FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2078804865> ?p ?o ?g. }

• W2078804865 endingPage "81" @default.
• W2078804865 startingPage "80" @default.
• W2078804865 abstract "The article by Chrysos et al. in the current issue of this journal raises a number of important points in relation to the management of patients with a mechanical large bowel obstruction. The first of these is the trend towards performing a primary resection and anastomosis to treat such patients.1,2 This has been a major evolution in surgical management because in the past it was believed that performing an anastomosis in the setting of acute obstruction was associated with an unacceptably high mortality and morbidity. Hence, the widespread use of three stage and two stage procedures to treat such patients. Currently, in patients with right sided colonic obstructions, there is general acceptance of the principle of performing a primary resection and anastomosis.2 Yet concerns still persist with regards to left sided colonic obstructions. This is why the Hartmann’s procedure is still accepted as a sound technique for the management of such lesions. The problem with a Hartmann’s procedure is that the reversal procedure is associated with a significant mortality and morbidity and, in view of this, a high percentage of patients (32–60%)1 are never reversed. There is a growing body of evidence in the literature to support the use of primary resection and anastomosis as a sound alternative in the management of patients with mechanical bowel obstruction. Such procedures can be performed with an acceptable mortality (7–12%) and morbidity in the emergency setting. Yet to perform a primary resection and anastomosis requires a certain level of surgical expertise, and in the emergency setting (and often after hours), such expertise may not always be readily available. Hence, it may be more appropriate that a trainee surgeon performs either a defunctioning stoma or a Hartmann’s procedure. The second issue raised in the article by Chrysos et al. is whether a subtotal/total colectomy is superior to a segmental resection and on table-lavage in managing patients with obstructions in the left side of the colon or upper rectum. Clearly, in the presence of caecal perforation or infarction, subtotal/total colectomy is the treatment of choice. However, in obstructed patients who do not have such indications, the decision is not as clear cut. Proponents of subtotal colectomy claim that it has a similar mortality and morbidity to segmental resection, and that the functional results do not impact significantly on the majority of patients. In addition, it removes the risk of synchronous cancers which may occur in some 2–3% of patients, and it also removes synchronous polyps which may occur in up to 10% of patients. It is interesting to review the results of the only clinical trial which has compared subtotal colectomy (n = 47) with segmental resection and on table-lavage (n = 44) in patients with left sided colonic obstructions.1 In that trial, it was noted that patients undergoing subtotal colectomy had a significantly higher bowel frequency and were more likely to consult their local doctors as a result of this. In addition, although the anastomotic leak rate was not significantly different (4/47 vs 2/44) between the two groups, patients undergoing a subtotal colectomy were significantly more likely to require a permanent stoma (7/47 vs 1/44). These results indicated a disadvantage in both function and morbidity in patients undergoing a subtotal colectomy when compared with segmental resection. The third issue relates to the use of a J-pouch ileorectal anastomosis to improve the functional outcome of patients having total colectomies with partial removal of the upper rectum. This is a novel procedure which follows on from the successful use of an ileal J-pouch to reconstruct patients following proctocolectomy. It makes intuitive sense that such an approach may benefit patients having a total colectomy. Chrysos et al. have performed this procedure on four selected patients and documented a successful outcome in terms of mortality, morbidity and function over a short-term follow up. Yet what may seem to be a reasonable approach does not always translate into a successful clinical outcome. The use of total colectomy and J-pouch ileorectal anastomosis for managing patients with obstructing rectosigmoid lesions is an interesting new technique which deserves further evaluation. Such evaluation needs to look carefully at not only the operative mortality and morbidity, but also the functional outcome, both short- and long-term. A recent article by Ko et al.3 highlights just how important bowel function and bowel frequency are to a patient’s quality of life. The authors in particular noted how a patient’s bowel function impacted not only on their perception of their physical health, but also their mental health and social function capabilities. In conclusion, the management of mechanical large bowel obstruction has seen a trend towards performing primary resection and anastomosis. In left sided colonic obstructions, the choice between subtotal/total colectomy and segmental resection and on table-lavage is still open to debate. However, the use of total colectomy and ileorectal anastomosis is clearly associated with impairments in bowel function, and in some patients this can impact significantly on their quality of life. The use of a J-pouch ileorectal anastomosis to reduce these functional problems is an interesting idea which warrants further evaluation." @default.
