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Prem Puri - One of the best experts on this subject based on the ideXlab platform.
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morphological basis of persistent bowel problems following a properly performed Pull through Operation for hirschsprung s disease
2019Co-Authors: David Coyle, Prem PuriAbstract:Despite having a technically satisfactory Pull-through Operation for Hirschsprung’s disease (HSCR) (complete resection of all aganglionic or hypoganglionic colon with hypertrophic nerve trunks while avoiding injury to the sphincter mechanism), a substantial proportion of patients continue to experience symptoms such as intractable constipation, soiling, or recurrent Hirschsprung-associated enterocolitis. Some of these patients are later found to have a retained segment of aganglionic or transition zone colon. This may be avoided with more rigorous definition of what constitutes transition zone colon and by ensuring that a margin, the recommended length of which has yet to be determined, of colon above the normally ganglionated intraoperative biopsy is also resected.
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inflammatory bowel disease in patients with hirschsprung s disease a systematic review and meta analysis
Pediatric Surgery International, 2018Co-Authors: Hiroki Nakamura, Prem Puri, Tristan L LimAbstract:Hirschsprung-associated enterocolitis (HAEC) continues to be an important cause of morbidity in patients with Hirschsprung’s disease (HSCR). HAEC can occur at any time during the course of the disease. The reported incidence of HAEC before surgery ranges from 6 to 50%, and after surgery, it ranges from 2 to 35%. HAEC and inflammatory bowel disease (IBD) have similar clinical presentation including diarrhea, hematochezia, and abdominal pain. In recent years, isolated cases of IBD have been reported in patients who had surgical treatment for HSCR. The exact pathogenesis of HAEC or IBD is not known. However, both conditions are characterized by an abnormal intestinal mucosal barrier function, which may be a common pathway. The purpose of this meta-analysis was to determine the clinical presentation and outcome in patients with HSCR who developed IBD after Pull-through Operation. A systematic literature search for relevant articles was performed in four databases using the combinations of the following terms “inflammatory bowel disease”, “Crohn/Crohn’s disease”, “ulcerative colitis”, and “Hirschsprung disease/Hirschsprung’s disease” for studies published between 1990 and 2017. The relevant cohorts of HSCR associated with IBD were systematically searched for clinical presentation and outcomes. 14 studies met defined inclusion criteria, reporting a total of 66 patients who had HSCR associated with IBD. Mean age at first Operation for HSCR was 5.8 months, mean age at diagnosis of IBD was 7.7 years, and the majority of patients were male (73%). The extent of aganglionosis was total colonic aganglionosis in 41% of patients, long segment in 45%, and rectosigmoid in 14%. The majority of patients underwent a Duhamel procedure (84%) for HSCR. The distribution of IBD was Crohn’s disease in 72.3% of patients, ulcerative colitis in 16.9%, and others in 10.8%. Eight articles (47 patients) reported about HAEC, and 22 patients (47%) had experienced HAEC after surgery for HSCR. Male patients with extensive colonic aganglionosis who continue to suffer from postoperative HAEC after a Duhamel procedure are more susceptible to develop IBD. Recognition of IBD may be important in the long-term follow-up of HSCR patients who have had postoperative HAEC.
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altered distribution of small conductance calcium activated potassium channel sk3 in hirschsprung s disease
Journal of Pediatric Surgery, 2015Co-Authors: David Coyle, Anne Marie Odonnell, Prem PuriAbstract:Abstract Purpose SK3 channels are voltage-independent Ca 2+ -dependent K + channels that play a key role in regulating smooth muscle membrane potential during purinergic inhibitory neurotransmission in the colon. Dysmotility problems are common after a properly performed Pull-through Operation for Hirschsprung's disease (HSCR). We hypothesised that ganglionic bowel just proximal to the transition zone is abnormal and designed this study to investigate SK3 channel expression in HSCR. Methods Entire resected bowel specimens were collected at the time of Pull-through surgery for HSCR (n=6). Control colonic specimens were obtained at the time of colostomy closure in patients following anorectoplasty (n=6). SK3 protein expression was assessed qualitatively using immunofluorescence with confocal microscopy and quantitatively using western blot (WB) analysis. Results Positive SK3 immunofluorescence was seen in the mucosa and in all three smooth muscle layers and the myenteric plexus in control specimens. SK3 immunofluorescence co-localised with PDGFRα. A band was detected at ~70kDa on WB. SK3 protein expression was barely detectable in aganglionic tissue and markedly reduced in the ganglionic bowel of 3 patients with HSCR compared to controls. Conclusion Decreased SK3 expression in ganglionic bowel may explain the basis of persistent bowel symptoms in some patients following a properly performed Pull-through Operation for HSCR.
