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de Vos tot Nederveen Cappel WH, Buskens E, van Duijvendijk P, Cats A, Menko FH, Griffioen G, Slors JF, Nagengast FM, Kleibeuker JH, Vasen HFA. Decision analysis in the surgical treatment of colorectal cancer due to a mismatch repair gene defect. Gut 2003; 52:1752-5. [PMID: 14633956 PMCID: PMC1773904 DOI: 10.1136/gut.52.12.1752] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND In view of the high risk of developing a new primary colorectal carcinoma (CRC), subtotal colectomy rather than segmental resection or hemicolectomy is the preferred treatment in hereditary non-polyposis colorectal cancer (HNPCC) patients. Subtotal colectomy however implies a substantial decrease in quality of life. To date, colonoscopic surveillance has been shown to reduce CRC occurrence. AIMS To compare the potential health effects in terms of life expectancy (LE) for patients undergoing subtotal colectomy or hemicolectomy for CRC. METHODS A decision analysis (Markov) model was created. Information on the 10 year risk of CRC after subtotal colectomy (4%) and hemicolectomy (16%) and stages of CRCs detected within a two year surveillance interval (32% Dukes' A, 54% Dukes' B, and 14% Dukes' C) were derived from two cohort studies. Five year survival rates used for the different Dukes stages (A, B, and C) were 98%, 80%, and 60%, respectively. Remaining LE values were calculated for hypothetical cohorts with an age at CRC diagnosis of 27, 47, and 67 years, respectively. Remaining LE values were also calculated for patients with CRC of Dukes' stage A. RESULTS The overall LE gain of subtotal colectomy compared with hemicolectomy at ages 27, 47, and 67 was 2.3, 1, and 0.3 years, respectively. Specifically for Dukes' stage A, this would be 3.4, 1.5, and 0.4 years. CONCLUSIONS Unless surveillance results improve, subtotal colectomy still seems the preferred treatment for CRC in HNPCC in view of the difference in LE. For older patients, hemicolectomy may be an option as there is no appreciable difference in LE.
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Dunker MS, Bemelman WA, Slors JF, van Duijvendijk P, Gouma DJ. Functional outcome, quality of life, body image, and cosmesis in patients after laparoscopic-assisted and conventional restorative proctocolectomy: a comparative study. Dis Colon Rectum 2001; 44:1800-7. [PMID: 11742165 DOI: 10.1007/bf02234458] [Citation(s) in RCA: 216] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study was to assess the functional outcome and the quality of life of laparoscopic-assisted ileal pouch-anal anastomosis compared with conventional ileal pouch-anal anastomosis. Further, body image and cosmesis were evaluated in both groups. METHODS Sixteen patients who underwent a laparoscopic-assisted ileal pouch-anal anastomosis between March 1996 and September 1999 were matched with 19 patients who had a conventional ileal pouch-anal anastomosis. Patients were matched for the time period after surgery, distribution of familial adenomatous polyposis/ulcerative colitis, and one/two-stage procedure. Thirty-two patients agreed to fill out a set of questionnaires that assessed functional outcome, quality of life, body image, and cosmesis. Quality of life was measured with the Short Form 36 Health Survey questionnaire and the Gastrointestinal Quality of Life Index. The Body Image Questionnaire was used to measure patients' perceptions of and satisfaction with their own body and their attitude toward their bodily appearance (body image) and the degree of satisfaction of patients with respect to the physical appearance of the scar (cosmesis). RESULTS Patients in the conventional group were older than patients in the laparoscopic-assisted group (mean 39.2 +/- 8.4 vs. 30.6 +/- 7.1 years; P < 0.01). No differences were found in functional outcome and quality of life. Satisfaction with the cosmetic result of the scar was significantly higher in the laparoscopic-assisted group compared with the conventional group. Body image score was higher in the laparoscopic-assisted group when compared with the conventional group, although not significant. CONCLUSIONS The functional outcome and quality of life of laparoscopic-assisted ileal pouch-anal anastomosis is not different from conventional ileal pouch-anal anastomosis. In the long-term, better cosmesis is the most important advantage after laparoscopic surgery.
