Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In an effort to avoid the failures of perineal wound healing that are common after proctectomy, 57 patients who had abdominoperineal resection of the rectum or total proctocolectomy for ulcerative colitis (35 patients), Crohn's colitis (12), or carcinoma (10) had primary closure of the levator muscles and perineal tissues. No attempt was made to approximate the pelvic peritoneum. The small bowel was allowed to fill the pelvic space, which was also drained by suction catheters brought out through the lower abdominal wall. The skin and subcutaneous tissues were allowed to heal by secondary intention in seven patients who had excessive preoperative perineal sepsis from fistulas, deep fissures, and abscesses. All seven wounds healed within 2 months. Of the other 50 patients, whose wounds were closed to the skin, 48 were discharged with completely healed perineal wounds. Two patients had sterile pelvic hematomas that drained through the perineum and delayed wound healing 1 month and 2 months. There were no postoperative perineal, pelvic, or intraabdominal abscesses. Immediate postoperative ambulation was allowed. There was no increased short-term or long-term incidence of small bowel obstruction related to this procedure, nor did perineal hernia occur after long-term observation (mean: 5.3 years). This method of accomplishing perineal wound healing is simpler, safer, more comfortable, and remarkably effective in eliminating the prolonged morbidity of an unhealed perineal wound. It is superior to any other reported method of managing the perineal wound in patients with inflammatory bowel disease and may be applicable to the treatment of cancer without compromising the chances for cure.
 ...
PMID:Improved management of the perineal wound after proctectomy. 407 88

We report results from a single surgeon's 10-year team experience with laparoscopic total abdominal colectomy. We review our series, which includes a large subgroup of ill, high-risk patients with acute colitis requiring urgent surgery. From 1993 to 2003, we performed 65 laparoscopic total abdominal colectomies. All patients referred for total abdominal colectomy were offered the laparoscopic approach. We prospectively collected the following data on all patients: demographics, surgical indications, preoperative status, duration of surgery, intraoperative blood loss, operative complications, length of stay, subsequent operations, patient satisfaction, and lessons learned from our team experience. Preoperative diagnoses included ulcerative colitis (n=55), Crohn's colitis (n=3), colonic inertia (n=4), and familial adenomatous polyposis (n=3). Among the patients with inflammatory bowel disease, 70% of cases were performed on ill patients, refractory to medical management, requiring urgent surgery. This subgroup was managed with laparoscopic total abdominal colectomy and Brooke ileostomy, with ileoanal pouch anastomosis deferred. Operative times were long, ranging from 6 to 11 hours. Mean intraoperative blood loss was 200 ml. Mean length of stay was 4.3 days and ranged from 2 to 13 days. There were no conversions to open surgery and there were no deaths. Complications occurred in 12% of patients and included intra-abdominal abscess (n=2), wound infection (n=3), stoma stenosis (n=1), and incisional hernia (n=2). Postoperative patient satisfaction was high. Subsequent operations, including restorative proctectomy, were also performed laparoscopically. Laparoscopic total abdominal colectomy is technically challenging and requires a team approach but offers patients significant benefit in length of stay and surgical recovery. This operation can be effectively used with minimal morbidity in difficult, ill patients requiring urgent surgery.
 ...
PMID:Laparoscopic total abdominal colectomy in the acute setting. 1613 78