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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Access to lesions in the mid-rectum can be difficult. This report summarizes our experience with a posterior approach to the rectum in 22 men and 13 women, age range 21 to 96 years. Surgical indications included villous tumours, rectal prolapse, rectal strictures or rectal fistulae. No postoperative complications were observed in 20 patients, but fistulae developed in seven patients, of whom three required proximal colostomy and surgical treatment. Four healed spontaneously. Two patients developed sacrococcygeal hernia. Pathologic examination of villous tumour showed extensive malignant change in three cases requiring rectal resection with end-to-end colo-anal anastomosis. In two patients mild incontinence developed, treated by biofeedback. Residual peri-anal pain was reported by two patients. The posterior approach to the rectum is particularly useful for benign lesions too high for a transanal resection and too low for a transabdominal resection.
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PMID:Posterior approach to the rectum for treatment of selected benign lesions. 187 16

Between April 1986 and April 1989, each of 108 patients received an ileum neobladder, 94 patients for total bladder substitution after radical cysto-prostatectomy and 14 for augmentation of a fibrotic and contracted bladder following tuberculosis, interstitial cystitis or radiotherapy of the pelvis. The operative technique is standardized, relatively simple and safe, and it prevents upper urinary tract deterioration and reflux. Continence is preserved in more than 80% of all patients by the function of the external urethral sphincter and by the high capacity and the low internal pressure of the intestinal reservoir. Follow-up of more than 3 months postoperatively was possible in 96 patients, the evaluation including micturition behavior at home and a urodynamic investigation. Stress incontinence requiring correction by an artificial sphincter was found in 3 and nocturnal incontinence necessitating some external device in 6 patients. There was no perioperative mortality. Local tumor recurrence and/or metastases occurred in 14 patients; 7 patients died postoperatively, 5 owing to tumor progression, 1 of pneumonia and serve metabolic acidosis, and 1 owing to septicemia of unknown cause. Re-operation was necessary in 13 patients, in 6 because of mechanical ileus or intra-abdominal abscess, in 3 because of stenosis of the uretero-ileal anastomosis, in 1 because of tumor progression, in 1 because of vesico-vaginal fistula, in 1 patient because of incisional hernia, and in 1 because of wound dehiscence. Urethrotomy or dilatation of urethral strictures was necessary in 8 patients. All other early and late complications were rare and could be managed by conservative means.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[3 years' experience with the ileum neobladder--the first 108 patients]. 276 96

Rectal prolapse and solitary rectal ulcer syndrome are both benign conditions affecting the rectum, mainly in women; prolapse tends to occur late in life, while solitary rectal ulcer syndrome has a predilection for the younger adult. Complete rectal prolapse probably starts as a mid-rectal intussusception, although a combination of this theory and the 'sliding hernia' theory has been proposed by Altemeier et al (1971). The pelvic floor weakness associated with prolapse, which gives rise to incontinence, is most likely due to a traction injury to the pudendal nerve. Anorectal manometry will indicate those incontinent patients likely to benefit from rectopexy. Abnormal descent of the perineum may be found in rectal prolapse and solitary rectal ulcer syndrome as well as descending perineum syndrome per se. The clinical features of these three conditions can overlap. Solitary rectal ulcer syndrome is essentially due to prolapse and traumatization of the rectal mucosa. Inappropriate puborectalis contraction, abnormal perineal descent, and overt rectal prolapse have all been cited as possible mechanisms of development of the condition. Defecography is the radiologic investigation of choice. Electromyography, as in rectal prolapse, may show evidence of pudendal nerve damage although incontinence is rare.
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PMID:The pathogenesis and pathophysiology of rectal prolapse and solitary rectal ulcer syndrome. 353 17

Ventral herniation of the bladder occurred in 2 patients following Marshall-Marchetti-Krantz procedures for stress incontinence. Symptoms included suprapubic pain, urgency, incontinence, and a ventral abdominal hernia. The diagnosis was easily established by cystography in both patients. Possible etiologic factors included postoperative wound infection in 1 patient and possibly suspension of the anterior bladder to the pubis in the other.
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PMID:Ventral bladder hernia following Marshall-Marchetti-Krantz procedure for stress urinary incontinence. 373 13

