able to expel the balloon were statistically significant. Thus the balloon expulsion test may have predictive value when considering colectomy in patients with severe idiopathic constipation.

Adolescent↗

PubMed1975

The functional consequences of colectomy.

The colon plays a decisive role in salt and water conservation in the intact human, normally removing from the terminal intestine approximately one liter of isotonic fluid that escapes small bowel absorption. The primary purpose of this colon function is probably to prevent extracellular fluid volume depletion and only incidentally to produce a normal solid stool. The patient with an ileostomy can partly adapt to replace the absorptive capacity lost after colectomy but is still vulnerable if salt and water intake ceases completely. In contrast, patients with ileorectostomies and some patients with continent ileostomies can almost totally adapt to loss of the colon. These findings suggest that the ileal mucosa can adapt under certain conditions to absorb at rates and concentrations previously thought impossible. This property of ileal mucosa might be utilized in the future to significantly improve the condition of patients who require total colectomy.

Adaptation, Physiological↗

PubMed1978

Small-bowel adaptation after colectomy in rats.

Colectomy with ileoproctostomy or ileostomy was performed in rats. The animals were killed at different time intervals after operation. In histological sections from the small intestine the total crypt cell number and vinblastine-arrested mitoses were counted, and the villus height was measured; these parameters were compared with the corresponding ones in unoperated controls and in rats subjected to ileal transection. After ileoproctostomy the rats remained in good condition, whereas ileostomy was followed by weight loss, debility and a great mortality. After ileoproctostomy, ileostomy and ileal transection there was an increased number of mitoses in the crypts during the 28 days' observation period, indicating an increased rate of cell proliferation. Increased villus height was observed after ileoproctostomy as well as after ileostomy. The mucosal hyperplasia may play a role for the increase in water and salt absorption capacity after colectomy. Probably, however, the hyperplasia of the small-intestinal mucosa cannot fully compensate for the loss of the colon in rats. Preservation of the absorptive function of the rectum, as in ileoproctostomy, is necessary for adequate water and salt absorption.

Adaptation, Physiological↗

PubMed1975

Sequelae of colectomy and ileostomy: comparison between Crohn's colitis and ulcerative colitis.

A comparison is made of the immediate and long term mortality of colectomy and ileostomy between 73 patients who had Crohn's colitis and 442 who had ulcerative colitis. The immediate mortality in Crohn's disease is 4%. In ulcerative colitis it is 10%, chiefly because of the higher proportion of emergency operations. The late mortality in both groups is 10%, chiefly as a result of recurrence of Crohn's disease or the sequellae of colonic malignancy present at the time of colectomy for ulcerative colitis. A further comparison is made between the postoperative course of the 64 surviving patients with Crohn's disease and a comparable sample of 65 patients who had an ileostomy for ulcerative colitis in the same era. There was a similar incidence of postoperative septic complications in the two groups (35%). The readmission rate was twice as high in the Crohn's disease patients. Ileostomy reconstruction for mechanical complication was needed in 21 patients with Crohn's disease compared with 6 with ulcerative colitis. Further ileal resection was required for recurrent disease on another 25 occasions in the patients with Crohn's disease but never in those with ulcerative colitis. Long therm review graded the clinical status as excellent or good in 70% of those with Crohn's disease compared with 95% with ulcerative colitis.

Adult↗

PubMed1992

[Minimal intestinal preparation before colectomy for cancer. Experience of 189 cases].

189 cases of colectomy for cancer have undergone limited bowel preparation by one or two enemas the day before surgery. The anastomosis has been performed manually with a continuous suture of resorbable material. Hospital mortality is 1.6% for the whole series and limited to 0.5% for elective resections despite the old age of the patients included (70.6 +/- 11 years, with 40.7% more than 75 years). Morbidity rate is 13.9% and of 2.6% for local septic complications. No clinical anastomotic dehiscence was demonstrated. From these results, poor local bowel preparation does not appear to be a risk factor of colectomy for cancer.

Adenocarcinoma↗