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18 recordsLinked to original sources
PubMed1979

Continent anal ileostomy with mucosal proctectomy: a bloodless technique using a surgical ultrasonic aspirator in dogs.

At present, mucosal proctectomy with ileo-anal anastomosis is a difficult, time-consuming operation involving much blood loss, often associated with impaired postoperative continence. A new operation has been devised in our department in which a surgical ultrasonic aspiratory, the CUSATM System (Cavitron Corporation) was used to fragment directly and strip bloodlessly mucosa from the rectal wall in 20 dogs as part of a simple ileo-anal sleeve anastomosis. All dogs were closely followed for up to 10 months. The only operative mortality occurred in the first dog where the upper rectum sloughed because the superior haemorrhoidal artery was divided. Preoperative weight was regained within the first 2 months. Initially stools were loose and frequent. Within 2 weeks the daily stool count was 5-6 with gradual thickening to semisolid consistency by 6 weeks. Finally 3-4 normal stools were passed daily. Postoperatively, all dogs remained contingent.

Animals↗
PubMed1978

Perineal wound healing after proctectomy for inflammatory bowel disease.

One hundred fifty-one cases of patients who underwent proctectomy for inflammatory bowel disease at the Lahey Clinic were analyzed with respect to the factors that predispose to delay in perineal wound healing. Significantly poorer healing took place in patients with Crohn's colitis, in men with ulcerative colitis, and in patients with ulcerative colitis who underwent one-stage operations. Factors that were not statistically significant but that appeared to contribute to delay in healing were younger age of patients and presence of anal fistula. A comparison is made with the results of other series, and recommendations for treatment and prevention are presented.

Adolescent↗
PubMed1978

Endorectal mucosal resection without proctectomy as an adjunct to abdominoperineal resection for nonmalignant conditions: clinical experience with five patients.

Five patients with chronic ulcerative colitis underwent endorectal excision of the rectal mucosa without removing the rectal muscle in combination with total colectomy and cutaneous ileostomy. This operative technique will cure the patient of the primary disease and obviates many of the usual unpleasant complications following total proctectomy, such as prolonged perineal drainage and sexual and bladder dysfunction. It has the further advantages of lower operative blood loss and earlier safe ambulation. On the basis of favorable clinical experience with these patients, we believe that the operation warrants further clinical trial in patients who have biopsy-proven ulcerative colitis without severe rectal ulcerations as well as in certain other nonmalignant conditions originating in the rectal mucosa.

Adolescent↗
PubMed1978

[Primary healing of the sacral cavity after proctectomy - a solvable surgical problem (author's transl)].

Primary healing of the perineal wound and the sacral cavity after a.p. resection of the rectum is an old surgical problem. In order to achieve primary healing we are using a lengthened omental graft to fill up the sacral space. Since January 1977 to July 1977 we used this method in 17 patients. 15 patients had very low rectal cancers. 2 patients had to undergo proctocolectomy because of ulcerative colitis. In 14 cases we achieved primary healing, among these the colitis patients. Overall we had three abscess formations in the sacral cavity. One of these patients got in addition an obstruction postoperatively.

Abscess↗
PubMed1977

Total colectomy and mucosal proctectomy with preservation of continence in ulcerative colitis.

Since ulcerative colitis is a mucosal disease, it would appear possible to remove the diseased rectal mucosa and preserve all anorectal musculature. When performed in conjunction with total colectomy, the terminal ileum could then be placed inside the retained muscular wall of the rectum and anastomosed to the anus. This would remove all of the disease and yet preserve anorectal continence. Seventeen patients with chronic ulcerative colitis have undergone this operation with satisfactory results in 15 and no deaths. Many details of preoperative, operative and postoperative management are presented which are imperative for a successful result. Sufficient experience has been gained that the operation can now be recommended.

Abscess↗
PubMed1979

Clinical experience with total colectomy and endorectal mucosal resection for inflammatory bowel disease.

During the past 3 yr, 17 patients with chronic ulcerative colitis and 6 with Crohn's disease who had severe rectal and colonic involvement underwent excision of the rectal mucosa without removal of the rectal muscle in combination with total colectomy and cutaneous ileostomy as a 1- or 2-stage procedure. This operative technique has cured each of the patients of their primary colonic and rectal disease and has obviated many of the unpleasant complications that often occur after total proctectomy, such as impotence, prolonged perineal drainage, and bladder dysfunction. The operation has the further advantages of lower operative blood loss, shorter operative time, and earlier safe ambulation. On the basis of the favorable experience with mucosal proctectomy, sphincterotomy, and perineal drainage in 23 patients, none of whom experienced major complications, we believe that this operation warrants further clinical trial in patients with inflammatory bowel disease involving the rectum, which is refractory to medical therapy. Total proctectomy might eventually find scant application in patients with inflammatory bowel disease.

Adolescent↗
PubMed1976

Grafting the unhealed perineal wound after coloproctectomy for Crohn disease.

