MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Seminars in Colon and Rectal Surgery' source. Thu, 11 Mar 2010 14:30:20 +0100 http://www.medworm.com/index.php?rid=3285432&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000669%2Fabstract%3Frss%3Dyes For many individuals, emptying their bowels is an automatic event but for some, particularly women, the process of evacuating stool may be difficult. Pelvic evacuation dysfunction refers to a constellation of symptoms such as prolonged repeated straining at bowel movements, sensation of incomplete evacuation, the need for digital manipulation, and different postures to initiate or complete bowel movements. Evacuation disorders are a result of multiple factors that include anatomical (rectocele, enterocele, and sigmoidocele), physiological (impaired rectal sensation) and functional components (nonrelaxing puborectalis). A systematic and complete pelvic floor history and physical examination should be elicited on all patients with complaints consistent with pelvic evacuation dysfunction. Ano... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3285432 Fri, 19 Feb 2010 14:25:21 +0100 3285432 http://www.medworm.com/index.php?rid=3285431&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000657%2Fabstract%3Frss%3Dyes Surgical options for the management of rectal prolapse are extensive. Choosing the correct modality to suit patients needs requires an understanding of the principles of each approach and their benefits in correcting the underlying anatomical and functional defects. The abdominal approach has a lower recurrence rate and when performed laparoscopically, offers all the benefits of minimally invasive surgery including early return of bowel function, reduced analgesic requirements, and reduced time to discharge. The addition of resection to the rectopexy depends on the degree of constipation and redundancy of the sigmoid colon. It carries the risk of anastomostic leakage. The coexistence of slow-transit constipation or obstructed defecation will alter the management pathway. Patients with inco... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3285431 Fri, 19 Feb 2010 14:25:21 +0100 3285431 http://www.medworm.com/index.php?rid=3285430&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000645%2Fabstract%3Frss%3Dyes Fecal incontinence is a devastating condition for patients and a challenge for physicians. There are many underlying causes that contribute to this major problem of which, a disrupted anal sphincter muscle is the only theoretically surgically treatable cause. Injury may be due to defects in the external anal sphincter and/or internal anal sphincter or a defect or a weakening of only the internal anal sphincter. A mere 20 years ago, the only available surgical methods were defect repair, levator muscle plication, or creation of a stoma. The internal anal sphincter is not amenable for surgical repair and despite initially promising short-term results of sphincteroplasty, the long-term outcomes have been very disappointing. The lack of reliable robust treatment prompted the development of new... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3285430 Fri, 19 Feb 2010 14:25:20 +0100 3285430 http://www.medworm.com/index.php?rid=3285429&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000633%2Fabstract%3Frss%3Dyes The most common surgical treatment for fecal incontinence is sphincteroplasty, but this treatment option requires a localized anatomic sphincter injury and outcomes vary and tend to deteriorate with time. Other surgical techniques have therefore been developed. Postanal repair was designed to restore the anorectal angle with muscle plication of the posterior aspect of the anal canal. Initial improvement rates are acceptable, but only a small proportion of patients reports complete alleviation of symptoms and outcomes deteriorate with time. Suboptimal long-term outcome has lead to decreased use of the procedure. Electrostimulation of a transposed gracilis muscle around the anal canal can yield excellent results in selected patients. Complication rates are high when performed in nonspecialis... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3285429 Fri, 19 Feb 2010 14:25:20 +0100 3285429 http://www.medworm.com/index.php?rid=3285428&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000621%2Fabstract%3Frss%3Dyes Fecal incontinence and constipation are benign conditions that can have a significant effect on the lifestyles of those affected. In order for clinicians to better understand a patient's baseline symptoms and, more importantly, to have a measure that can evaluate and compare different treatments and their outcomes, patient-validated self-report tools that assess symptoms and quality of life are essential. