The Colorectal Development Unit: impact on functional outcome for the electrically stimulated gracilis neoanal sphincter.

Objective: A Colorectal Development Unit (CDU) was established to treat patients with end stage faecal incontinence with the electrically stimulated gracilis neoanal sphincter (ESGN). The aim of this study was to investigate the impact of the CDU on functional outcome and complications.

Methods: From March 1997 to March 2003, 53 patients underwent ESGN formation.

The combination of electrically stimulated gracilis neoanal sphincter and continent colonic conduit: a step forward for total anorectal reconstruction?

Purpose: Patients undergoing total anorectal reconstruction for anorectal atresia or following abdominoperineal resection of the rectum do not fare as well after an electrically stimulated gracilis neoanal sphincter as patients with incontinence alone. This retrospective study reports the outcome for the combination of a continent colonic conduit or antegrade continence enema procedure with an electrically stimulated gracilis neoanal sphincter in patients with atresia or following an abdominoperineal resection of the rectum as part of total anorectal reconstruction to overcome combined incontinence and evacuatory dysfunction.

Methods: Between September 1994 and September 1999, 11 continent colonic conduits were fashioned in 11 patients with an electrically stimulated gracilis neoanal sphincter as part of total anorectal reconstruction for end-stage fecal incontinence.

Use of a continent colonic conduit for treatment of refractory evacuatory disorder following construction of an electrically stimulated gracilis neoanal sphincter.

Background: This study reports the outcome from the addition of a continent colonic conduit (CCC) to an electrically stimulated gracilis neoanal sphincter in patients with severe evacuatory disorder following formation of a neosphincter for end-stage faecal incontinence.

Methods: One hundred and twenty patients had an electrically stimulated gracilis neoanal sphincter constructed for end-stage faecal incontinence. Seven patients developed severe evacuatory disorders; construction of a CCC was required in six patients and an antegrade continence enema procedure in one.

Referral guidelines for colorectal cancer--do they work?

Aims And Methods: Urgent referral guidelines for patients with suspected colorectal cancer were introduced in 2000. In a district general hospital, we prospectively assessed the effect of these guidelines on the number of urgent referrals received and the number found to have cancer.

Results: Over the first year, 180 urgent referrals were received of whom 95 (55%) fitted the guidelines.

Linear discriminant analysis of symptoms in patients with chronic constipation: validation of a new scoring system (KESS).

Purpose: The aim of this study was to devise a symptom scoring system to assist in diagnosing constipation and in discriminating among pathophysiologic subgroups.

Method: A structured symptom scoring questionnaire (11 questions) was completed by 71 chronically constipated patients and by 20 asymptomatic controls. The symptom score was correlated with a previously validated constipation score (Cleveland Clinic Score).

Vertical reduction rectoplasty: a new treatment for idiopathic megarectum.

Background: The aetiology of idiopathic megarectum is unknown and the results of surgery are often unsatisfactory. Rectal hyposensation is common and poor perception of rectal filling may contribute to the poor evacuatory function. By reducing the capacity of the rectum, it was hypothesized that sensory thresholds to rectal distension and perception of urge to defaecate would be improved.

Comparative study of two sites of colonic conduit placement in the treatment of constipation due to rectal evacuatory disorders.

Background: Chronic constipation may be treated by antegrade colonic irrigation via a colonic conduit.

Methods: Two alternative sites of colonic conduit construction were evaluated for their effect on the symptoms of 21 consecutive women with intractable constipation primarily due to rectal evacuatory disorders. The conduit was constructed in the sigmoid colon in the first 11 patients and in the transverse colon in the subsequent ten.

Anorectal reconstruction--restoring continence after abdominoperineal excision of the anorectum.

This article describes the technique of anal sphincter reconstruction using electrically stimulated graciloplasty. The results of recent published series of reconstruction after abdominoperineal excision are analyzed, and the modifications used to reduce complications are explored. Techniques of rectal reconstruction and methods of improving evacuation are also discussed.

Epidemiology of Helicobacter pylori: acquisition, transmission, population prevalence and disease-to-infection ratio.

This article focuses on factors relating to acquiring Helicobacter pylori, including re-acquiring H. pylori infection after successfully treatment. It considers variables that increase the risk of infection and explores the chances that an infected individual will develop symptomatic disease.