RESUMEN
OBJECTIVE: The aim of the study was to evaluate the results of Kock continent ileostomy (CI) during the same period when ileal pouch-anal anastomosis was the preferred operation for patients with ulcerative colitis (UC) or familial adenomatous polyposis (FAP). METHOD: During the period 1983-2002, 50 patients underwent CI. The surgical technique was unchanged during the period. Follow-up included all patients. Forty-eight patients had UC, two of these had the diagnosis later changed to Crohn's disease and two had FAP. RESULTS: Twenty-two patients had 38 reoperations, four (8%) of whom had the pouch removed. The main causes for reoperation included leakage and difficulty in intubation due to sliding of the nipple valve (42%), fistula formation (29%) and stenosis (21%). Seventeen (45%) underwent a revision of the nipple valve and the pouch and nine (24%) a local procedure. The reoperation rate was higher among patients having a conventional ileostomy converted to CI than among those having CI. As a primary procedure (P = 0.016). The risk of a second reoperation was higher for those reoperated within the first year after having a CI, than for those reoperated later (P = 0.007). CONCLUSIONS: The reoperation rate of patients with CI is high but the removal rate of the pouch is low and is not associated with a high rate of revision. CI is a good alternative to conventional ileostomy in patients not suitable for restorative proctocolectomy or where this procedure has failed.
Asunto(s)
Poliposis Adenomatosa del Colon/cirugía , Colitis Ulcerosa/cirugía , Reservorios Cólicos , Resultado del Tratamiento , Humanos , ReoperaciónRESUMEN
OBJECTIVE: Tumours in the middle and upper part of the rectum are not easy accessible to local excision. Transanal endoscopic microsurgery (TEM) has been recommended for excision of sessile adenomas in the middle and upper part of the rectum, and for small cancers in patients not fit for major surgery. The purpose of this study was to evaluate postoperative morbidity and local recurrence after TEM. MATERIAL AND METHODS: Seventy-nine patients were treated by TEM in the period 1994-2001. The median age was 74 years. The indications for TEM were rectal adenoma in 72 patients and rectal cancer in 7 patients. The tumours were located within 18 cm from the dentate line, median 10 cm. There were performed 69 transmural and 10 mucosal excisions. Mean follow up was 24 months (range 1-95 months). Twenty (25%) patients died during the follow up period, two because of metastases and 18 of other causes. RESULTS: Seven patients had complications. Two (2.5%) patients had peroperative perforation in the intra-abdominal part of the rectum treated by laparotomy. Five (6%) patients had postoperative cardiopulmonal or surgical complications. Eight patients with benign pre-operative histopathological examination had cancer. The local recurrence rate (13%) was similar for adenomas and for carcinomas. CONCLUSION: TEM is a safe technique well tolerated also by high-risk patients, and should be the preferred method in patients with benign tumours in the middle and upper part of the rectum, and in selected cases of early rectal cancer. Benign pre-operative histology does not preclude malignancy and some patients may need further treatment for unexpected malignancy.
Asunto(s)
Adenoma/cirugía , Microcirugia/métodos , Proctoscopía/métodos , Neoplasias del Recto/cirugía , Adenoma/diagnóstico por imagen , Adenoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Colonoscopía , Endosonografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Neoplasias del Recto/diagnóstico por imagen , Neoplasias del Recto/patología , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
During 1980-89, 224 patients, 129 women and 95 men, median age 72 years (18-96 years), were treated for common bile duct stones. 26 of the patients had remote cholecystectomy. 67 patients had additional acute cholecystitis, 37 acute cholangitis and 25 acute pancreatitis. 173 patients underwent a traditional open operation, 37 endoscopic papillotomy (EPT) and 14 were treated conservatively. No deaths occurred after elective operations in 52 patients, and one death occurred after early planned operation in 95 patients. Emergency operations and delayed operations for acute disease were encumbered with a lethality of 12%. During the last two years of the study, old septic patients were treated with papillotomy, and there was no mortality among the last 39 patients. The study shows that non-septic patients with common bile duct stones can be safely treated by open operation. Old patients with severe complicated gall stone disease should be treated by endoscopic papillotomy at an early stage.