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residual aganglionosis after Pull through Operation for hirschsprung s disease a systematic review and meta analysis
Pediatric Surgery International, 2011Co-Authors: Florian Friedmacher, Prem PuriAbstract:Purpose Most patients with Hirschsprung’s disease (HD) have a satisfactory outcome after Pull-through (PT) Operation. However, some children continue to have persistent bowel symptoms after the initial Operation and may require redo PT. Redo PT Operation in HD is usually indicated for anastomotic strictures or residual aganglionosis (RA). We designed this meta-analysis to determine the incidence and outcome of RA among patients with HD following PT Operation.
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residual aganglionosis after Pull through Operation for hirschsprung s disease a systematic review and meta analysis
Pediatric Surgery International, 2011Co-Authors: Florian Friedmacher, Prem PuriAbstract:Most patients with Hirschsprung’s disease (HD) have a satisfactory outcome after Pull-through (PT) Operation. However, some children continue to have persistent bowel symptoms after the initial Operation and may require redo PT. Redo PT Operation in HD is usually indicated for anastomotic strictures or residual aganglionosis (RA). We designed this meta-analysis to determine the incidence and outcome of RA among patients with HD following PT Operation. A meta-analysis of redo PT Operations for HD reported in the literature between 1985 and 2011 was performed. Detailed information was recorded in patients with RA and transition-zone bowel (TZB), including recurrent bowel problems, histological findings on repeat rectal biopsy, type of redo PT Operation and outcome. Twenty-nine articles reported 555 patients with redo PT Operations. 193 (34.8%) patients demonstrated abnormal histological findings on rectal biopsy with 144 patients showing RA and 49 patients showing TZB. These 193 patients presented with persistent constipation (n = 135), recurrent enterocolitis (n = 45) and abnormal histology of the Pulled-through bowel (n = 13). Mean age at redo PT was 4.4 years (range 4 months–17 years). Redo procedures were Duhamel (n = 57), transanal endorectal PT (n = 40), Soave (n = 35), Swenson (n = 10), posterior sagittal approach (n = 1) and not reported (n = 50). Follow-up information after redo PT was available in 134 (69.4%) patients and not available in 59 patients. Of the 134 patients, 99 (73.9%) patients had normal bowel habits, 19 patients had persistent constipation/soiling and 16 patients had recurrent enterocolitis. This meta-analysis reveals that RA and TZB are the underlying causes of persistent bowel symptoms in one-third of all patients with HD requiring redo PT Operation. Most patients have a satisfactory outcome after redo Operation. Rectal biopsy should be performed in all patients with recurrent bowel problems after PT Operation.
Yuanjun Jiang - One of the best experts on this subject based on the ideXlab platform.
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urethral Pull through Operation for the management of pelvic fracture urethral distraction defects
Urology, 2011Co-Authors: Lei Yin, Chuize Kong, Yuyan Zhu, Yuxi Zhang, Yuanjun JiangAbstract:Objective To present our institutional experience in the management of pelvic fracture urethral distraction defects with urethral Pull-through Operation. Methods Seventy-six patients (average age 34.5 years) with posterior urethral strictures caused by pelvic fracture urethral distraction defects underwent urethral Pull-through Operation at our department from July 1995 to September 2009. The estimated urethral stricture length was 2.0–3.5 cm (mean 2.5). Of these patients, 31 (41%) had undergone failed urethroplasty or urethrotomy after the initial management, and 5 (7%) had urethrorectal fistula. Urethral Pull-through Operation was performed 4–7 months (mean 4.9) after initial treatment or failed urethral reconstruction. The clinical outcome was considered a failure when any postoperative intervention was needed. Results Follow-up was 14–74 months (mean 42.5). The overall success rate was 89% (68/76). All treatment failures occurred within the first 6 months postoperatively. Failed repairs were successfully managed with internal urethrotomy in 1 patient, by urethral dilation in 6, and by another urethroplasty in 1. All patients were urinary-continent postoperatively. Of the potent patients, 2 (5%) became impotent after urethroplasty. There was no chordee, penile shortening, or urethral fistula recurrence. Conclusion Urethral Pull-through Operation might be a less demanding and less time-consuming procedure. It does not increase the rate of impotence or incontinence and, with a high success rate, might serve as an alternative method for the management of pelvic fracture urethral distraction defects.
