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J Crowe - One of the best experts on this subject based on the ideXlab platform.
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endoscopic balloon Sphincteroplasty papillary dilation for bile duct stones efficacy safety and follow up in 100 patients
Gastrointestinal Endoscopy, 1995Co-Authors: Padraic Mac Mathuna, P White, E Clarke, J Lennon, Raphael B Merriman, J CroweAbstract:Background Because sphincterotomy accounts for a major portion of the morbidity and mortality associated with ERCP, we have proposed endoscopic balloon papillary dilation or Sphincteroplasty as an alternative. Methods We report the outcome in a series of 100 patients in whom balloon Sphincteroplasty was attempted for bile duct stones up to 20 mm in diameter, with a median follow-up of 16 months (range 6 to 30). Results During one ERCP session using Sphincteroplasty alone, the bile duct was cleared in 78%, mechanical lithotripsy being required in 10% for stones greater than 12 mm in diameter. Incomplete duct clearance was achieved in a further 4%, all of whom underwent repeat ERCP with successful duct clearance without recourse to sphincterotomy. Failure to clear the bile duct with Sphincteroplasty in the remaining 18% was primarily related to large stone size ( > 15 mm). Sphincterotomy was required to clear the duct in 7%. Another 6% comprised elderly high-risk patients with multiple large stones greater than 15 mm who were treated by stent insertion plus ursodeoxycholic acid. No papillary hemorrhage was observed; uncomplicated pancreatitis occurred in 5%. During a median follow-up of 16 months, 2% had recurrent symptomatic bile duct stones considered to have been unrecognized following the initial ERCP: these were removed after repeat Sphincteroplasty. No clinical evidence of papillary stenosis was observed during follow-up. Conclusions Endoscopic balloon papillary dilation or Sphincteroplasty is a safe and effective alternative to sphincterotomy in the management of bile duct stones less than 12 mm; larger stones may require mechanical lithotripsy to facilitate duct clearance.
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endoscopic Sphincteroplasty a novel and safe alternative to papillotomy in the management of bile duct stones
Gut, 1994Co-Authors: Mac P Mathuna, P White, E Clarke, J Lennon, J CroweAbstract:Removal of bile duct stones during endoscopic retrograde cholangiopancreatography (ERCP) usually includes papillotomy. Papillotomy is associated with occasional complications and in addition, the longterm sequelae of papillotomy in young patients having laparoscopic cholecystectomy remain unclear. As an alternative to papillotomy, this study prospectively evaluated the efficacy and safety of endoscopic balloon Sphincteroplasty to facilitate bile duct clearance. Of 32 patients with bile duct stones (diameter 3-30 mm) at ERCP, Sphincteroplasty was considered inappropriate in four patients because of stone size (> 20 mm) necessitating papillotomy for bile duct clearance. Sphincteroplasty was performed in the remaining 28 patients to permit duct clearance by dormier basket, balloon or mechanical lithotripsy. The bile duct was cleared in 22 patients (79%) while additional measures including papillotomy or stent insertion were required in the remaining six patients (21%) because of stone size or technical difficulties. There was no associated papillary haemorrhage. Pancreatitis was seen in one patient (4%) but resolved within 24 hours. Our preliminary experience suggests that Sphincteroplasty is a safe and effective sphincter preservation technique that significantly reduces the necessity for papillotomy in the management of bile duct stones.
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endoscopic balloon Sphincteroplasty for benign papillary stenosis an alternative to surgical or endoscopic papillotomy
Irish Journal of Medical Science, 1993Co-Authors: Mac P Mathuna, J Lennon, J CroweAbstract:Benign papillary stenosis is an uncommon but well recognised cause of recurrent biliary pain usually in post-cholecystectomy patients characterised by biliary dilatation without bile duct calculi or malignancy. Endoscopic or surgical papillotomy is the recommended treatment but may be associated with a higher complication rate than when performed for bile duct stones. We report 2 cases of papillary stenosis treated by endoscopic balloon dilatation or “Sphincteroplasty”, as a less traumatic intervention which improved biliary drainage and provided symptomatic relief. Our preliminary experience suggests more widespread evaluation of balloon Sphincteroplasty should be considered for papillary stenosis.
Steven D Wexner - One of the best experts on this subject based on the ideXlab platform.
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Redo Sphincteroplasty: are the results sustainable?
