Diseases of the colon and rectum
-
Toradol (ketorolac tromethamine; Syntex Labs, Palo Alto, CA) is a nonsteroidal anti-inflammatory drug introduced for intramuscular injection to control postoperative pain. Its action is peripheral. Therefore, it seemed appropriate to inject it directly into the anal sphincter muscles when these are exposed during anorectal procedures. ⋯ Unexpectedly, only two patients (2 percent) needed catheterization for urinary retention. The usual incidence is 20 to 30 percent. To date we have seen none of the complications associated with the use of anti-inflammatory drugs.
-
Case Reports Comparative Study
Clinical studies in surgical journals--have we improved?
A critical appraisal of all clinical studies published in 1980 and 1990 in three surgical journals--Diseases of the Colon and Rectum (DCR), Surgery (SURG), and the British Journal of Surgery (BJS)--was made to ascertain the frequency with which various research designs appeared, the standard of individual clinical studies, and a comparison of changes in the past decade. Clinical studies were classified into case studies or comparative studies. Comparative studies included randomized controlled trials (RCT), nonrandomized controlled trials, retrospective cohorts, and case-control studies. ⋯ There was no significant difference in the standard of comparative studies among the three journals in 1990. In conclusion, there has been no overall increase in the proportion of stronger clinical trial designs in the journals reviewed. A small increase seen in the overall standard of comparative studies was not statistically significant.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Prospective, randomized trial comparing pain and clinical function after conventional scissors excision/ligation vs. diathermy excision without ligation for symptomatic prolapsed hemorrhoids.
Forty-nine consecutive patients with symptomatic prolapsed hemorrhoids were prospectively randomized for conventional scissors excision with ligation (Group A; n = 16) or diathermy excision without ligation (Group B; n = 33). The median time taken to complete the procedure was 20 minutes (range, 10-40 minutes) and 10 minutes (range, 5-35 minutes) in Groups A and B, respectively (P < 0.05). Length of hospital stay was similar in both groups, with a median of three days and a range of two to five days. ⋯ There was no statistical difference in the severity of postoperative pain between the two groups. The use of postoperative oral analgesics was significantly lower in Group B (P < 0.02), but there was no significant difference in the demand for intramuscular or topical analgesics. Diathermy excision of hemorrhoids is significantly faster than scissors excision, there is less bleeding, the vascular pedicles need not be ligated, and there is significant reduction in the requirement for oral analgesics postoperatively without any increase in early or late postoperative complications.
-
Fibrin adhesives have been advocated as a protective sealant in high-risk colonic anastomoses to prevent leakage. To assess the effect of fibrin glue sealing on the healing ischemic anastomosis, we compared the healing of sutured colonic anastomoses in the rat, with and without fibrin adhesive (Groups IA and IB), and ischemic anastomoses with and without fibrin adhesive (Groups IIA and IIB). On days two, four, and seven, 10 animals in each group were sacrificed. ⋯ Ischemia at the anastomotic site results in weaker anastomotic strength on day four postoperatively. Also in ischemic anastomoses, fibrin sealant does not improve wound healing during the first seven days. Adhesion formation on ischemic intestinal anastomoses was not prevented by fibrin sealing.
-
Adult patients with an idiopathic megarectum or megacolon can experience severe constipation requiring surgical treatment. Some of these patients have a proximal colon of normal diameter, with dilatation involving only the left or distal colon and rectum. The results of partial colonic and rectal resection with coloanal anastomosis in such patients have been reviewed. ⋯ One patient has an ileostomy because of persistent constipation after the procedure. One subject died because of postoperative bleeding from the anastomosis and subsequent cardiac and respiratory complications. This operation may have a place in the treatment of severe constipation caused by idiopathic megarectum and megacolon, but careful preoperative motility studies and meticulous attention to operative technique are required for a good outcome.