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12/31/1969 03:59 PM
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Colon & Rectal Surgery: THE CURRENT ROLE OF LAPAROSCOPY FOR FECAL DIVERSION AND STOMA REVERSAL
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Colon & Rectal Surgery: THE CURRENT ROLE OF LAPAROSCOPY FOR FECAL DIVERSION AND STOMA REVERSAL. Colon and Rectal Clinic of Orlando, Orlando, Fla. ABSTRACTS OF SCIENTIFIC PAPERS: PDF Only
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12/31/1969 03:59 PM
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Gasless Laparoscopic-Assisted Intestinal Stoma Creation Through A Single Incision
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Department of Surgery, Division of Colon and Rectal Surgery, University of Miami, Miami, Fla. GASLESS LAPAROSCOPIC-ASSISTED INTESTINAL STOMA CREATION THROUGH A SINGLE INCISION.
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12/31/1969 03:59 PM
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Early Diagnosis of Parastomal Hernia
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2. Shellito PC. Complications of abdominal stoma surgery. Dis Colon Rectum 1998;41:1562-1572 An abscess was found to the right of the stoma at the lower end of the incision wound, and this was
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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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Biliary Atresia: An Evolving Perspective
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colon; From 1967 to 1984, 50 of our patients with extrahepatic biliary, atresia had surgical exploration. Of 40 biliary drainage procedures, bile drained in 21 (52%). Thirty-four patients had portoenterostpmy, three had portocholecystostomy, and the most recent six patients had a valved hepatoduodenal conduit. Successful biliary drainage was related to the presence of microscopic ducts at the porta hepatis in 20 of 21 infants. Twenty patients are alive, 12 from two to six years postpperatively (one with a liver transplant). Seven have normal serum bilirubin values. Height and weight exceed the 50th percentile in 5/15 patients studied. Multiple episodes of cholangitis have occurred in 11 patients with portoenterostomy and two with hepatoduodenal conduits. In 12 patients, hemorrhage from the stoma necessitated closure of the stoma before 1 year of age. Five of the six patients with hepatoduodenal conduit are alive two years postoperatively.
(C) 1986 Southern Medical Association
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12/31/1969 03:59 PM
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Gastroplasty in Morbid Obesity: Observations in 300 Patients
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colon; Morbid obesity is associated with a number of life-threatening complications. Medical treatment of morbid obesity is rarely successful. Gastric reduction has replaced intestinal bypass as the surgical treatment of choice. Indications for operation are fairly standardized, and complications and results are similar in most large series. In our series of 300 gastroplasties done during the past four years, weight loss compares favorably with that in other reported series. Our hospital complication rate has been low because of short operating time and early ambulation. Postoperative vomiting has been reduced by enlarging the stoma. Revision rate was between 1% and 2% per year. The surgical treatment of morbid obesity requires a great deal of personal contact between surgeon and patient in the preoperative and postoperative periods. Because these patients tend not to comply with the dietary restrictions of the operation, close follow-up care is required.
(C) 1985 Southern Medical Association
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12/31/1969 03:59 PM
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Outpatient Bowel Preparation For Elective Colon Resection
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colon; To determine the safety and cost-effectiveness of outpatient preoperative bowel preparation with polyethylene glycol-electrolyte lavage solution, we retrospectively analyzed 726 cases of colectomy done by colon and rectal surgeons between July 1987 and July 1991. Included were 319 patients who had elective segmental or total abdominal colectomy with primary anastomosis. Patients who required protective proximal stoma were excluded. Patients requiring emergency surgery, colostomy closure, and restorative proctocolectomy were excluded. Patients were separated into two groups equally matched by age, sex, procedure done, and comorbidity: 145 had bowel preparation as outpatients and 174 as inpatients. Both groups had similar numbers of days hospitalized, days receiving nothing by mouth, and days requiring nasogastric intubation or gastrostomy tube, as well as similar postoperative complications. There was one wound infection, one anastomotic leak, and one death in each group. Cost of outpatient preparation was approximately $40. Cost of inpatient preparation, including a semiprivate room, was approximately $400. Outpatient preparation with polyethylene glycol-electrolyte lavage solution and oral antibiotics before elective colon resection can be done with equivalent safety and at a substantial cost savings.