Thoracic disc herniation is a rare and slowly progressive disease which most commonly occurs at the lower thoracic spine without any preceding trauma. We reported a case with acutely developed vesicorectal dysfunction due to a ruptured disc at Th 11-12. This symptom disappeared soon after disc removal via the transpedicular approach combined with transversectomy. This 45-year-old woman suddenly suffered, without previous trauma, from severe back pain radiating down to the posterior thighs. Since difficulty in urination and defecatory incontinence succeeded two days later, she was transferred to our hospital. Neurological examination on admission revealed anesthesia below S1, hypotonic bladder with almost perfectly preserved urinary sensation, complete lack of anal reflex, and only weak motor function in the lower extremities. Both knee and ankle jerks were diminished bilaterally. A herniated disc was initially suspected at L5-S1 on the MRI, but denied by both myelography and CT myelography. These studies showed a disc hernia compressing the cord at Th 11-12 on the left side. Since the hernia was located centrolaterally, we employed the transpedicular approach. To make removal of the more centrally located hernia easier, we further added transversectomy of the twelfth vertebra. This hernia was successfully removed under the operating microscope without further damage to the cord being incurred. We did not perform any instrumental fixation, because we thought preservation of the rib and costvertebral joint could contribute to the stability of the spine. Her vesicorectal symptom subsided immediately after the operation. She was free of any symptoms except for the remaining mild perianal numbness a year and seven months postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Lower thoracic disc herniation with acutely developed vesicorectal dysfunction: case report]. 832 56

We report our surgical, late complications and functional outcome of 157 consecutive restorative proctocolectomies with an ileoanal J pouch at the Department of Surgery L, Arhus City Hospital. Nine patients had familial adenomatous polyposis, while 148 patients were operated for ulcerative colitis. All patients had a protecting ileostomy. There was no mortality. Surgical complications after J pouch: Six patients were reoperated, five due to intra-abdominal bleeding, one for ileus. There was only one pelvic abscess, and it was drained percutaneously. There were no fistulae, no anastomotic leakage and no early pouch removal. Surgical complications after ileostomy closure: Eight patients were reoperated; two due to wound infections, five for ileus and one due to a wound rupture. Late Complications: Four pouches were removed, due to incontinence, difficult evacuation, chronic pouchitis or Crohn's disease. There were three late pouchovaginal fistulae more than one year after surgery. Five patients had surgery for ileus, one for an intra-abdominal abscess, one for a perianal fistula and eight for incisional hernia. Functional outcome: One year after pouch surgery more than 90% of patients were satisfied with the operation, 2.2% had regretted and 3.6% were in doubt. The functional result was satisfactory in the majority of the patients, but 21.1% had one or more night evacuations and 13.9% had variable degrees of incontinence.
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PMID:[Results of ileoanal reservoir surgery]. 865 Jul 82

Between 1988 and 1996, 23 male patients with bladder cancer underwent bladder substitution after cystectomy, using either the hemi-Kock, Hautmann, and Reddy procedures. The mean postoperative follow-up period was 36 months, with a range of 3 to 85 months. There were no perioperative deaths, and early postoperative complications occurred in 7 patients (30%); transient urine leak from the pouch in 4, wound infection in 3 and pyelonephritis in 2 patients. Twenty-two of the 23 patients (96%) were continent during the day, while 7 (30%) had nocturnal incontinence. All 3 patients with the Reddy procedure had nocturnal incontinence. Complete continence was preserved in 70% of the patients. Dysuria was seen in 4 patients, including retention in 1 patient. Late complications included urethral stricture in 3, wound hernia in 2, metabolic acidosis in 1, stone in the pouch in 1, and gallbladder stone in 1 patient. However, reoperation was necessary in 1 patient for internal urethrotomy and 1 patient for removal of a stone in the neobladder. Mild degree of hydronephrosis and unilateral reflux were seen in 3 patients each, and followed up conservatively. No urethral recurrence has occurred and only 1 patient died of cancer. The need for reoperation was very low and the high reservoir capacity resulted in continence from the beginning in most patients. We considered the neobladder useful as an alternative form of urinary diversion in selected cases.
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PMID:Clinical experience of orthotopic urinary reservoirs in male patients with bladder cancer. 912 53