2016Co-Authors: Kwang Dae Hong, Giovanna Dasilva, John T Dollerschell, David Maron, Steven D WexnerAbstract:Objective: This study aimed to investigate the long-term outcomes of patients who undergo redo Sphincteroplasty (RS). Methods: Patients with fecal incontinence (FI) who underwent RS between November 1988 and December 2011 were retro-spectively identified from a prospective database. A questionnaire and telephone survey assessed current Cleveland Clini
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redo Sphincteroplasty are the results sustainable
Gastroenterology Report, 2015Co-Authors: Kwang Dae Hong, Giovanna Dasilva, John T Dollerschell, David J Maron, Steven D WexnerAbstract:Objective: This study aimed to investigate the long-term outcomes of patients who undergo redo Sphincteroplasty (RS). Methods: Patients with fecal incontinence (FI) who underwent RS between November 1988 and December 2011 were retrospectively identified from a prospective database. A questionnaire and telephone survey assessed current Cleveland Clinic Fecal Incontinence Score (CCFFIS; best 0, worst 20) and Fecal Incontinence Quality of Life (FIQoL; best 4.1, worst 1) scale. Success was defined as no further continence surgery, no stoma and CCFFIS <9 at completion of follow-up. The Wilcoxon and Mann-Whitney U tests were used for comparing quantitative variables. Bivariate logistic regression analysis was done to identify predictive factors for success. Results: Fifty-six (66.7%) of 84 patients who underwent RS were available for evaluation at a median follow-up of 74 (range: 12–283) months. The mean CCFFIS decreased from 16.5 ± 3.7 to 11.9 ± 6.6 (P < 0.001) at last follow-up. Twelve patients (21.4%) underwent further continence surgery for failed Sphincteroplasty, three (5.4%) of whom had a permanent stoma. Eighteen patients (32.1%) had a CCFFIS <9 at the completion of follow-up, and 16 (28.6%) had long-term success. Twenty-four patients evaluated for FIQoL had a mean value of 2.6 (range: 1.0–4.1). Postoperative CCFFIS was correlated with FIQoL (Spearman’s correlation coefficient = −0.854, P < 0.001). Logistic regression analysis did not reveal any significant predictive variables for success of RS. Conclusion: Based on our criteria for success, the long-term success rate for RS over a median of 74 months is poor.
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suboptimal results after Sphincteroplasty another hazard of obesity
Techniques in Coloproctology, 2014Co-Authors: Kwang Dae Hong, Giovanna Dasilva, John T Dollerschell, Steven D WexnerAbstract:This study aimed to investigate the outcomes of Sphincteroplasty in obese patients. Patients with fecal incontinence (FI) who underwent sphincter repair were identified and divided into obese [body mass index (BMI) ≥ 30 kg/m2] and nonobese (BMI < 30 kg/m2) groups. Cleveland Clinic Florida FI Score (CCFFIS: 0 best and 20 worst) and FI quality of life (FIQoL) score (mean global FIQoL: 4.11 best and 1 worst) were recorded. Wilcoxon and Mann–Whitney U tests compared quantitative variables; Fisher’s exact test was used for categorical variables. Seventy-nine patients (78 females; mean age: 57 ± 15 years) were divided into obese (n = 15) and nonobese (n = 64) groups and were similar in age, etiology, physiologic parameters, and preoperative CCFFIS. Median follow-up was 64 (13–138) months. There were 3 (25 %) and 11 (17 %) complications in the obese and nonobese groups, respectively (p = 0.68), the most common being wound infection. Mean CCFFIS decreased from 16.0 ± 3.9 to 11.5 ± 6.5 in the obese (p < 0.001) and 16.2 ± 3.4 to 8.4 ± 5.0 in the nonobese groups (p < 0.001). Postoperative CCFFIS correlated with FIQoL (Spearman’s correlation coefficient = −0.738, p < 0.001). Nonobese patients had significantly higher CCFFIS improvement (48 vs. 28 % p = 0.04) and a superior mean global FIQoL score (2.19 ± 0.9 vs. 2.93 ± 0.8, p < 0.01). Four (29 %) obese and 11 (17 %) nonobese patients required further surgery after failed Sphincteroplasty (p = 0.45). Risk of complications and need of further continence surgery were similar between obese and nonobese patients. However, obese patients experienced less improvement after Sphincteroplasty.