The unhealed perineal wound following proctectomy for Crohn disease is a most unfortunate and disabling complication; treatment has been generally unsuccessful and disappointing. Since 1967, we have managed these wounds by skin-grafting the raw surface of the saucerized wound, rather than by attempting to obliterate the cavity. The graft is applied to the defect two or three days after wide debridement and saucerization. No attempt is made to cover more than the readily accessible raw surface. The graft is first dressed on the third postoperative day, and daily thereafter. The patient receives 40 units of corticotropin (ACTH) daily during his hospital stay; the drug therapy is continued in smaller dosage for several months. Results to date have been satisfactory, with seven wounds totally dry, and 37 resurfaced sufficiently so as to make the amount of drainage negligible. Four patients had results classified as poor.

Adolescent↗
PubMed1977

Treatment of toxic megacolon. A comparative review of 29 patients.

A review of 29 patients with toxic megacolon complicating ulcerative colitis was undertaken to (1) compare the results of medical and surgical treatment; (2) determine the optimal timing for surgical intervention, and (3) identify possible precipitating factors. Twenty-one patients were treated medically with nasogastric suction, steroids, parental fluids, blood transfusions, and antimicrobial agents. Of the 21 patients, 11 (53%) showed improvement by subjective and objective criteria and 10 (47%) failed to respond. Sixteen patients were treated surgically. This group was subdivided into 8 patients who failed to respond to medical treatment and 8 treated surgically. Total proctocolectomy with ileostomy was performed in 8 and subtotal colectomy and ileoproctostomy in 8, with subsequent proctectomy and ileostomy in 6 patient. Six of 8 patients (75%) treated primarily surgically improved, and 2 (25%) died. Seven of 8 patients (87.5%) treated surgically after failure of medical trial showed definite postoperative improvement, and 1 (12.5%) failed. Those who were operated on within the first 48-72 hr after the diagnosis of toxic megacolon was made responded uniformly well. Anticholinergics, opiates,, barium enema, and colonoscopy were identified as possible precipitating factors in 70% of cases. The results of this tudy in this patient population indicate that early surgical therapy in toxic megacolon is associated with better results than medical therapy (P less than 0.025). Although intensive, optimal medical therapy plays a significant role in the management of toxic megacolon, failure to induce rapid improvement within 48-72 hr constitutes an indication for definitive surgical treatment.

Adolescent↗
PubMed1979

Value of sigmoidoscopy and biopsy in detection of carcinoma and premalignant change in ulcerative colitis.

Of 111 carcinomas developing in 73 patients with ulcerative colitis, 46 (41.5%) arose in the rectum where they are directly accessible to sigmoidoscopy. Fifty-eight per cent of single carcinomas developed in the rectum. The extent and frequency of rectal dysplasia was assessed by examining slides of rectal mucosa with an eyepiece micrometer. Slides from 46 patients with carcinoma and 22 patients with dysplasia but no carcinoma in whom proctectomy or proctocolectomy had been carried out were examined by this method. Thirteen of 15 patients with carcinoma of the colon (87%) and 21/22 patients (95%) with large bowel dysplasia showed evidence only of rectal dysplasia. However, there was marked variability in the proportion of dysplastic rectal mucosa even in those patients with rectal carcinoma, while in some patients dysplasia was limited to a small focus. Because of the possibility of false negative biopsies due to sampling error, multiple biopsies should be taken to detect dysplasia. Their state should be recorded and deliberately varied at subsequent visits. Careful sigmoidoscopy and multiple biopsies in this study had potential value as an aid in the detection of 85-90% of all carcinomas. In practice the figure would almost certainly be lower due to intrinsic bias (see discussion) so that, although regular sigmoidoscopy and biopsy would be of great value when colonoscopy is not available, the latter should be included in any long-term programme of carcinoma prevention.

Biopsy↗
PubMed1977

[Results of inadequate aftercare following surgical correction of proctatresia (author's transl)].

For deep proctatresia, postoperative aftercare consisting of adequate, long-term bougienage is important. On the basis of 10 cases, it was shown that inadequate postoperative bougienage for proctatresia leads to formation of a megacolon and to overflow incontinence. The incontinence can then only be controlled by carrying out a proctectomy and a sigmoidectomy together with surgical formation of the gracilis. This proved to be satisfactory for all 10 cases presented.

Anal Canal↗
PubMed1976

Systemic prophylaxis with doxycycline in surgery of the colon and rectum.

