Saleh M. Abbas

Meta-analysis of oral water-soluble contrast agent in the management of adhesive small bowel obstruction.

Adhesions are the leading cause of small bowel obstruction. Identification of patients who require surgery is difficult. This review analyses the role of Gastrografin® as a diagnostic and therapeutic agent in the management of adhesive small bowel obstruction.

Clinical variables associated with positive angiographic localization of lower gastrointestinal bleeding.

Background:  Localizing the source of severe lower gastrointestinal (GI) bleeding is often difficult but is important to plan the extent of colonic resection. The purpose of the present paper was to audit the Auckland Hospital experience of selective angiography, in localizing lower GI bleeding.

Long-term outcome of postanal repair in the treatment of faecal incontinence

Background:  Idiopathic faecal incontinence is a common debilitating problem; the results of surgical treatment are variable with only a small proportion of patients achieving full continence.

Long-Term Results of the Anterior Delorme’s Operation in the Management of Symptomatic Rectocele

PURPOSEAlthough the results of surgery for symptomatic rectocele seem satisfactory initially, there is a trend toward deterioration with time. This study was designed to assess the long-term outcome of Anterior Delorme’s operation for rectocele.METHODSQuestionnaires were sent to all females who had Anterior Delorme’s operation performed in Auckland between 1990 and 2000. The questionnaires included obstructed defecation symptoms and a validated fecal incontinence severity index questionnaire and fecal incontinence quality of life questionnaire. Preoperative and postoperative obstructed defecation symptoms and incontinence score were compared.RESULTSA total of 150 females (mean age, 56 (range, 30–83) years) who had an Anterior Delorme’s operation for a rectocele were identified. One hundred seven patients (71.5 percent; mean age, 56 years) completed the questionnaire. Median follow-up was four (range, 2–11) years. The number of patients with obstructed defecation reduced from 87 preoperatively to 23 postoperatively using Rome II criteria (P < 0.0001). Postoperatively there was a reduction in the number of patients with each of the symptoms of obstructed defecation from 83 to 27 for straining, 87 to 33 for incomplete emptying, 64 to 14 for feeling of blockage, 41 to 10 for digitation (P < 0.0001 for all). The median incontinence score reduced from 20 of 61 preoperatively to 12 of 61 postoperatively (P = 0.0001).CONCLUSIONSIn patients with symptomatic rectocele, Anterior Delorme’s operation provides long-term benefit for patients with obstructed defecation and leads to a significant improvement of incontinence scores.

Use of Statins in Adhesive Small Bowel Obstruction

BACKGROUND Adhesive small bowel obstruction (ASBO) causes considerable morbidity and may require surgical intervention. The role of statins in adhesion prevention is of increasing interest, though no investigation of its impact on ASBO and operative rates has been conducted. This study investigates the impact of statin use on operative rates in ASBO. METHODS A retrospective review of all patients with ASBO within our institution from January 1997 to December 2007 was conducted. Demographic data, potential confounders, and treatment received (conservative/operative) were recorded. Statistical significance was determined using the two-tailed Fishers exact test for categorical data and the Mann-Whitney U test for continuous data. Univariate and logistic regression were conducted to control for potential known confounders. RESULTS There were 419 cases of ASBO with 253 (60.4%) females. The median age of diagnosis was 62 (15-93) years and the median ASA score was 2 (1-4). Forty-nine (11.7%) patients required operative management, the median day-stay was three (1-154) d and 151 (36%) patients were taking statins. On univariate analysis, statin use was associated with decreased operative rates (P = 0.02). The relative risk was 0.46 with an absolute risk reduction of 7.9% (95% CI: 2.1%-13.7%). The number needed to treat was 13 (NNT = 13; 95% CI: 7.3-46.8). Statin use was associated with decreased operative rates using a logistic regression model (P = 0.04). CONCLUSION Statin use is independently associated with decreased operative rates in ASBO.

Prostatic sarcoma after treatment of rectal cancer

BackgroundThe relationship between radiation exposure for treatment of cancer and occurrence of a second primary cancer at the irradiated site is well known. This phenomenon is however rare in prostate.Case presentationA 75-year-old farmer was treated for rectal cancer with preoperative 45 Gy of radiotherapy and abdominoperineal resection. Four years later he developed symptoms of bladder outlet obstruction and acute urinary retention. He underwent a transurethral resection of the prostate. Histological examination of the removed prostate tissue and immunohistochemistry revealed it to be a poorly differentiated sarcoma.ConclusionWe believe this to be the first reported case of radiation-induced sarcoma following radiotherapy treatment for rectal cancer. Since radiotherapy plays a pivotal role in the contemporary treatment of rectal adenocarcinoma, it is relevant to be aware of the potential long-term carcinogenic complications of radiotherapy of the pelvis.

Postanal Pelvic Floor Repair

Postanal repair was developed by Sir Allan Parks in the 1970s [1] and popularised in the early 1980s for patients with neuromyopathic faecal incontinence. The original objective of this operation was to restore the anorectal angle, which was thought to be an important factor in continence. In 1975, Parks suggested the flap-valve theory that stressed the importance of the acute anorectal angle. According to this theory, a rise in intra-abdominal pressure caused the upper end of the anal canal to be occluded by anterior rectal mucosa, preventing rectal contents from entering the anal canal. Neuromyopathic faecal incontinence was associated with perineal descent and an obtuse anorectal angle, which rendered the flap-valve-like mechanism ineffective. Further investigations, however, failed to show changes of the anorectal angle, and currently, it is thought that an improvement of muscular contractility is responsible for any improvement in continence [2].