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physiological and clinical outcome of anterior Sphincteroplasty
British Journal of Surgery, 2005Co-Authors: L Oliveira, J Pfeifer, Steven D WexnerAbstract:A total of 55 women underwent Sphincteroplasty for the treatment of faecal incontinence related to anterior defects. Patients were followed prospectively for a mean of 29 months to evaluate the outcome overall and according to age. All patients were evaluated clinically by means of a questionnaire and graded using an incontinence scoring system ranging from 0 (perfect continence) to 20 (complete incontinence). Some 52 patients (95 per cent) had had a previous vaginal delivery and 30 (55 per cent) had a history of previous anal sphincter repair. Physiological and functional parameters in patients with a successful outcome (n = 39) were compared with those in patients with a poor outcome (n = 16). The results were also compared in patients under (n = 39) and over (n = 16) 60 years of age. Overall, patients with a successful outcome had a significant change in mean and maximal resting and squeeze pressures. These changes correlated well with the increase in the high-pressure zone (HPZ) length from 1.0-2.2 cm (P = 0.0002) and with functional outcome (change in incontinence score from 15.3 to 5.8; P < 0.0001). In patients over 60 years of age, a significant change in mean squeeze pressure (P = 0.03) and HPZ length (P = 0.01) was noted and correlated with functional outcome (change in incontinence score from 14.3 to 6.4; P < 0.0001). A successful outcome after anterior Sphincteroplasty is related to improvement in sphincter function even in an older population. These results demonstrate that age itself does not seem to be a predictor of poor outcome. Patients should not be denied a repair exclusively on grounds of age.
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pudendal neuropathy is predictive of failure following anterior overlapping Sphincteroplasty
Diseases of The Colon & Rectum, 1998Co-Authors: Robert Gilliland, D F Altomare, Helio Moreira, L Oliveira, Janice Gilliland, Steven D WexnerAbstract:PURPOSE: This study assessed the efficacy of anterior overlapping Sphincteroplasty and parameters predictive of a successful outcome. METHODS: Clinical findings and physiologic investigations of female patients who underwent anterior overlapping Sphincteroplasty for fecal incontinence between 1988 and 1996 were reviewed. The extent of sphincter damage was assessed at needle electromyography as the number of quadrants exhibiting decreased motor unit potentials. Prolonged pudendal nerve terminal motor latencies were those of greater than 2.2 ms. The size of the endoanal ultrasound defect was assessed as degrees circumference of the external sphincter in which viable muscle was absent. Patients were reviewed by telephone questionnaire and were asked to grade the outcome of their surgery as excellent or good (success) or fair or poor (failure). Incontinence was graded using a scoring system of 0 (perfect continence) to 20 (complete incontinence). RESULTS: There were 100 patients who had an overlapping Sphincteroplasty; complete follow-up information was obtained for 77 patients at a median of 24 (range, 2–96) months. The median age was 47 (range, 25–80) years and they had a median duration of incontinence of four (range, 0.1–39) years. Prior Sphincteroplasty had been performed in 30 patients with a median of one (range, 1–7) operations. Investigations performed included electromyography (n=49), pudendal nerve terminal motor latency (n=71), endoanal ultrasound (n=49), and manometry (n=67). Sixty percent of patients had improved continence and 42 (55 percent) considered their surgery to have been successful as attested to by a significant decrease in their incontinence score (from 15.1±4.5 to 4.3±4.2;P<0.0001). Neither patient age, parity, prior Sphincteroplasty, cause or duration of incontinence, extent of electromyography damage, size of the endoanal ultrasound defect, nor any manometric parameter correlated with outcome. However, 62 percent of 59 patients with bilaterally normal pudendal nerve terminal motor latencies had a successful outcome compared with only 16.7 percent of 12 patients with unilateral or bilateral prolonged pudendal nerve terminal motor latencies (P<0.01). CONCLUSION: Bilateral normal pudendal nerve terminal motor latencies are the only factors predictive of long-term success after overlapping Sphincteroplasty.
Carlo Ratto - One of the best experts on this subject based on the ideXlab platform.