Asunto(s)
Cálculos Biliares/cirugía , Adulto , Anciano , Colecistectomía , Endoscopía , Femenino , Cálculos Biliares/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/mortalidadRESUMEN
During the period 1980 to 1989, 342 patients with acute cholecystitis, 202 women and 140 men, with median age 71 (19-100) years, were admitted to our department. The treatment strategy during the period was early planned cholecystectomy in operable stabile patients with a duration of the disease of less than 7-8 days. Seven patients (2.0%) died, three after emergency operation, three after delayed operation when conservative treatment had failed, and one after medical treatment only. None of 192 patients treated with early planned operation died, and there was no lethality among the patients below the age of 75. The stay in hospital was reduced by 5.2 days after early planned operation. Early planned cholecystectomy for acute cholecystitis is a safe and cost-effective treatment.
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Colecistectomía/métodos , Colecistitis/cirugía , Colelitiasis/complicaciones , Procedimientos Quirúrgicos Electivos , Enfermedad Aguda , Adulto , Anciano , Colecistectomía/economía , Colecistitis/etiología , Colelitiasis/cirugía , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/mortalidadRESUMEN
A 10-year retrospective review of 1,013 patients with gallstone disease is analysed. The median age of the patients was 66 (18-100) years. 499 patients (49%) were admitted as emergencies. There was a significant relationship between the patient's age, complicated disease and lethality. The mortality was 1%. No patients below the age of 70 died. There was also a significant relationship between duration of the disease and mortality. Emergency operations and delayed operations for acute disease were encumbered with the highest lethality (7%), while early planned operation for acute disease and elective operations showed a lethality of 0.5 and 0.2% respectively. We advocate a more liberal attitude towards elective operations and early operative intervention in elderly patients who do not respond to medical treatment.
Asunto(s)
Colelitiasis/mortalidad , Adulto , Anciano , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Complicaciones Posoperatorias/diagnóstico , Pronóstico , Estudios RetrospectivosRESUMEN
OBJECTIVE: To examine the association between blood transfusion and infective complications after biliary operations. DESIGN: Retrospective cohort study. SETTING: District hospital. SUBJECTS: 875 consecutive patients who required biliary operations. MAIN OUTCOME MEASURES: Postoperative infective morbidity in hospital. RESULTS: 73 patients (8%) developed postoperative infections in hospital. Univariate analysis showed that the development of infections was significantly associated with blood transfusion (p < 0.001), stones in the common bile duct (p < 0.001), operations on the common bile duct (p < 0.001), T-tube drainage (p < 0.001), duration of operation (p = 0.008), and age (p = 0.03). Multivariate logistic regression analysis showed that only blood transfusion and stones in the common bile duct were independent predictors of infection. The corrected odds ratios for infection were 4.7 (95% confidence interval (CI) 2.4 to 9.3) when 1-3 units of blood were given and 5.6 (95% CI 2.3 to 13.6) when more than three units were given. CONCLUSION: Transfusion is an independent risk factor in the development of postoperative infection in hospital in patients who have had biliary operations.
Asunto(s)
Infecciones Bacterianas/etiología , Enfermedades de las Vías Biliares/cirugía , Conservación de la Sangre , Transfusión Sanguínea , Complicaciones Posoperatorias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
311 medial femoral neck fractures (213 of them displaced) treated with a hip compression screw were studied retrospectively. 90 patients were treated with a primary hemiprosthesis during the same period. Fixation was lost in the case of seven fractures within three months after the operation. Two patients developed pseudarthrosis and 53 late segmental collapse. 54 patients have been reoperated, and given an endoprosthesis. The radiographs of 176 patients (114 displaced fractures) who were accessible for follow-up until failure, or for at least three years, were analysed. The rates of late segmental collapse were particularly high for fractures with a postoperative anterior angulation exceeding 15 degrees. Displacement and time until operation were independently related to late segmental collapse.