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Reconstructive Urology Urethral Pull-through Operation for the Management of Pelvic Fracture Urethral Distraction Defects
2011Co-Authors: Lei Yin, Chuize Kong, Yuyan Zhu, Yuxi Zhang, Yuanjun JiangAbstract:OBJECTIVE To present our institutional experience in the management of pelvic fracture urethral distraction defects with urethral Pull-through Operation. METHODS Seventy-six patients (average age 34.5 years) with posterior urethral strictures caused by pelvic fracture urethral distraction defects underwent urethral Pull-through Operation at our department from July 1995 to September 2009. The estimated urethral stricture length was 2.0–3.5 cm (mean 2.5). Of these patients, 31 (41%) had undergone failed urethroplasty or urethrotomy after the initial management, and 5 (7%) had urethrorectal fistula. Urethral Pull-through Operation was performed 4–7 months (mean 4.9) after initial treatment or failed urethral reconstruction. The clinical outcome was considered a failure when any postoperative intervention was needed. RESULTS Follow-up was 14–74 months (mean 42.5). The overall success rate was 89% (68/76). All treatment failures occurred within the first 6 months postoperatively. Failed repairs were successfully managed with internal urethrotomy in 1 patient, by urethral dilation in 6, and by another urethroplasty in 1. All patients were urinary-continent postoperatively. Of the potent patients, 2 (5%) became impotent after urethroplasty. There was no chordee, penile shortening, or urethral fistula recurrence. CONCLUSION Urethral Pull-through Operation might be a less demanding and less time-consuming procedure. It does not increase the rate of impotence or incontinence and, with a high success rate, might serve as an alternative method for the management of pelvic fracture urethral distraction defects. UROLOGY 78: 946–951, 2011. © 2011 Elsevier Inc.
Lei Yin - One of the best experts on this subject based on the ideXlab platform.
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urethral Pull through Operation for the management of pelvic fracture urethral distraction defects
Urology, 2011Co-Authors: Lei Yin, Chuize Kong, Yuyan Zhu, Yuxi Zhang, Yuanjun JiangAbstract:Objective To present our institutional experience in the management of pelvic fracture urethral distraction defects with urethral Pull-through Operation. Methods Seventy-six patients (average age 34.5 years) with posterior urethral strictures caused by pelvic fracture urethral distraction defects underwent urethral Pull-through Operation at our department from July 1995 to September 2009. The estimated urethral stricture length was 2.0–3.5 cm (mean 2.5). Of these patients, 31 (41%) had undergone failed urethroplasty or urethrotomy after the initial management, and 5 (7%) had urethrorectal fistula. Urethral Pull-through Operation was performed 4–7 months (mean 4.9) after initial treatment or failed urethral reconstruction. The clinical outcome was considered a failure when any postoperative intervention was needed. Results Follow-up was 14–74 months (mean 42.5). The overall success rate was 89% (68/76). All treatment failures occurred within the first 6 months postoperatively. Failed repairs were successfully managed with internal urethrotomy in 1 patient, by urethral dilation in 6, and by another urethroplasty in 1. All patients were urinary-continent postoperatively. Of the potent patients, 2 (5%) became impotent after urethroplasty. There was no chordee, penile shortening, or urethral fistula recurrence. Conclusion Urethral Pull-through Operation might be a less demanding and less time-consuming procedure. It does not increase the rate of impotence or incontinence and, with a high success rate, might serve as an alternative method for the management of pelvic fracture urethral distraction defects.
