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| J Pouch Complications |
| J Pouch Complications of ileal j pouch could occur in the later stages as well as early stages. Stricture of anastomosis, Fistula (anal & vaginal) & Poor anorectal function are possible late complications while Dehydration from high output stoma, Transient urinary dysfunction, Bowel obstruction, Pouch bleeding, Pelvic & wound sepsis are possible early complications. |
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(source: Southern Medical Journal).
More Information (source: Southern Medical Journal).
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12/31/1969 03:59 PM
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Current Controversies in Pouch Surgery
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Restorative proctocolectomy with ileal pouch anal anastomosis has become the most commonly used procedure for elective treatment of patients with mucosal ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in an attempt to obtain optimal functional results with low morbidity and mortality, and yet provide a cure for the disease. These modifications of the technique are discussed in this review, limited to the current points of controversy. We reviewed the current literature describing restorative proctocolectomy with ileal pouch anal anastomosis. The current "hot topics" for debate are transanal mucosectomy with hand-sewn anastomosis versus the double-stapled technique, the use of diverting ileostomy, indeterminate colitis, the role of laparoscopy, and indications for pouch surgery in the elderly. Longer follow-up of patients and increased knowledge and experience with pouch surgery, coupled with active prospective evaluation of the procedure are required to settle these issues. Patients must be fully informed to understand inherent risks of each choice.
(C) 2003 Southern Medical Association
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12/31/1969 03:59 PM
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Management of Patients With Modified Hunt Pouch Esophagojejunostomy After Total Gastrectomy for Carcinoma of Stomach
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The Hunt pouch and its various modifications have been used as an esophagojejunostomy technic after total gastrectomy or esophagogastrectomy for benign and malignant conditions. This pouch procedure may be particularly useful for palliative gastric resections in which the patient's ability to ingest adequate foodstuffs might be enhanced by a larger reservoir, thereby improving nutritional status and possibly facilitating chemotherapy or radiation therapy or both. Intravenous hyperalimentation has been used to advantage preoperatively and postoperatively to help nutritionally depleted patients better tolerate such an operation and has been useful during treatment of complications related to the procedure. Three recent bases are discussed to illustrate the above propositions.
(C) 1976 Southern Medical Association
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12/31/1969 03:59 PM
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Port Site Metastasis Remote from the Time of Initial Laparoscopy.: GYN/OB-2
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both the associated short- and long-term complications. A 54-year-old white female was initially and descending end colostomy with Hartmann's pouch formation. She received carboplatin and
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12/31/1969 03:59 PM
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Anemia After Gastric Bypass: Still a Risky Business?
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Anemia After Gastric Bypass: Still a Risky Business? 17. Lee WJ, Yu PJ, Wang Zemel R, Betancourt S, et al. Hematologic complications of gastric bypass for morbid obesity. South Med J 1989;82:1108-1110
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12/31/1969 03:59 PM
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Anemia Following Roux-en-Y Surgery for Morbid Obesity: A Review
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Morbid obesity is a significant problem in the Western world. Recently, there has been an increase in the number of patients undergoing surgical weight loss procedures. Currently, the most widely performed procedure is the Roux-en-Y gastric bypass operation which combines restriction of food intake with malabsorption of calories and various nutrients, resulting in weight loss and nutritional deficiencies, respectively. Various types of anemia may complicate Roux-en-Y and commonly include deficiencies of iron, folate, and vitamin B12. Iron deficiency is particularly common and may result from many mechanisms including poor intake, malabsorption, and mucosal bleeding from marginal ulceration. However, less appreciated etiologies of nutritional anemia include deficiencies of B-complex vitamins, ascorbic acid, and copper. Replacement of the missing or decreased constituent usually reverses the anemia. Since physicians of various medical and surgical specialties are often involved with the postoperative care of bariatric patients, a review of anemia in this patient population is warranted.
(C) 2008 Southern Medical Association
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12/31/1969 03:59 PM
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Thyroid Abscess Due to Acinetobacter calcoaceticus: Case Report and Review of the Causes of and Current Management Strategies for Thyroid Abscesses
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Thyroid abscess was a common condition in the era before antibiotics. In the current medical environment, however, it is a clinical entity that is seldom encountered. We report the case of a unique cause of thyroid abscess, the environmental Gram-negative bacterium Acinetobacter calcoaceticus. Review of the published causes of thyroid abscess since 1980 demonstrated that although Gram-positive bacteria (Staphylococcus and Streptococcus species) remain the most common causes, there has been a marked decrease in the number of cases caused by mycobacteria, Salmonella species, and anaerobes when compared with the early part of the 20th century. Patients infected with the human immunodeficiency virus, however, still develop mycobacterial and fungal thyroid infections with some regularity. Reported modes of management of thyroid abscess vary, but drainage remains an integral component of therapy for resolution of the infection.
(C) 2003 Southern Medical Association
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12/31/1969 03:59 PM
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Pediatric Obesity: Impact and Surgical Management
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The incidence of children in the United States who are overweight or obese is increasing at an alarming rate, and many obesity-related complications are now being described in children. There appears to be no current pharmacologic treatment or surgical procedure that is both safe and effective for millions of obese children. Bariatric surgery may be useful, however, in carefully selected obese children with associated serious comorbidities unresponsive to medical or dietary interventions. The complications of pediatric obesity are discussed, as well as current medical and surgical management of this disorder.
(C) 2006 Southern Medical Association
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12/31/1969 03:59 PM
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Ischemic Colitis: A Clinical Review
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Ischemic colitis is the most common form of intestinal ischemia. It manifests as a spectrum of injury from transient self-limited ischemia involving the mucosa and submucosa to acute fulminant ischemia with transmural infarction that may progress to necrosis and death. Although there are a variety of causes, the most common mechanism is an acute, self-limited compromise in intestinal blood flow. Patients typically have mild abdominal pain and tenderness over the involved segment of bowel. There is usually passage of blood mixed with stool, but hemodynamically significant bleeding is unusual. Although computed tomography may have suggestive findings, colonoscopy is the procedure of choice for diagnosis. Supportive care with intravenous fluids, optimization of hemodynamic status, avoidance of vasoconstrictive drugs, bowel rest, and empiric antibiotics will produce clinical improvement within 1 to 2 days in most patients. Twenty percent of patients will have development of peritonitis or may deteriorate despite conservative management and will require surgery.
(C) 2005 Southern Medical Association
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12/31/1969 03:59 PM
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Metabolic, Renal, and Nutritional Consequences of Bariatric Surgery: Implications for the Clinician
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Management of obesity-associated comorbidities costs about $60 billion/year, about 5% of total US healthcare expenditure. Bariatric surgery is the only proven effective weight loss therapy for severely obese patients with a BMI >=35 kg/m2. Bariatric surgery produces long-term weight loss, improves quality of life, and reduces the number of sick days and medication costs. Surgery has a profound effect on the metabolic milieu and nutritional status from the first few days after surgery, even before significant weight loss has been achieved. Metabolic effects of bariatric surgery reduce obesity-related comorbidities like type 2 diabetes, hypertension, metabolic syndrome, and cardiovascular disease risk. Improvement in renal function is seen, but adverse effects like oxalate nephropathy can lead to chronic kidney disease or end-stage renal disease (CKD/ESRD). Surgery can also lead to micronutrient deficiencies, making dietary supplementation necessary. Reduction in insulin resistance and hypertension after surgery makes medication adjustment imperative. Improvement in comorbidities and nutritional deficiencies after bariatric surgery has important clinical implications.
(C) 2010 Southern Medical Association
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