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Affiliation(s)
- M S Dunker
- Department of Surgery, Academic Medical Center, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands
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Abstract
CD4+ T lymphocytes in the lamina propria (LP) of the gut play a central role in the immune response in inflammatory bowel disease (IBD). CXCR3 is a chemokine receptor expressed on activated T lymphocytes, and a key component for the recruitment of T helper (Th1) effector cells to the site of inflammation. To determine if CXCR3 is involved in localization of T cells to the gut in IBD patients, we investigated the expression of CXCR3 on CD4+ T lymphocytes in the LP and in the submucosa of resection specimens from 51 IBD patients and 15 control patients. Positive cells were microscopically scored using a semiquantitative analysis on a five-point scale. We found that CD4+ T cells, CXCR3+ cells, and CD4+CXCR3+ T cells in the LP were slightly increased in both IBD groups compared with control non-IBD specimens. In addition, CD4+ and CXCR3+ cells in the submucosa were significant increased in the CD group compared with the control group. CD4+ and CXCR3+ expression was not statistically different between CD and UC. Flow cytometry was used to analyze the percentage of CXCR3+ cells within the CD4+ T-cell population isolated from biopsy specimens and peripheral blood from IBD patients and control patients. There was no difference in the percentage of CD4+CXCR3+ cells between the different groups in the gut as well as in the circulation. These results suggest that CD4+CXCR3+ T cells migrate to the normal and inflamed intestinal mucosa, indicating a role in maintaining normal gut homeostasis. The selective expression of CXCR3+ cells in the submucosa of CD patients might also indicate that these cells play a role in inflammation.
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Affiliation(s)
- Y H Yuan
- Laboratory of Experimental Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
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Dunker MS, Bemelman WA, Slors JF, van Hogezand RA, Ringers J, Gouma DJ. Laparoscopic-assisted vs open colectomy for severe acute colitis in patients with inflammatory bowel disease (IBD): a retrospective study in 42 patients. Surg Endosc 2000; 14:911-4. [PMID: 11080402 DOI: 10.1007/s004640000262] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) can be complicated by severe acute colitis. Emergency colectomy is mandatory if patients do not respond to intensive medical therapy. A minimally invasive approach such as laparoscopic-assisted colectomy might be beneficial in these patients. Therefore, we set out to assess the feasibility and the safety of emergency laparoscopic-assisted colectomy in IBD patients with severe acute colitis. METHODS A total of 42 consecutive patients underwent an emergency colectomy with end-ileostomy. Ten patients had laparoscopic-assisted colectomy, and 32 had open colectomy. Pre- and perioperative parameters, morbidity, and mortality were analyzed. RESULTS The two groups were comparable for patient characteristics. There were no conversions in the laparoscopic group. The operation time was longer in the laparoscopic group than in the open group (271 vs 150 min; p < 0.001), but the hospital stay was shorter (14.6 vs 18.0 days; p = 0.05). Complications were similar for the two groups. CONCLUSION Laparoscopic-assisted colectomy in IBD patients with severe acute colitis is feasible and as safe as open colectomy.
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Affiliation(s)
- M S Dunker
- Department of Surgery, Academic Medical Center, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands
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Bemelman WA, Slors JF, Dunker MS, van Hogezand RA, van Deventer SJ, Ringers J, Griffioen G, Gouma DJ. Laparoscopic-assisted vs. open ileocolic resection for Crohn's disease. A comparative study. Surg Endosc 2000; 14:721-5. [PMID: 10954817 DOI: 10.1007/s004640000186] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The objective of this study was to compare laparoscopic-assisted ileocolic resection for Crohn's disease of the distal ileum with open surgery in two consecutive groups of patients. METHODS From 1995 until 1998, 48 patients underwent open ileocolic resection at the Academic Medical Center (AMC) in Amsterdam, while 30 patients had laparoscopic-assisted ileocolic resection at the Leiden University Medical Center (LUMC). Patient characteristics, perioperative course, and recovery were compared. Differences between the groups were tested using Student's t-test for independent groups and chi-square tests when appropriate. RESULTS The open and the laparoscopic patient groups were comparable for age, gender, body mass index (BMI), prior abdominal surgery, and length of resected bowel. The conversion rate was 6.6%. Laparoscopic operating times (138+/-SD 36 min) were significantly longer than those observed in the open group (104+/-SD 34 min). Discharge was significantly earlier in the laparoscopic group than the open group (5.7 vs 10.2 postoperative days, p<0.007). Postoperative morbidity did not differ significantly between the patients treated traditionally (14.6%) and laparoscopically (10%). CONCLUSION Compared to open surgery, laparoscopic ileocolic resection for Crohn's disease is associated with similar morbidity rates, a shorter hospital stay, and improved cosmetic results, justifying the laparoscopic approach as the procedure of choice.