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3285428 Fri, 19 Feb 2010 14:25:20 +0100 3285428 http://www.medworm.com/index.php?rid=3285427&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS104314890900061X%2Fabstract%3Frss%3Dyes The evaluation and testing of conditions attributed to the posterior compartment of the pelvic floor is an important component in the management of patients presenting with fecal incontinence, constipation, and anal pain. In recent years, numerous advances in radiological and physiological investigatory techniques have become available to the clinician. This can enable the underlying pathogenesis of the condition to be determined, which in turn can aid diagnosis and guide medical, behavioral, and surgical treatment. This review looks at current concepts and advances in the evaluation and testing of posterior pelvic floor disorders. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3285427 Fri, 19 Feb 2010 14:25:20 +0100 3285427 http://www.medworm.com/index.php?rid=3285426&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000608%2Fabstract%3Frss%3Dyes Pelvic floor disorders encompass symptoms, including urinary incontinence, pelvic organ prolapse, and fecal incontinence. Challenges to treating individuals with pelvic floor disorders include under-reporting of symptoms and inconsistent diagnostic criterion. Nearly 1 in 4 individuals in the United States has experienced a pelvic floor disorder. Incontinence disorders are more frequent in women and the prevalence increases with age. Obstetrical trauma is a common factor in the development of pelvic floor dysfunction. Morbidly obese individuals have a higher prevalence of pelvic floor disorders and weight loss may lead to improvement of symptoms. Evaluation and treatment should address the individual's productivity and quality of life in addition to anatomic and functional limitations. Pelv... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3285426 Fri, 19 Feb 2010 14:25:20 +0100 3285426 http://www.medworm.com/index.php?rid=3285425&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000591%2Fabstract%3Frss%3Dyes For health care providers, patients with pelvic floor problems can be one of the most complex and frustrating groups of patients we treat. There are many factors that must function in harmony for acceptable evacuation to occur at the correct moment. Minute changes in 1 aspect of the pelvis can lead to life altering results. Both ends of the spectrum can make patients miserable. I cannot imagine being afraid to leave my home and do daily activities for fear of having an uncontrolled spontaneous evacuation of stool. Likewise, sitting on the commode for hours daily, attempting to evacuate, and getting up only to feel you need to return to empty your rectum must be extremely frustrating. The degree patients go to alter their diet, activities, and schedule in an attempt to gain some control ove... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3285425 Fri, 19 Feb 2010 14:25:20 +0100 3285425 http://www.medworm.com/index.php?rid=3098123&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000396%2Fabstract%3Frss%3Dyes As robotic technology becomes more commonplace, the demand for structured training programs in robotic surgery will increase. Every new technology has its learning curve and robotic surgery is no exception. The ideal training program in robotic surgery should progress from laboratory exercises to a mentored clinical experience in patients. This review presents the reported experience on teaching robotic surgery, suggests protocols for training colorectal surgeons as well as elaborates on the tools to objectively measure technical proficiency. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098123 Tue, 01 Dec 2009 00:00:00 +0100 3098123 http://www.medworm.com/index.php?rid=3098122&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000499%2Fabstract%3Frss%3Dyes This article reviews the technical issues that are commonplace in colorectal robotic procedures and describes available solutions. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098122 Tue, 01 Dec 2009 00:00:00 +0100 3098122 http://www.medworm.com/index.php?rid=3098121&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000451%2Fabstract%3Frss%3Dyes Since the concept of minimally invasive surgery was introduced, advances in technology have broadened laparoscopic approaches to the gastrointestinal tract. In particular, the development of robotic surgery has provided surgeons with greater comfort and the ergonomic tools necessary to overcome some of the limitations associated with conventional laparoscopic surgery. The da Vinci robotic system has been widely used in urological and gynecologic surgery and has now expanded into gastrointestinal procedures, including colorectal surgery. However, the robotic approach carries its own potential set of complications. This review will summarize the complications associated with robotic-assisted colorectal surgery in the current published report as well as robotic surgical failures seen when usi... