D. Burke

The use of vacuum-assisted closure of abdominal wounds: a word of caution

Objectiveu2002 Vacuum‐assisted closure (VAC) has been used in our centre to aid the closure of abdominal wounds. The aim of this study was to examine the clinical outcome of patients in whom VAC therapy had been used in conjunction with laparostomy.

Clinical and Subclinical Leaks After Low Colorectal Anastomosis: A Clinical and Radiologic Study

PurposeThis study was designed to examine the natural history of subclinical leaks and their effect on bowel function and quality of life and to evaluate water-soluble contrast enema features that predict anastomotic healing after leaks.MethodsConsecutive patients who underwent low rectal anastomosis were followed up postoperatively for leaks. All leaks were confirmed radiologically with CT scanning and water-soluble contrast enema imaging. Water-soluble contrast enemas were serially repeated to identify healing. Characteristics on initial water-soluble contrast enema were correlated with observed healing. Postoperatively, patients were required to fill in a quality of life and a bowel function questionnaire.ResultsA total of 138 patients underwent low rectal anastomosis procedures with a median follow-up period of 26 (interquartile range, 19–37) months. There were 23 documented leaks of which 13 (9 percent) presented clinically and 10 (8 percent) presented subclinically. Ileostomy closure was possible in 4 of 13 (30 percent) patients with a clinical leak and all 10 (100 percent) patients with a subclinical leak. Median quality of life scores were lower for patients with clinical leaks and no ileostomy closure (P = 0.03). Bowel function for subclinical leak patients and clinical leak patients with ileostomy closure were similarly impaired. The presence of a cavity (P = 0.01) and a stricture (P = 0.01) at the anastomotic site were unfavorable radiologic features associated with nonhealing.ConclusionsSubclinical leaks are more benign in their natural history compared with clinical leaks. Quality of life and bowel function is no better in patients with a subclinical leak compared with patients with a clinical leak who have ileostomy closure. Anastomotic leaks may resolve if favorable radiologic features are present.

Infliximab in the surgical management of complex fistulating anal Crohn's disease.

Objectivesu2003 To assess prospectively the efficacy and safety of treatment of perianal Crohns disease by means of a combination of surgical management and a standardized protocol for the intravenous infusion of infliximab.

The outcome of loop ileostomy closure: a prospective study

Backgroundu2002 The use of a loop ileostomy is an effective method to protect pelvic anastomoses, although there is some debate as to the routine use of a stoma. A second operation is required to close the stoma, with potential complications.

Morbidity and mortality after closure of loop ileostomy

Backgroundu2002 A temporary loop ileostomy is commonly used to protect low pelvic anastomoses. Closure is associated with morbidity and mortality. This study investigated patterns of complications after loop ileostomy closure and factors associated with morbidity and mortality.

MRI assessment of the bony pelvis may help predict resectability of rectal cancer.

Objectiveu2002 The outcome after surgical treatment of rectal cancer may be influenced by the technical difficulty of the operation, which is thought to be affected by pelvic size. The aim of this study was to examine the association between bony pelvic dimensions and CRM involvement.

A Randomized, Double-Blind Trial of the Effect of Metronidazole on Pain After Closed Hemorrhoidectomy

AbstractPURPOSE: Patients consider hemorrhoidectomy to be a painful operation. Attempts to reduce the length of inpatient stay have concentrated mainly on a reduction in postoperative pain. Metronidazole has been shown to reduce pain after open hemorrhoidectomy. The aim of this study was to evaluate the effect of metronidazole after closed hemorrhoidectomy. nMETHODS: Thirty-eight patients undergoing closed hemorrhoidectomy were randomly allocated to receive metronidazole 400 mg (n = 18) or placebo (n = 20) three times daily for seven postoperative days. All patients received a stool softener and analgesics perioperatively. Linear analog scales were used to assess expected pain, actual pain and patient satisfaction. Time to first bowel movement, return to normal activity, complications, and use of additional analgesics were recorded. nRESULTS: Both groups of patients experienced less pain than expected. Patients in the metronidazole group required fewer additional analgesics postoperatively (6.3 vs. 26.3 percent), and satisfaction scores in the placebo group were higher at one week (0.5 vs. 2.5), although these differences were not statistically significant. There were no differences in pain actually experienced, time to first bowel movement, return to normal activity, or complications between the two groups. Satisfaction scores at six weeks for all patients were relatively high, with no significant difference between the groups. nCONCLUSION: Closed hemorrhoidectomy results in high patient satisfaction and low pain scores. The use of postoperative metronidazole did not reduce postoperative pain.

The Impact of Preoperative Immunomodulation on Pouch-Related Septic Complications After Ileal Pouch-Anal Anastomosis

PurposeWe studied preoperative and perioperative factors with particular attention to the role of immunomodulatory medication, which may impact the incidence of pouch-related septic complications.MethodsA retrospective review of data from patients who underwent ileal pouch surgery during a 20-year period from 1985 to 2005 was performed. Preoperative use of immunomodulatory medication along with perioperative clinical, surgical, and disease variables were recorded. Patients were monitored for pouch-related sepsis in the early (within 30xa0days of surgery) and late (after 30xa0days of surgery) postoperative periods. Univariate and multivariate logistic regression analysis was performed.ResultsThere were 445 patients (206 females; 46.4 percent). Median age was 36 (interquartile range, 27–46) years. Median follow-up period was 52 (interquartile range, 26–86) months. Complete data were available for 335 patients. Early sepsis was seen in 58 patients (17.3 percent). Another 22 patients (6.5 percent) developed late sepsis. On multivariate analysis, only steroid use remained predictive of higher rates of early sepsis (odds ratio, 1.81; 95 percent confidence interval, 1.02–3.45; Pu2009=u20090.002). Likewise on multivariate analysis, both male gender (odds ratio, 0.24; 95 percent confidence interval, 0.09–0.71; Pu2009=u20090.007) and 5-aminosalicylic-acid use (odds ratio, 0.22; 95 percent confidence interval, 0.08–0.76; Pu2009=u20090.023) remained predictive of lower rates of sepsis.ConclusionsPreoperative steroid use is associated with higher rates of early but not late pouch-related septic complications. We recommend that patients be weaned of steroids before ileal pouch surgery or be warned of the higher risk of postoperative sepsis.

Intra-anal collagen injection for the treatment of faecal incontinence

Intra‐anal injectable agents have been used to treat faecal incontinence. The aim of this study was to report the experience of a cohort of patients who underwent intra‐anal injection of collagen and to determine which patients benefited from the technique.

Dysbiosis and pouchitis

The exact aetiology of pouchitis is unknown, but an association with dysbiosis has been suggested. This is a retrospective review of 17 studies published between 1985 and 2005, identified by a search of the Medline, Pubmed and Embase databases.