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Eur J Pediatr Surg. 2003 Jun;13(3):187-94.
Long-term results of Rehbein's procedure: a retrospective study in German-speaking countries.

Rassouli R, Holschneider AM, Bolkenius M, Menardi G, Becker MR, Schaarschmidt K, Illing P, Hagel CI, Holland-Cunz S, Loffler W, Schmittenbecher PP, Baumgartner G, Lochbuhler H, Hochst B, Schreiber M, Tewes G, Willital GH, Hopner F, Seifarth F, Cattarius-Kiefer U, Burger D, Engec B, Monse T, Benneck J.

Department of Pediatric Surgery, Children's Hospital of Cologne, Amsterdamer Strasse 59, 50735 Cologne, Germany.

AIM: In contrast to other countries, no collective study of Rehbein's procedure in German-speaking nations has been performed. Therefore, our intention was, analogously to Goto and Ikeda's (10) Japanese study in 1984, Kleinhaus's (13) study on Swenson's procedure in 1979, Bourdelat's (2) French-Canadian investigation into Duhamel's technique in 1997 and Martuciello's (11) and Teitelbaum's (16) follow-up in the year 2000, to perform a follow-up study of Rehbein's technique of deep anterior resection. METHODS: The data of 200 patients from 22 German-speaking centers in Switzerland, Austria and Germany were collected. These data were gathered by questionnaire and the children were followed up in the individual participating hospitals for at least 3.5 years after the procedure. The procedure was performed between 1993 and 1997, over a 5-year period. The questionnaire contained 74 items including anamnestic data, diagnostic postoperative treatment and reoperations. RESULTS: Concerning the incidence of anastomotic leaks and resolving anastomotic strictures there was no significant difference between the results in our series and those of the collective analyses made by Hofmann von Kap-herr (7), Holschneider (9) and Sherman (18). In 6.6 % of the 191 patients an anastomotic leak and in 9.9 % a rectal stricture, which had to be dilated, was observed. Concerning late complications, 22.8 % of the children suffered from constipation, 4.3 % from encopresis, 10.6 %



Dis Colon Rectum. 2003 Sep;46(9):1218-25.
Predictors of response to biofeedback treatment in anal incontinence.

Fernandez-Fraga X, Azpiroz F, Aparici A, Casaus M, Malagelada JR.

Digestive System Research Unit, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.

PURPOSE: Biofeedback is considered an effective treatment for anal incontinence, but a substantial proportion of patients fails to improve. The purpose of this study was to identify the key predictors of outcome. METHODS: We retrospectively analyzed the clinical and physiologic data of 145 patients consecutively treated in our unit for anal incontinence by biofeedback. Clinical evaluation was performed by means of a structured questionnaire that included previous history, symptoms of incontinence, and bowel habit. Anorectal evaluation measured anal pressure profiles, neural reflexes, defecatory dynamics, rectal compliance, and rectal sensitivity. Biofeedback treatment was performed by a manometric technique with reinforcement sessions scheduled every three months and daily exercising at home. Six months after the onset of biofeedback treatment the clinical response was evaluated as good (improvement of incontinence) or poor (no improvement or worsening). RESULTS: Of 126 patients (104 female; age range, 17-82 years) with at least six-month follow-up, 84 percent had a good response to treatment. By univariate analysis, several factors, such as age, history of constipation, abnormal defecatory maneuver, and rectal compliance, were significantly related to treatment response, but by multivariate logistic regression only age and defecatory maneuver were independent predictors of the response. The association of both factors provided the best sensitivity and specificity; 48 percent of patients younger than age 55 years and with abnormal defecatory maneuver had negative response to treatment, whereas 96 percent of patients age 55 years or older with normal defecatory maneuver had a positive response. CONCL



Dis Colon Rectum. 2003 Sep;46(9):1260-5.
Delorme's procedure for rectal prolapse: clinical and physiological analysis.

Tsunoda A, Yasuda N, Yokoyama N, Kamiyama G, Kusano M.

Second Department of Surgery, School of Medicine, Showa University, Tokyo, Japan.

PURPOSE: Clinical and physiological results of Delorme's procedure were assessed retrospectively in patients undergoing this procedure for rectal prolapse. METHODS: A consecutive series of 31 patients (7 males, 24 females; age, 14-93, mean 70 years) with full-thickness, rectal prolapse were treated by Delorme's procedure between 1994 and 2002. Median follow-up was 39 (range, 6-96) months. RESULTS: Good results were achieved in 27 patients (87 percent), prolapse recurrence was observed in 4 (13 percent), and mean recurrence time was 14 (range, 3-25) months. There were no postoperative deaths. Minor complications occurred in four patients. The median changes in preoperative and postoperative physiologic patterns in 16 patients were as follows: resting pressure from 21.0 (range, 5-48) to 23.5 (range, 12-76) cm H2O (P = 0.030), squeeze pressure from 64.0 (range, 27-248) to 108.0 (range, 32-264) cm H2O (P = 0.041), volume at first sensation from 100 (range, 70-180) to 70 (range, 40-130) ml (P = 0.002), maximum tolerated volume from 260 (range, 120-400) to 160 (range, 70-400) ml (P = 0.001). Incontinence improved in 63 percent. No patient became constipated, and 38 percent of those constipated preoperatively improved. The preoperative incontinence score improved from 11.5 (range, 1-20) to 6.0 (range, 0-20) after operation (P < 0.0001). CONCLUSION: Delorme's procedure had a low morbidity, did not lead to constipation, improved anal continence, and had a reasonably low recurrence rate. Improved anal sphincter and rectal sensation were associated with a reduced incidence of defecatory problems after Delorme's procedure.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12972972&dopt=Abstract constipation laxative colon cleansing



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