P. M. Sagar

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

Objective  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.

Quality of life after restorative proctocolectomy with a pelvic ileal reservoir compares favorably with that of patients with medically treated colitis

There remains some reluctance among physicians to refer patients for restorative proctocolectomy (RP). They argue that their patients would be worse off with a pouch because of the attendant problems of urgency and frequent bowel actions. The aim of this study was to compare quality of life in patients who had undergone RP with that of patients with ulcerative colitis on long-term medical treatment. A detailed questionnaire and the Hospital Anxiety and Depression (HAD) test were completed by 103 patients who had undergone RP and by 95 patients with ulcerative colitis on medical treatment and in remission attending a gastroenterology clinic. Patients with a pouch had a greater frequency of bowel action [five times per 24 hours (range, 4–7)vs.two times per 24 hours (range, 1–3);P<0.001] but less urgency of defecation [12/103 (11.7 percent)vs.69/95 (72.6 percent);P<0.001] than patients with medically treated colitis. Efficiency of evacuation, discrimination between flatus and feces, use of perianal pads, and perianal soreness were similar. Use of antidiarrheal medication was more common in the pouch group [53 of 103 patients (51.5 percent)vs.3 of 95 patients (3.2 percent);P< 0.05], whereas use of topical steroids was more common in medically treated patients [40 of 95 patients (47.1 percent)vs.9 of 103 patients (8.7 percent);P<0.05]. Limitation of social activity and HAD scores were significantly higher in medically treated patients. Quality of life for patients with a pouch appears to be as good as that for patients with medically treated colitis.

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

Objectives  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.

Long-term failure and function after restorative proctocolectomy - a multi-centre study of patients from the UK National Ileal Pouch Registry.

Objective  There is little information on the long‐term failure and function after restorative proctocolectomy (RPC). The results of data submitted to a national registry were analysed.

The outcome of loop ileostomy closure: a prospective study

Background  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

Background  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.

Composite abdominosacral resection for recurrent rectal cancer.

En bloc resection of the tumour and adjacent involved organs offers the only realistic curative option for patients with locally recurrent rectal cancer. This study assessed outcomes of composite resection for recurrent tumours involving the sacrum.

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.