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Reconstructive Urology Urethral Pull-through Operation for the Management of Pelvic Fracture Urethral Distraction Defects
2011Co-Authors: Lei Yin, Chuize Kong, Yuyan Zhu, Yuxi Zhang, Yuanjun JiangAbstract:OBJECTIVE To present our institutional experience in the management of pelvic fracture urethral distraction defects with urethral Pull-through Operation. METHODS Seventy-six patients (average age 34.5 years) with posterior urethral strictures caused by pelvic fracture urethral distraction defects underwent urethral Pull-through Operation at our department from July 1995 to September 2009. The estimated urethral stricture length was 2.0–3.5 cm (mean 2.5). Of these patients, 31 (41%) had undergone failed urethroplasty or urethrotomy after the initial management, and 5 (7%) had urethrorectal fistula. Urethral Pull-through Operation was performed 4–7 months (mean 4.9) after initial treatment or failed urethral reconstruction. The clinical outcome was considered a failure when any postoperative intervention was needed. RESULTS Follow-up was 14–74 months (mean 42.5). The overall success rate was 89% (68/76). All treatment failures occurred within the first 6 months postoperatively. Failed repairs were successfully managed with internal urethrotomy in 1 patient, by urethral dilation in 6, and by another urethroplasty in 1. All patients were urinary-continent postoperatively. Of the potent patients, 2 (5%) became impotent after urethroplasty. There was no chordee, penile shortening, or urethral fistula recurrence. CONCLUSION Urethral Pull-through Operation might be a less demanding and less time-consuming procedure. It does not increase the rate of impotence or incontinence and, with a high success rate, might serve as an alternative method for the management of pelvic fracture urethral distraction defects. UROLOGY 78: 946–951, 2011. © 2011 Elsevier Inc.
Wang Zhiwei - One of the best experts on this subject based on the ideXlab platform.
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clinical research of laparoscopic radical resection for rectal cancer by Pull through Operation without assistant incision
Journal of Modern Oncology, 2012Co-Authors: Wang ZhiweiAbstract:Objective:To evaluate the value of laparoscopic radical resection for rectal cancer by Pull-through Operation without assistant incision.Methods: The clinical and pathological data of 26 patients with stage Dukes A was analyzed retrospectively.26 patients were preformed laparoscopic radical resection for rectal cancer by Pull-through Operation without assistant incision,among which 21cases by Dixon Operation and 5cases by Miles Operation.Results: All 26 patients were successfully preformed laparoscopic radical resection for rectal cancer.No one died during Operation.The upper incision margin exceeded 10cm from the border of tumor and the lower incision margin exceeded 3cm.Histological type of 26 cases was adenocarcinoma.Postoperative pathological examination revealed no residual of cancer cells in stump.The intraoperative blood loss was(15-310)ml(mean 87.89ml) and Operation time was(109-297) min(mean 173.45min).The postoperative recovery time of intestinal peristalsis was 27-88h hours(mean 49.97 hours).(2-20) lymph nodes were removed(mean 12.3) during Operation.The postoperative hospital stay time was(7-12) days,with an average of 8.69 days.There was postoperative hemorrhage in 1 case without other operative complications such as anastomotic leakage and stenosis.No metastasis,recurrence or trocar incision implantation was found in the follow-up period except one patient with local recurrence.Conclusion: There is minimal suffering in laparoscopic radical resection for rectal cancer by Pull-through Operation without assistant incision,which is safe and feasible with good cosmetic efficiency,lower complications,and rapidly recovery.It can obtain almost the same benefits as the open Operation.
Ya Xiao - One of the best experts on this subject based on the ideXlab platform.
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modified urethral Pull through Operation for posterior urethral stricture and long term outcome
The Journal of Urology, 2008Co-Authors: Pingxian Wang, Mingqi Fan, Yinpu Zhang, Chibing Huang, Jiayu Feng, Ya XiaoAbstract:Purpose: We present our experience, technique and long-term results of the modified urethral Pull-through Operation for posttraumatic posterior urethral stricture.Materials and Methods: A total of 113 patients with posttraumatic posterior urethral stricture resulting from pelvic fracture injury underwent the modified urethral Pull-through Operation at our department from August 1999 to March 2007. Patient age was 17 to 69 years (mean 35.2). Stricture length was 1.5 to 4.7 cm (mean 2.6). Of the patients 52 (46.0%) had undergone at least 1 previous failed management for stricture, including urethroplasty in 29 (25.7%). Followup included symptomatic and urinary flow rate evaluation, which was performed 6 and 12 months after the modified urethral Pull-through Operation in all patients and thereafter when needed, and urethrography and/or urethroscopy in patients with voiding symptoms. Clinical outcomes were considered a success when no postoperative procedure was needed.Results: Patients were followed for 12 t...