Since 1998, a second opinion practice in Amsterdam has tried to find a method for providing the patient with decision support. Current literature is studied and discussed with the patient and support is given with the interpretation of medical information. This also means providing insight into the peculiarities of doctors' diagnostic and therapeutic reasoning. Informed consent or the decision to refuse treatment should be based on sound arguments and balanced information. Due to a disc hernia, a 60-year-old man suffered from immobilizing pain and a loss of strength in his right leg. Surgery was proposed but the patient had found additional information on the Internet, which the neurosurgeon was not prepared to discuss. A 40-year-old woman suffering from incontinence was offered periurethral collagen injection therapy. She had found a medical article on this subject for which she sought an explanation. On the basis of this discussion questions were formulated which she could pose to her urologist. A 70-year-old woman with shoulder pain, who was not satisfied with the pain medication prescribed by her general practitioner, came to discuss the possibilities of second opinion and referral to a specialist. A 29-year-old woman had consented to a surgical correction of a urethral stenosis, now wondered whether she could be treated laparoscopically. She phoned for advice and to find out what sort of questions she should pose to her urologist.
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PMID:[Helping the patient to decide]. 1176 9

Sigmoid resection is indicated in the treatment of complete rectal prolapse (CRP) in patients with prolonged colorectal transit time (CTT). Its use, however, has been limited because of fear of anastomotic leakage. This study challenges the current practice of dividing the mesorectum by prospectively evaluating the impact of sparing the superior rectal artery (SRA) on leak rates after laparoscopic sigmoid resection (LSR) for CRP. During a 30-month period, data on 33 selected patients with CRP were prospectively collected. Three patients were withdrawn from the analysis, as they had neither resection nor anastomosis. Twenty-nine women and 1 man (median age 55 range 21-83 years) underwent LSR with preservation of SRA for a median CRP of 8 (3-15) cm. There were 20 ASA I and 10 ASA II patients. Ten patients had undergone previous surgery. Four patients complained of dyschezia, whereas incontinence was present in 26 patients. Anal ultrasound showed isolated internal sphincter defects in 2 patients. Four young adults (21-32 years) had normal CTT, whereas 26 older patients had a median CTT of 5(4-6) days. Defecography demonstrated 10 enteroceles, two sigmoidoceles, and one rectal hernia through the levator ani muscle. Mortality was nil. Median operating room time was 180 (120-330) min, suprapubic incision length 5(3-7) cm, estimated blood loss 150 (50-500) mL, specimen length 20 (12-45) cm, solid food resumption 3(1-6) days, and length of stay 4.5(2-7) days. Thirty-day complications were not related to anastomosing and occurred in 20% of the patients. Median follow-up was 34.1 (18-48) months. One patient had a recurrence. Although the evidence provided by the present study suggests that sparing SRA has a favorable impact on anastomotic leak rates, these nonrandomized results need further evaluation. The division of the mesorectum at the rectosigmoid junction seems not necessary, and its sparing should therefore be considered as it may contain anastomotic leak rates.
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PMID:Preserving the superior rectal artery in laparoscopic sigmoid resection for complete rectal prolapse. 1471 98

We comprehensively reviewed the published literature on urinary diversion, specifically examining the surgical complications associated with conduit, continent cutaneous diversion and orthotopic urinary diversion. Appropriate patient selection and adherence to proper surgical technique are of paramount importance in preventing surgical complications of urinary diversion. Complications can be broadly divided into those related to bowel, conduit or reservoir, stoma and ureterointestinal anastomosis. Each type of urinary diversion has unique characteristics predisposing to certain surgical complications as well as similarities related to intestinal surgery. With conduit urinary diversions, problems related to the stoma such as stomal stenosis and parastomal hernia present not uncommonly. With continent cutaneous diversion, complications include difficulties with catheterizing of the efferent limb, formation of pouch stones and urinary leakage. With orthotopic neobladder formation, voiding dysfunction manifesting as incontinence or hypercontinence may present unique challenges in patient management. Increased surgical experience and technical refinements have led to decreasing surgical complication rates for all types of diversion in contemporary series.
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PMID:Surgical complications of urinary diversion. 1531 37


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