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098121 Tue, 01 Dec 2009 00:00:00 +0100 3098121 http://www.medworm.com/index.php?rid=3098120&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000670%2Fabstract%3Frss%3Dyes The intended application of robotics in surgery was in the field of cardiac surgery. The addition of robot was thought to improve surgeon dexterity in a small field with the added advantage of a minimal invasive approach. Shortly thereafter, urologists recognized that this modality could be used in the deep pelvis and brought the robot to its current most widely used application, the robotic prostatectomy. In the subsequent years, the use of this technology for other “pelvic organs” such as the uterus, rectum, and bladder evolved. Similarly, during this time period, minimally invasive surgical techniques were being studied in colorectal surgery. The results of the Clinical Outcomes of Surgical Therapy trial in 2004 concluded that laparoscopic approaches to colon cancer could be perform... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098120 Tue, 01 Dec 2009 00:00:00 +0100 3098120 http://www.medworm.com/index.php?rid=3098119&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS104314890900044X%2Fabstract%3Frss%3Dyes Robotic surgery has many features that make it superior to traditional laparoscopic surgery. However, the use of the robot is limited by the need to reposition the robot during colon and rectal operations encompassing more than one abdominal quadrant. A “hybrid” technique has been developed which combines traditional laparoscopy with a robotic pelvic dissection. With this combined approach, the benefits of the 2 techniques can be maximized, while minimizing their limitations. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098119 Tue, 01 Dec 2009 00:00:00 +0100 3098119 http://www.medworm.com/index.php?rid=3098118&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000438%2Fabstract%3Frss%3Dyes Various surgical options exist for patients with pelvic organ prolapse. Conventionally, open procedures have been performed laparoscopically with similar results and fewer morbidity. However, widespread use of laparoscopy to treat rectal and vaginal vault prolapse has been limited by the technical challenges of performing these surgeries with a minimally invasive approach. Robotic surgery allows for improved visualization and ergonomics, enabling the surgeon to perform complicated procedures more easily. Robotically assisted laparoscopic rectopexies and sacrocolpopexies have been shown to have excellent results but they increase operative time and cost. Further investigation is needed to demonstrate clear advantages to using this approach over conventional laparoscopy. (Source: Seminars in... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098118 Tue, 01 Dec 2009 00:00:00 +0100 3098118 http://www.medworm.com/index.php?rid=3098117&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000463%2Fabstract%3Frss%3Dyes There are many potential advantages of using robotics for resection of the left colon and the sigmoid colon. These include stable traction of the vascular pedicles, preservation of the aortic and the hypogastric nerve plexus, improved accessibility for take-down of the splenic flexure, and easily applicable intracorporeal colorectal or colocolic anastomosis. This chapter provides a detailed description of the technique used in a robotic dissection for a left colectomy or sigmoidectomy. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098117 Tue, 01 Dec 2009 00:00:00 +0100 3098117 http://www.medworm.com/index.php?rid=3098116&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000426%2Fabstract%3Frss%3Dyes Robotic colectomy has been shown to be a feasible and safe procedure. Although left-sided colectomy and proctectomy have received the most attention in robotics application, the advantages of robotic technology apply equally to resection of the right colon. A description of a technique for robotic right hemicolectomy with intracorporeal anastomosis is presented, and it addresses some of the inherent limitations of current robotic systems. The potential advantages and disadvantages of robotics for right colon surgery are also discussed. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098116 Tue, 01 Dec 2009 00:00:00 +0100 3098116 http://www.medworm.com/index.php?rid=3098115&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000414%2Fabstract%3Frss%3Dyes Robotic surgery is a growing field that has introduced a new range of instruments, procedures, and protocols into the standard OR suite. The safety and efficiency of robotic assistance in surgical practice depend significantly on the presence of a consistent, trained, and experienced nursing staff and OR team. Establishing a robotic coordinator position goes a long way in optimal OR scheduling, timely procurement of instruments, training of nursing staff, and in collaborating between surgeons across multiple services. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098115 Tue, 01 Dec 2009 00:00:00 +0100 3098115 http://www.medworm.com/index.php?rid=3098114&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000402%2Fabstract%3Frss%3Dyes Surgical robots, although relatively new, have developed quickly. The development of surgical robots is reviewed in this article. The surgical robots have applications in many surgical specialties. The most widely used surgical robotic system is the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) that is based on an immersive, “master-slave” paradigm which enhances the surgeon's abilities. Surgical robotics is changing rapidly, and any development in surgical robots in future will allow greater application of robotic devices to increasingly more difficult procedures and hard to access anatomical sites, with significant improvement in patient outcomes. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098114 Tue, 01 Dec 2009 00:00:00 +0100 3098114 http://www.medworm.com/index.php?rid=3098113&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000384%2Fabstract%3Frss%3Dyes The relevance of this issue of Seminars in Colon and Rectal Surgery on “Robotics in Colorectal Surgery” cannot be overemphasized. With the use of robotic assistance in prostatic surgery rapidly emerging as a standard of care, the application of robotic technology in other surgical disciplines is gaining increasing importance. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=3098113 Tue, 01 Dec 2009 00:00:00 +0100 3098113 http://www.medworm.com/index.php?rid=2884269&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000190%2Fabstract%3Frss%3Dyes Perineal hernia is an uncommon complication following major pelvic surgery. The estimated incidence of herniation is 0.2%-3.5% following abdominoperineal resection. Symptomatic patients may undergo repair by a transabdominal, transperineal, combined abdominoperineal, or laparoscopic approach. Controversy continues with regard to the method of repair with many surgeons employing the use of mesh or local muscular flaps to buttress the pelvic floor. Recurrence rates are moderate but are also limited by small number of cases reported in the literature. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2884269 Mon, 31 Aug 2009 23:00:00 +0100 2884269 http://www.medworm.com/index.php?rid=2884268&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000487%2Fabstract%3Frss%3Dyes We present here a review of these procedures with and without graft reinforcement as well as the current report supporting their use. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2884268 Mon, 31 Aug 2009 23:00:00 +0100 2884268 http://www.medworm.com/index.php?rid=2884267&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000189%2Fabstract%3Frss%3Dyes The literature regarding mesh-related complications especially in the posterior vaginal compartment is incomplete and often it remains unclear whether the surgical technique or the employed mesh caused the complication. As the industry pushes and surgical training of conventional techniques diminishes, the use of synthetic mesh is tempting and anatomical results are promising. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2884267 Mon, 31 Aug 2009 23:00:00 +0100 2884267 http://www.medworm.com/index.php?rid=2884266&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000177%2Fabstract%3Frss%3Dyes Parastomal herniation is an often encountered consequence of stoma formation. Most parastomal hernias never require surgical intervention. Of the numerous procedures for the repair of parastomal hernias, the best outcomes have been obtained with the application of synthetic mesh. The potential for serious complications arising from synthetic mesh has prompted investigations of biological implants as an alternative. These grafts provide an acellular collagen scaffold into which host cells migrate, producing the appropriate native tissue. The experience with the biomaterials AlloDerm, Permacol, Surgisis Gold, and Veritas for parastomal hernia repair has yielded satisfactory results in small, nonrandomized, short-term studies and case reports. Similarly, limited audits suggest the promise of ... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2884266 Mon, 31 Aug 2009 23:00:00 +0100 2884266 http://www.medworm.com/index.php?rid=2884265&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000165%2Fabstract%3Frss%3Dyes Complications after open or laparoscopic approaches to ventral or incisional hernia repair with mesh span a wide range of severity. Intraoperative injuries to the bowel are rare but may necessitate a change in the operative plan. Postoperative complications are comprised of those common to all general surgery, for example, thromboembolism and superficial surgical site infection, and are typically managed no differently. Unique to recovery from hernia surgery however can be increased pain after mesh placement, seroma related to large dissection planes, infections of the mesh, as well as pulmonary insufficiency due to changes or loss in abdominal domain. Laparoscopic approaches to ventral or incisional hernia have dramatically affected the morbidity of surgery but may introduce complications... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2884265 Mon, 31 Aug 2009 23:00:00 +0100 2884265 http://www.medworm.com/index.php?rid=2884264&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000153%2Fabstract%3Frss%3Dyes Laparoscopic ventral hernia repair (LVHR) offers a minimally invasive option for the repair of congenital or incisional abdominal wall hernias. A key component of LVHR is the placement of a prosthetic or biological mesh intraperitoneally to cover the defect without reapproximating the fascial edges with a primary suture repair. The optimum mesh provides high tensile strength, reducing the risk of recurrence, stimulates host tissue ingrowth without promoting adhesion or fistula formation, resists secondary infection and seroma formation, and is affordable. Numerous mesh materials are available on the market, each with specific advantages and disadvantages. However, no single mesh possesses all the qualities of the ideal mesh and relatively few studies have been performed comparing meshes of... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2884264 Mon, 31 Aug 2009 23:00:00 +0100 2884264 http://www.medworm.com/index.php?rid=2884263&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000141%2Fabstract%3Frss%3Dyes The objective of this review is to describe the biomechanical properties of commonly used mesh materials and the available evidence regarding their effects on wound healing. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2884263 Mon, 31 Aug 2009 23:00:00 +0100 2884263 http://www.medworm.com/index.php?rid=2884262&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS104314890900013X%2Fabstract%3Frss%3Dyes The concept of using a reinforcing material in the repair of hernias is ancient, as Dr Northington and Dr Asfaw point out in this issue. The practice has, at various times and points in recent history, fallen in and out of favor as new uses, and new complications, have arrived. It is evident from most data that the use of mesh in the repair of large ventral and inguinal hernias has clear benefit in reduction of recurrence rates over primary repair alone. Clearly, this comes at the price of mesh-related complications, as Drs Resnick and Bleier point out. The main problem using mesh in these circumstances seems to be determining which mesh to use. So little data exist favoring one type of mesh over another that empiricism seems to be the rule at times. Even so, detailed retrospective reviews... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2884262 Mon, 31 Aug 2009 23:00:00 +0100 2884262 http://www.medworm.com/index.php?rid=2693336&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000104%2Fabstract%3Frss%3Dyes Abdominal salvage surgery is a major undertaking for patients with imminent ileal pouch failure. The success of abdominal salvage surgery for sepsis is less than for a nonseptic indication. Although functional outcomes following abdominal revisional surgery can improve significantly, pouch failure after abdominal salvage continues steadily over time. Complications may occur and the duration of treatment, including in-hospital stay, may have a serious impact on a patient who has already suffered disappointment and ill health owing to the threatened failure after primary restorative proctocolectomy. The chance of success is an essential part of the consultation process and must be discussed fully. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2693336 Sun, 31 May 2009 23:00:00 +0100 2693336 http://www.medworm.com/index.php?rid=2693335&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000116%2Fabstract%3Frss%3Dyes An extended resection of the colon and rectum may be required in a variety of diseases, including neoplastic, inflammatory, and functional conditions. Restorative procedures after an extended resection are meant to avoid a permanent stoma, achieve good function and quality of life (QoL), and reduce complication rates to a minimum. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2693335 Sun, 31 May 2009 23:00:00 +0100 2693335 http://www.medworm.com/index.php?rid=2693334&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000128%2Fabstract%3Frss%3Dyes Ileal pouch anal anastomosis is the procedure of choice for most patients undergoing proctocolectomy for ulcerative colitis and a proportion of patients with familial adenomatous polyposis. Since its first description in 1978, there has been evolution and refinement in the technical aspects of ileoanal pouch construction. This has been facilitated by advancements in stapler technology, and an increased focus on functional outcome. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2693334 Sun, 31 May 2009 23:00:00 +0100 2693334 http://www.medworm.com/index.php?rid=2693333&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000050%2Fabstract%3Frss%3Dyes Restorative proctocolectomy and ileal pouch anal anastomosis (RP/IPAA) have been the procedures of choice for patients with ulcerative colitis, or familial adenomatous polyposis, and those with other diagnoses who require surgery. The options for this procedure are J, S, or W ileal pelvic pouch anastomosed by either stapled or hand-sewn technique. J-pouch is the preferred technique of most surgeons. The stapled IPAA is quicker, more secure, and safer, with better function, while the hand-sewn IPAA allows removal of the diseased anal transitional zone. Recently, in most of the centers, the use of a hand-sewn IPAA has been limited to those with dysplasia or lower rectum cancer and to when a stapled IPAA has failed. Although leaving intact rectal mucosa after stapled IPAA could be a potential... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2693333 Sun, 31 May 2009 23:00:00 +0100 2693333 http://www.medworm.com/index.php?rid=2693332&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000098%2Fabstract%3Frss%3Dyes Ileorectal anastomosis (IRA) or ileorectostomy refers to the connection of terminal ileum to rectum following extirpation of the colon by total abdominal colectomy. This procedure is of great historical interest having been initially championed by Stanley Aylett from the UK, and used for over 50 years, as an alternative to proctocolectomy and permanent ileostomy for patients with ulcerative colitis. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2693332 Sun, 31 May 2009 23:00:00 +0100 2693332 http://www.medworm.com/index.php?rid=2693331&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000062%2Fabstract%3Frss%3Dyes This article presents current indications, technical aspects and outcomes of this historical procedure, the Turnbull-Cutait abdominoperineal pull-through anastomosis, and reviews the relevant literature. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2693331 Sun, 31 May 2009 23:00:00 +0100 2693331 http://www.medworm.com/index.php?rid=2693330&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000074%2Fabstract%3Frss%3Dyes Preservation of rectal function after low anterior resection or proctectomy with formation of a neorectum has improved the quality of life of many patients with rectal cancers. This would mean preserving the anal sphincters and avoiding a permanent stoma while reconstructing a neorectum to improve the bowel function of patients. Following proctectomy, the traditional anastomosis will be a straight coloanal end-to-end anastomosis to restore bowel continuity. However, this is associated with very poor bowel function. The construction of a colonic J-pouch anastomosis is introduced to reduce this problem. While colonic J-pouch anastomosis is able to obviate some of the functional problems of straight coloanal anastomosis, it comes with an additional problem of pouch evacuation. Therefore, alte... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2693330 Sun, 31 May 2009 23:00:00 +0100 2693330 http://www.medworm.com/index.php?rid=2693329&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000086%2Fabstract%3Frss%3Dyes Following a resection of a rectal cancer with a total mesorectum excision, bowel continuity can be restored by different types of coloanal anastomosis: straight anastomosis, J-pouch, coloplasty, or side-to-end. A J-pouch is made after resection of the rectum. Two 6-cm colon limbs are folded up and a colotomy is made at the apex of the J. A side-to-side anastomosis is then performed on the antimesenteric side for 7 cm. For coloplasty, an 8- to 10-cm longitudinal incision is made along the antimesenteric side, starting 4 cm above the distal cut edge and the incision is closed transversely. A side-to-end anastomosis can be made using a stapler device introduced through the anus or through the distal end of the colon or hand-sewn via a perineal approach. Every coloanal anastomosis should be dr... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2693329 Sun, 31 May 2009 23:00:00 +0100 2693329 http://www.medworm.com/index.php?rid=2693328&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148909000049%2Fabstract%3Frss%3Dyes This edition of Seminars in Colon and Rectal Surgery includes articles that describe the techniques to construct a new rectal reservoir and outcomes after these reconstructive procedures. The first article, by Jeremie H. Lefevre and Yann Parc from Paris, France, describes the techniques of colonic J-pouch, coloplasty, and side-to-end anastomosis. Meta-analysis and comparison of outcomes of colonic J-pouch, coloplasty, and side-to-end anastomosis are covered by Boon-Swee Ooi and Jiunn-Herng Lai from Singapore. Indications and outcomes of rectal reconstruction using the Turnbull-Cutait abdominoperineal pullthrough anastomosis is reviewed by I. Emre Gorgun and Jeffrey W. Milsom from New York. Peter Siaperas and John Hartley from Cottingham, UK, provide indications and outcomes of ileorectal a... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2693328 Sun, 31 May 2009 23:00:00 +0100 2693328 http://www.medworm.com/index.php?rid=2478580&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000730%2Fabstract%3Frss%3Dyes Rectovaginal fistulas are a common type of anal fistulous disease that presents a distressing problem for the patient and a challenge for the treating physician. The symptoms can be minimal but frequently are disabling and associated with significant psychosocial and sexual dysfunction. Successful management must consider the etiology of the fistula and the health of both the rectum and the patient. It is important to completely evaluate the patient before any consideration is given to surgical correction. This includes evaluation of the function of the anal sphincter and the involvement of any other organ systems. The surgical management of fistulas between the anorectum and the vagina depends on the size, location, and cause of the fistula; anal sphincter function and overall health stat... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478580 Sun, 01 Mar 2009 05:00:00 +0100 2478580 http://www.medworm.com/index.php?rid=2478579&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000729%2Fabstract%3Frss%3Dyes Complex fistulas are difficult to treat. The options available are advancement flaps, fibrin glue, and, of late, anal fistula plug (AFP). A sizable proportion of the published studies are from the US and Europe. The results from these studies were analyzed and compared to the results of the published literature from the east (Asia and Australia). The overall success rate ranges from 46% to 100% for advancement flaps, 14% to 78% for fibrin glue, and 24% to 87% for AFP technique. However, the present data is insufficient to conclude the superiority of either (ie, fibrin glue or AFP procedure) over the other. So, depending on the surgeon's preference, either of the two procedures may be recommended as the first line of approach to tackle complex fistulas. Advancement flap procedure is associa... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478579 Sun, 01 Mar 2009 05:00:00 +0100 2478579 http://www.medworm.com/index.php?rid=2478578&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000717%2Fabstract%3Frss%3Dyes Impressed by the initial success rates (80%) of the Cook Surgisis AFP anal fistula plug for the closure of both cryptoglandular and Crohn's associated anorectal fistulas, the preliminary results from Europe showed healing rates of 41% and 61%, respectively. However, no impairment of continence was documented. Analyzing the current experiences of the plug procedure from a German perspective, a variety of issues are under debate including the role of bowel preparation, treatment of fistula tract, closure of the internal opening, postoperative management, and, finally, financial reimbursement. Furthermore, the “ideal” indication has to be defined. In general, the introduction of the plug has accelerated a “new” discussion on the optimal treatment of high anorectal fistulas. Further an... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478578 Sun, 01 Mar 2009 05:00:00 +0100 2478578 http://www.medworm.com/index.php?rid=2478577&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000705%2Fabstract%3Frss%3Dyes Anorectal fistulae are a heterogeneous group of disorders that can cause significant pain, social impairment, hygienic problems, and, rarely, sepsis. Surgery is the mainstay of treatment for anorectal fistulae, yet no one procedure is universally efficacious and safe. Simple fistulae can often be treated by simple fistulotomy, but complex fistulae present a more complicated scenario—effective surgical treatment options are compromised by increased risk of incontinence. Likewise, safe treatment alternatives have low risk of postoperative incontinence but low success rates. The Surgisis AFP appears to be an effective and safe treatment alternative for complex fistula, including Crohn's fistula, based on initial reports. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478577 Sun, 01 Mar 2009 05:00:00 +0100 2478577 http://www.medworm.com/index.php?rid=2478576&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000699%2Fabstract%3Frss%3Dyes This article explains the mode of action of fibrin glue, reviews the current literature, and highlights the varied opinions and potential reasons for its lower long-term success rates. It also introduces the fistula plug, which has demonstrated fistula healing in recent reports. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478576 Sun, 01 Mar 2009 05:00:00 +0100 2478576 http://www.medworm.com/index.php?rid=2478575&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000687%2Fabstract%3Frss%3Dyes Medical devices fabricated from the tissues of animals have been used for decades to repair failing human tissues and organs. Only recently, however, the notion that these tissues can be processed in ways that retain the natural structure and composition of the extracellular matrix (ECM) and then implanted without inciting adverse immune system reactions has become reality. Because natural ECM contains a complex composition of biologically active molecules able to assist in the restoration of a functional ECM when the patient's ECM is characterized by abnormal levels of pro-inflammatory factors and matrix-degrading enzymes, naturally occurring ECM can be used as a strategy to induce healing in both chronic skin ulcers and in chronic, complex fistulas. In this article, we compare the functi... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478575 Sun, 01 Mar 2009 05:00:00 +0100 2478575 http://www.medworm.com/index.php?rid=2478574&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000675%2Fabstract%3Frss%3Dyes Complex perianal fistulas are a significant cause of morbidity with detrimental effects on patient's quality of life. Affected individuals often require repeated anorectal surgeries with the potential for fecal incontinence and the need for a permanent stoma. Endoanal advancement flaps which use the basic premise of covering the fistulous opening with healthy tissue are an important surgical option. The rectal advancement flap is the most commonly used. The sleeve advancement flap is reserved for patients with severe fistulous disease in particular perianal Crohn's. If an abdominal approach is required, then one may consider a Turnbull-Cutait. Other options include the use of anocutaneous flaps and their variants. For a rectovaginal fistula with a thin perineum and coexisting sphincter inj... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478574 Sun, 01 Mar 2009 05:00:00 +0100 2478574 http://www.medworm.com/index.php?rid=2478573&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000663%2Fabstract%3Frss%3Dyes Anal fistulotomy, the unroofing of the entire tract from the external to the internal opening, is the most effective and simple treatment for most patients with anal fistula. However, anal fistulotomy carries a risk of fecal incontinence that is related to the loss of sphincter function and the deformity of the anal canal that results from dividing the tissue encircled by the fistula. The main treatment challenge is how to select patients who will be cured of their fistula without developing postoperative fecal incontinence. The decision should be individualized according to the proportion of the muscle involved, the location of the tract, the patient's sex, history of previous anal surgery, continence, and finally, but not less importantly, the surgeon's experience. (Source: Seminars in C... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478573 Sun, 01 Mar 2009 05:00:00 +0100 2478573 http://www.medworm.com/index.php?rid=2478572&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000651%2Fabstract%3Frss%3Dyes Setons in the treatment of fistula-in-ano have been used for thousands of years. Although there are few high-quality prospective trials, there are numerous retrospective series documenting high cure rates of more than 90% with cutting setons or two stage seton fistulotomy. Both techniques, however, result in a variable rate of incontinence, higher with two stage seton fistulotomy where the internal anal sphincter is routinely divided. Incontinence rates for slow cutting setons are 10%-20% for minor incontinence with rates of 0%-10% for major incontinence; compared to rates of more than 35% and as high as 70% with the two-stage technique. Loose draining setons have an important role the management of Crohn's disease and can result in good palliation with minimal risk of deterioration of bow... Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478572 Sun, 01 Mar 2009 05:00:00 +0100 2478572 http://www.medworm.com/index.php?rid=2478571&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS104314890800064X%2Fabstract%3Frss%3Dyes This article aims to discuss the rationale for imaging and to review the options available. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478571 Sun, 01 Mar 2009 05:00:00 +0100 2478571 http://www.medworm.com/index.php?rid=2478570&cid=s_38654_17_f&fid=38654&url=http%3A%2F%2Fwww.seminarscolonrectalsurgery.com%2Farticle%2FPIIS1043148908000638%2Fabstract%3Frss%3Dyes Complex anorectal fistula is probably the most frustrating and challenging pathology in colorectal surgery. It has plagued mankind since the sun came up and continues to baffle and frustrate us even in the 21st century. (Source: Seminars in Colon and Rectal Surgery) Seminars in Colon and Rectal Surgery journals http://www.medworm.com/rss/comments.php?id=2478570 Sun, 01 Mar 2009 05:00:00 +0100 2478570