(C) 1997 Southern Medical Association
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12/31/1969 03:59 PM
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Ileocecal Intussusception Due to Isolated Metastasis from Primary Esophageal Adenocarcinoma
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Isolated metastases to the small intestine are rare, but are known to originate from malignant melanoma, or breast or lung cancer. To our knowledge, this is the first reported case of metastases from primary esophageal adenocarcinoma presenting as subacute small bowel obstruction due to ileocecal intussusception. Physicians should consider palliative resection and anastomosis or a bypass procedure in patients with intestinal obstruction.
(C) 2009 Southern Medical Association
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12/31/1969 03:59 PM
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Subcutaneous Emphysema, Muscular Necrosis, and Necrotizing Fasciitis: An Unusual Presentation of Perforated Sigmoid Diverticulitis
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With advancing age and the affluent, low-fiber Western diet, the incidence of diverticular disease is increasing. Fortunately, most cases can be managed conservatively without resorting to surgical intervention. Life-threatening complications such as perforation, especially when it is associated with gross fecal contamination, requires urgent aggressive surgical intervention. A 75-year-old man with absolute constipation and pain in the left iliac fossa underwent urgent laparotomy following fluid and antibiotic resuscitation. A posterior perforated sigmoid diverticulitis associated with myofascial necrosis and generalized pelvic emphysema was identified. In cases where perforation occurs posteriorly and the only external manifestation is surgical emphysema, the outcome is generally favorable.
(C) 2010 Southern Medical Association
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12/31/1969 03:59 PM
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Novel Endoscopic Triangulation Approach to Percutaneous Transgastric Placement of Jejunal Extension Feeding Tube
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In patients who have surgically-altered upper gastrointestinal anatomy, postoperative endoscopic enteral nutrition options can be limited by issues such as bowel stenosis and/or acute angulation. This report details the use of an endoscopic triangulation method combining per-oral and percutaneous transgastric approaches to overcome an efferent gastrojejunostomy limb stenosis, to successfully place a jejunal extension feeding tube through a newly placed PEG site. This description provides an alternative endoscopically feasible option for successful enteral nutrition access, thus obviating the need for additional operations to place surgical feeding tubes or to commit patients to long-term total parenteral nutrition.
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12/31/1969 03:59 PM
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A Short Perspective on the Surgical Restoration of Alaryngeal Speech
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Despite advances in conservative laryngeal surgery and radiotherapy, total laryngectomy still remains the procedure of choice for advanced-stage laryngeal carcinoma around the world. The loss of natural voice is very often traumatic for the total laryngectomy patient, presenting lifelong challenges for communication in a world that relies heavily on verbal communication. Functional rehabilitation of these patients has long been one of the major challenges facing clinicians, but it is only in the last three decades that the emphasis on restoration of function and quality of life has become almost as important as cure and survival. Although voice restoration for alaryngeal speakers can be attained with any of 3 speech options - esophageal speech, electrolarynx and surgical voice restoration (SVR) using a valve the SVR technique has today become the preferred method and 'gold standard.' Successful tracheo-esophageal voice restoration in laryngectomy patients can be very rewarding, and patients are no longer condemned to silence while they await the results of their cancer treatments. They can face the challenges of life with the knowledge that a near-normal quality of life is very much possible.
(C) 2009 Southern Medical Association
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12/31/1969 03:59 PM
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Synchronous Occurrence of Colorectal Adenocarcinoma and Colonic Gastrointestinal Stromal Tumor
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Synchronous Occurrence of Colorectal Adenocarcinoma and Colonic Gastrointestinal Stromal Tumor. Gastroenterology Department, Agios Savvas Cancer Hospital (Xinopoulos, Paraskevas)
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12/31/1969 03:59 PM
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Fig. Figure showing ...
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Fig. Figure showing the voice prosthesis in place between the posterior wall of the trachea and anterior wall of the neopharynx. The patient phonates by taking in a deep breath and occluding the stoma with his finger. With no obvious exit route, the expired air then travels through the one-way valve into the neopharynx and vibrates its walls. The resultant sound is then articulated as before to produce speech.
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