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fistulotomy with end to end primary Sphincteroplasty for anal fistula results from a prospective study
Diseases of The Colon & Rectum, 2013Co-Authors: Carlo Ratto, Francesco Litta, Angelo Parello, Lorenza Donisi, Giuseppe Zaccone, Veronica De SimoneAbstract:BACKGROUND:Fistulotomy plus primary Sphincteroplasty for complex anal fistulas is regarded with scepticism, mainly because of the risk of postoperative incontinence.OBJECTIVES:The aim of this study was to evaluate safety and effectiveness of this technique in medium-term follow up and to identify po
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sacral nerve stimulation is a valid approach in fecal incontinence due to sphincter lesions when compared to sphincter repair
Diseases of The Colon & Rectum, 2010Co-Authors: Carlo Ratto, Francesco Litta, Angelo Parello, Lorenza Donisi, Giovanni Battista DogliettoAbstract:PURPOSE:Anal sphincter lesions represent the major cause of fecal incontinence, particularly in women. Sphincteroplasty with overlap is the traditional treatment, but a significant reduction in benefits within 5 years of surgery has been reported. More recently, sacral nerve stimulation has been sug
Padraic Mac Mathuna - One of the best experts on this subject based on the ideXlab platform.
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The acute and long-term effect of balloon Sphincteroplasty on papillary structure in pigs
Gastrointestinal Endoscopy, 1996Co-Authors: Padraic Mac Mathuna, David Siegenberg, David Gibbons, Daniel Gorin, Michael J. O'brien, Nezem A. Afdhal, Ram ChuttaniAbstract:Abstract Background: Balloon dilation or Sphincteroplasty is emerging as a potentially safe and effective alternative to sphincterotomy in the management of bile duct stones. However, concerns related to the possible development of fibrosis or papillary stenosis led us to investigate the acute and long-term effects of balloon Sphincteroplasty on papillary structure. Methods: Sixteen pigs (45 to 50 kg) underwent transduodenal cannulation of the bile duct while under general anesthesia. Balloon Sphincteroplasty was performed in 10 pigs to a diameter of 8 mm at a pressure of 10 atm. Sphincterotomy was carried out in 3 pigs while 2 other untreated pigs acted as controls. Eleven animals were sacrificed at intervals from 15 to 120 minutes after balloon Sphincteroplasty or sphincterotomy. The remaining 5 animals were sacrificed between 6 and 12 weeks later. Histologic sections through the papilla were assessed for evidence of morphologic changes. Results: When compared with controls, sections taken 15 to 120 minutes after balloon Sphincteroplasty showed a progressive increase in acute inflammation extending transmurally. Intramucosal, but no transmural, hemorrhage was noted. No architectural distortion or smooth muscle disruption was observed in contrast to the transmural hemorrhage, smooth muscle disruption, and mucosal necrosis seen following sphincterotomy. After 6 to 12 weeks, mild chronic inflammation with follicular hyperplasia was present but no smooth muscle disruption or fibrosis was observed. Conclusion: Balloon Sphincteroplasty causes an acute transmural inflammatory response and chronic follicular hyperplasia but is not associated with fibrosis or altered papillary architecture. (Gastrointest Endosc 1996;44:650-5.)
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endoscopic balloon Sphincteroplasty papillary dilation for bile duct stones efficacy safety and follow up in 100 patients
Gastrointestinal Endoscopy, 1995Co-Authors: Padraic Mac Mathuna, P White, E Clarke, J Lennon, Raphael B Merriman, J CroweAbstract:Background Because sphincterotomy accounts for a major portion of the morbidity and mortality associated with ERCP, we have proposed endoscopic balloon papillary dilation or Sphincteroplasty as an alternative. Methods We report the outcome in a series of 100 patients in whom balloon Sphincteroplasty was attempted for bile duct stones up to 20 mm in diameter, with a median follow-up of 16 months (range 6 to 30). Results During one ERCP session using Sphincteroplasty alone, the bile duct was cleared in 78%, mechanical lithotripsy being required in 10% for stones greater than 12 mm in diameter. Incomplete duct clearance was achieved in a further 4%, all of whom underwent repeat ERCP with successful duct clearance without recourse to sphincterotomy. Failure to clear the bile duct with Sphincteroplasty in the remaining 18% was primarily related to large stone size ( > 15 mm). Sphincterotomy was required to clear the duct in 7%. Another 6% comprised elderly high-risk patients with multiple large stones greater than 15 mm who were treated by stent insertion plus ursodeoxycholic acid. No papillary hemorrhage was observed; uncomplicated pancreatitis occurred in 5%. During a median follow-up of 16 months, 2% had recurrent symptomatic bile duct stones considered to have been unrecognized following the initial ERCP: these were removed after repeat Sphincteroplasty. No clinical evidence of papillary stenosis was observed during follow-up. Conclusions Endoscopic balloon papillary dilation or Sphincteroplasty is a safe and effective alternative to sphincterotomy in the management of bile duct stones less than 12 mm; larger stones may require mechanical lithotripsy to facilitate duct clearance.