A prospective randomized double-blind study on the effects of doxycycline as prophylactic antibiotic in elective colonic surgery is presented. 82 patients were evaluated. 39 were treated and 43 were controls. Mechanical cleansing of the bowel and a low residue diet for two days was routine. 200 mg doxycycline or placebo (2 capsules) were given orally 4-6 hours preoperatively and 100 mg (1 capsule) for 5 postoperative days. A significantly lower incidence of wound sepsis, intraabdominal complications and septicemia was registered in the doxycycline compared to the control group, 12.8 and 44.2 per cent respectively. After proctectomies, infections in the perineal field occurred in 3/9 and 5/10 cases in respective groups. In the doxycycline group, however, they were the only complication, whereas among the controls they were generally combined with infections in the abdominal field, 4/5. Peroperative contamination seemed to carry easier consequences in the doxycycline group. The results are discussed further. Doxycycline appears to be an excellent antibiotic for peroperative and short postoperative prophylactic use in potentially contaminated abdominal operations, not only because of its observed effects, but also when its negligible tendency to cause adverse reactions is taken into consideration. Bacterial cultures, concentrations of doxycycline in serum and tissues and their relation to infections will be accounted for and discussed in a separate paper.

Bacteriological Techniques↗
PubMed2026

Minimally invasive versus open abdominoperineal resection and the risk of postoperative perineal hernia: a systematic review and meta-analysis.

BACKGROUND: The impact of minimally invasive surgery on the risk of postoperative perineal hernia after abdominoperineal resection (APR) or extralevator abdominoperineal excision (ELAPE) remains uncertain. This study compares perineal hernia rates and perioperative outcomes between minimally invasive and open approaches. METHODS: PubMed, Scopus, Web of Science, and Cochrane Library were searched through June 2026. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. A Bayesian meta-analysis was additionally performed for the primary outcome. RESULTS: Four comparative observational studies involving 763 patients were included; 249 underwent minimally invasive APR/ELAPE, and 514 underwent open APR/ELAPE. Postoperative perineal hernia was significantly more frequent following minimally invasive surgery (OR 4.13; 95% CI 2.24-7.61; p&#x2009;<&#x2009;0.001). Intraoperative blood loss was significantly lower in the minimally invasive group (MD&#x2009;-&#x2009;156.5 mL; 95% CI&#x2009;-&#x2009;298.4 to -&#x2009;14.5; p&#x2009;=&#x2009;0.03), as was operative time (MD&#x2009;-&#x2009;41.7&#xa0;min; 95% CI&#x2009;-&#x2009;60.8 to -&#x2009;22.5; p&#x2009;<&#x2009;0.01). No significant differences were observed in hospital stay (MD&#x2009;-&#x2009;2.5 days; 95% CI&#x2009;-&#x2009;5.4 to 0.4; p&#x2009;=&#x2009;0.09) or 30-day readmission rates (OR 1.41; 95% CI 0.82-2.42; p&#x2009;=&#x2009;0.209). Bayesian analysis yielded a posterior mean OR of 4.04 (95% CrI 1.96-8.36), corresponding to a 99.9% posterior probability that minimally invasive surgery increases the risk of postoperative perineal hernia. CONCLUSION: Minimally invasive APR/ELAPE was associated with an increased risk of postoperative perineal hernia compared with the open approach. Strategies to reduce this complication while preserving the benefits of minimally invasive surgery warrant further investigation.

Humans↗
PubMed2026

Intersphincteric resection versus abdominoperineal resection for lower rectal cancer: A systematic review and meta-analysis.

BACKGROUND: The optimal surgical approach for lower rectal cancer (LRC) remains debated, particularly between intersphincteric resection (ISR) and abdominoperineal resection (APR). While ISR offers potential sphincter preservation, its oncological efficacy compared to APR is unclear. METHODS: A systematic review was conducted to compare clinical and oncological outcomes of ISR versus APR in LRC patients. On December 8, 2024, a comprehensive search of Medline, Embase, Cochrane Library, Scopus, and Web of Science identified 24 retrospective studies involving 4502 patients. Key outcomes analyzed included positive circumferential resection margin (CRM), number of harvested lymph nodes (LNs), local recurrence (LR), length of hospital stay (LOS), early postoperative complications, and survival. RESULTS: Twenty-four retrospective studies involving 4502 patients (ISR: 2266 (50.3%) and APR: 1558 (34.6%)) met the eligibility criteria. ISR was associated with significantly lower rates of positive CRM (risk ratio (RR): 0.41, p&#x202f;<&#x202f;0.001), decreased early postoperative complications (RR: 0.76, p&#x202f;<&#x202f;0.001), lower LR (RR: 0.63, p&#x202f;=&#x202f;0.0038), and improvement in five-year overall survival (5YOS) (hazard ratio (HR)&#x202f;=&#x202f;0.42, p&#x202f;<&#x202f;0.001) and five-year disease-free survival (5YDFS) (HR&#x202f;=&#x202f;0.59, p&#x202f;<&#x202f;0.001). CONCLUSIONS: ISR demonstrates several advantages over APR in selected LRC patients, including lower rates of positive CRM, fewer early postoperative complications, reduced LR, greater LN harvest, shorter LOS, and improved long-term survival outcomes (5YOS and 5YDFS). Therefore, ISR can be considered a safe and effective alternative to APR in appropriately chosen patients, with careful patient selection and surgical expertise remaining essential.

Humans↗