Learn More
BACKGROUND Despite clinical evidence showing that steps can be taken perioperatively to enhance postoperative recovery and decrease morbidity in colonic operation patients, there is no comprehensive information on how widespread such practices are, or the combination of such steps into effective multimodal rehabilitation (fast-track) colonic surgery(More)
Tremendous variation in patient care exists, both among medical centers and among individual surgeons, in the field of colon and rectal surgery. Clinical or critical pathways based on “best demonstrated practices” from the medical literature have led to improved outcomes for many disease entities. The objective of this study was to develop a pathway for(More)
PURPOSE Rectal prolapse typically occurs in elderly patients, who are often poor surgical candidates because of the presence of multiple comorbidities. Abdominal approaches to procidentia have low recurrence rates but are associated with higher rates of morbidity and mortality. Perineal rectosigmoidectomy (Altemeier repair) is a safe and effective approach(More)
PURPOSE The aim of this study was to determine the optimal dose and dosing interval of nitroglycerin ointment to heal chronic anal fissures. METHOD A randomized, double-blind study of intra-anally applied nitroglycerin ointment (Anogesic) was conducted in 17 centers in 304 patients with chronic anal fissures. The patients were randomly assigned to one of(More)
PURPOSE Known late complications of ileal pouch-anal anastomoses include chronic pouchitis, poor pouch function, or stricture. These may jeopardize the pouch and may require pouch salvage procedures. Prolapse of the ileoanal pouch is a little-known complication infrequently noted in the literature. The objective of this study was to determine the prevalence(More)
Thirty-eight patients with condylomata acuminata of the anus, requiring surgical therapy, had the left half of the anus treated with conventional electrical cautery, while the right half of the anus was treated with the carbon dioxide laser at the same time. Patients were questioned about the amount of pain on both sides and were studied for evidence of(More)
Approach to the Patient One of the things that distinguishes surgeons who are comfortable and competent in the management of anorectal disease from others is their approach to the patient. Such an approach ideally should put the patient at ease and reduce the fear and embarrassment that are often associated, in the patient's mind, with seeking care for(More)
BACKGROUND The purpose of this study was to evaluate the adoption of laparoscopic colon surgery and assess its impact in the community at large. STUDY DESIGN The Surgical Care and Outcomes Assessment Program (SCOAP) is a quality improvement benchmarking initiative in the Northwest using medical record-based data. We evaluated the use of laparoscopy and a(More)
Acute massive hematochezia provides one of the greatest diagnostic and therapeutic challenges to the physician. Although most patients stop bleeding spontaneously and further evaluation can be carried on with less urgency, 10% to 15% require urgent diagnostic and therapeutic procedures. Clearly, the least invasive effective solution to the bleeding problem(More)