J Lennon - One of the best experts on this subject based on the ideXlab platform.
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endoscopic balloon Sphincteroplasty papillary dilation for bile duct stones efficacy safety and follow up in 100 patients
Gastrointestinal Endoscopy, 1995Co-Authors: Padraic Mac Mathuna, P White, E Clarke, J Lennon, Raphael B Merriman, J CroweAbstract:Background Because sphincterotomy accounts for a major portion of the morbidity and mortality associated with ERCP, we have proposed endoscopic balloon papillary dilation or Sphincteroplasty as an alternative. Methods We report the outcome in a series of 100 patients in whom balloon Sphincteroplasty was attempted for bile duct stones up to 20 mm in diameter, with a median follow-up of 16 months (range 6 to 30). Results During one ERCP session using Sphincteroplasty alone, the bile duct was cleared in 78%, mechanical lithotripsy being required in 10% for stones greater than 12 mm in diameter. Incomplete duct clearance was achieved in a further 4%, all of whom underwent repeat ERCP with successful duct clearance without recourse to sphincterotomy. Failure to clear the bile duct with Sphincteroplasty in the remaining 18% was primarily related to large stone size ( > 15 mm). Sphincterotomy was required to clear the duct in 7%. Another 6% comprised elderly high-risk patients with multiple large stones greater than 15 mm who were treated by stent insertion plus ursodeoxycholic acid. No papillary hemorrhage was observed; uncomplicated pancreatitis occurred in 5%. During a median follow-up of 16 months, 2% had recurrent symptomatic bile duct stones considered to have been unrecognized following the initial ERCP: these were removed after repeat Sphincteroplasty. No clinical evidence of papillary stenosis was observed during follow-up. Conclusions Endoscopic balloon papillary dilation or Sphincteroplasty is a safe and effective alternative to sphincterotomy in the management of bile duct stones less than 12 mm; larger stones may require mechanical lithotripsy to facilitate duct clearance.
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endoscopic Sphincteroplasty a novel and safe alternative to papillotomy in the management of bile duct stones
Gut, 1994Co-Authors: Mac P Mathuna, P White, E Clarke, J Lennon, J CroweAbstract:Removal of bile duct stones during endoscopic retrograde cholangiopancreatography (ERCP) usually includes papillotomy. Papillotomy is associated with occasional complications and in addition, the longterm sequelae of papillotomy in young patients having laparoscopic cholecystectomy remain unclear. As an alternative to papillotomy, this study prospectively evaluated the efficacy and safety of endoscopic balloon Sphincteroplasty to facilitate bile duct clearance. Of 32 patients with bile duct stones (diameter 3-30 mm) at ERCP, Sphincteroplasty was considered inappropriate in four patients because of stone size (> 20 mm) necessitating papillotomy for bile duct clearance. Sphincteroplasty was performed in the remaining 28 patients to permit duct clearance by dormier basket, balloon or mechanical lithotripsy. The bile duct was cleared in 22 patients (79%) while additional measures including papillotomy or stent insertion were required in the remaining six patients (21%) because of stone size or technical difficulties. There was no associated papillary haemorrhage. Pancreatitis was seen in one patient (4%) but resolved within 24 hours. Our preliminary experience suggests that Sphincteroplasty is a safe and effective sphincter preservation technique that significantly reduces the necessity for papillotomy in the management of bile duct stones.
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endoscopic balloon Sphincteroplasty for benign papillary stenosis an alternative to surgical or endoscopic papillotomy
Irish Journal of Medical Science, 1993Co-Authors: Mac P Mathuna, J Lennon, J CroweAbstract:Benign papillary stenosis is an uncommon but well recognised cause of recurrent biliary pain usually in post-cholecystectomy patients characterised by biliary dilatation without bile duct calculi or malignancy. Endoscopic or surgical papillotomy is the recommended treatment but may be associated with a higher complication rate than when performed for bile duct stones. We report 2 cases of papillary stenosis treated by endoscopic balloon dilatation or “Sphincteroplasty”, as a less traumatic intervention which improved biliary drainage and provided symptomatic relief. Our preliminary experience suggests more widespread evaluation of balloon Sphincteroplasty should be considered for papillary stenosis.