• W2078804865 created "2016-06-24" @default.
• W2078804865 creator A5025612986 @default.
• W2078804865 date "2002-02-01" @default.
• W2078804865 modified "2023-10-09" @default.
• W2078804865 title "The evolving management of mechanical large bowel obstruction" @default.
• W2078804865 cites W1937741250 @default.
• W2078804865 cites W2091142457 @default.
• W2078804865 cites W2114700628 @default.
• W2078804865 doi "https://doi.org/10.1046/j.1445-2197.2002.02345.x" @default.
• W2078804865 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/12074079" @default.
• W2078804865 hasPublicationYear "2002" @default.
• W2078804865 type Work @default.
• W2078804865 sameAs 2078804865 @default.
• W2078804865 citedByCount "1" @default.
• W2078804865 crossrefType "journal-article" @default.
• W2078804865 hasAuthorship W2078804865A5025612986 @default.
• W2078804865 hasConcept C141071460 @default.
• W2078804865 hasConcept C146357865 @default.
• W2078804865 hasConcept C151730666 @default.
• W2078804865 hasConcept C159110652 @default.
• W2078804865 hasConcept C179755657 @default.
• W2078804865 hasConcept C2777785015 @default.
• W2078804865 hasConcept C2779787475 @default.
• W2078804865 hasConcept C2909201322 @default.
• W2078804865 hasConcept C61434518 @default.
• W2078804865 hasConcept C71924100 @default.
• W2078804865 hasConcept C8443397 @default.
• W2078804865 hasConcept C86803240 @default.
• W2078804865 hasConceptScore W2078804865C141071460 @default.
• W2078804865 hasConceptScore W2078804865C146357865 @default.
• W2078804865 hasConceptScore W2078804865C151730666 @default.
• W2078804865 hasConceptScore W2078804865C159110652 @default.
• W2078804865 hasConceptScore W2078804865C179755657 @default.
• W2078804865 hasConceptScore W2078804865C2777785015 @default.
• W2078804865 hasConceptScore W2078804865C2779787475 @default.
• W2078804865 hasConceptScore W2078804865C2909201322 @default.
• W2078804865 hasConceptScore W2078804865C61434518 @default.
• W2078804865 hasConceptScore W2078804865C71924100 @default.
• W2078804865 hasConceptScore W2078804865C8443397 @default.
• W2078804865 hasConceptScore W2078804865C86803240 @default.
• W2078804865 hasIssue "2" @default.
• W2078804865 hasLocation W20788048651 @default.
• W2078804865 hasLocation W20788048652 @default.
• W2078804865 hasOpenAccess W2078804865 @default.
• W2078804865 hasPrimaryLocation W20788048651 @default.
• W2078804865 hasRelatedWork W2003443563 @default.
• W2078804865 hasRelatedWork W2003680463 @default.
• W2078804865 hasRelatedWork W2088977347 @default.
• W2078804865 hasRelatedWork W2147571964 @default.
• W2078804865 hasRelatedWork W2170962918 @default.
• W2078804865 hasRelatedWork W2346958970 @default.
• W2078804865 hasRelatedWork W2896462463 @default.
• W2078804865 hasRelatedWork W3206278152 @default.
• W2078804865 hasRelatedWork W4210336215 @default.
• W2078804865 hasRelatedWork W4242023254 @default.
• W2078804865 hasVolume "72" @default.
• W2078804865 isParatext "false" @default.
• W2078804865 isRetracted "false" @default.
• W2078804865 magId "2078804865" @default.
• W2078804865 workType "article" @default.