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Affiliation(s)
- W A Bemelman
- Department of Surgery, Leiden University Medical Center (LUMC), Amsterdam, The Netherlands
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van Duijvendijk P, Slors JF, Taat CW, van Lochem LT, Bonsel GJ, de Vries JW, Obertop H. What is the benefit of preoperative sperm preservation for patients who undergo restorative proctocolectomy for benign diseases? Dis Colon Rectum 2000; 43:838-42. [PMID: 10859086 DOI: 10.1007/bf02238024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE In patients with benign colorectal diseases undergoing a restorative proctocolectomy with an ileal pouch-anal anastomosis, semen cryopreservation seems rational to enable the possibility of procreation in case surgery leads to sexual disorders or impotence. The aim of this study was to determine the preoperative and postoperative semen quality in patients undergoing ileal pouch-anal anastomosis. In addition, the study sought to determine the incidence of surgery-induced sexual dysfunction to evaluate the economic efficiency of semen cryopreservation as compared with alternatives such as microsurgical epididymal sperm aspiration. METHODS Preoperative and postoperative semen analyses were offered to 97 patients with ileal pouch-anal anastomosis with benign colorectal diseases since 1989. The direct costs of the semen cryopreservation program were determined and compared with those of alternatives. RESULTS In 34 of 40 consecutive patients with ileal pouch-anal anastomosis who made use of preoperative semen preservation, normal sperm concentrations, motility, and morphology were found. Mean semen characteristics of all 23 patients who returned for postoperative analysis were not different from preoperative values, but they were for total sperm number. Two patients developed temporary retrograde ejaculation postoperatively. None of the preserved semen samples was used, thus semen cryopreservation benefited none of these patients. The total costs of semen cryopreservation are between 2.2 and 5 times higher than the costs for one microsurgical epididymal sperm aspiration procedure. CONCLUSIONS Preoperative semen cryopreservation in patients undergoing ileal pouch-anal anastomosis because of benign colorectal diseases is quite feasible. However, most likely because of improved surgical techniques and the increasing number of effective alternatives, preoperative semen cryopreservation in patients with ileal pouch-anal anastomosis is no longer cost effective.
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Affiliation(s)
- P van Duijvendijk
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Van Duijvendijk P, Slors JF, Taat CW, Oosterveld P, Sprangers MA, Obertop H, Vasen HF. Quality of life after total colectomy with ileorectal anastomosis or proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis. Br J Surg 2000; 87:590-6. [PMID: 10792315 DOI: 10.1046/j.1365-2168.2000.01442.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Knowledge of postoperative health status is important in decision-making about the type of operation necessary in patients with familial adenomatous polyposis (FAP). This study compared the quality of life (QoL) between patients with an ileorectal anastomosis (group 1) and those with an ileal pouch-anal anastomosis (group 2). METHODS QoL was assessed with both a generic questionnaire (Short Form-36 Health Survey; SF-36) and a disease-specific questionnaire (European Organization for Research and Treatment of Cancer Colorectal QoL Questionnaire; EORTC QLQ-CR38). The SF-36 consists of 36 items representing eight generic health domains, and the EORTC QLQ-CR38 comprises 38 items representing disease-specific health domains. Both questionnaires were distributed among 323 patients with FAP known at the Dutch Polyposis Registry who had previously undergone either operation. The results of the SF-36 were compared with the scores of age- and sex-matched respondents from the general population. RESULTS Some 279 patients (86 per cent), 161 in group 1 and 118 in group 2, completed the questionnaire. Generic and disease-specific QoL was the same for groups 1 and 2. The SF-36 scores of both groups were significantly lower than those of the general population. CONCLUSION There were no differences with respect to health status between patients in groups 1 and 2, and preference for either procedure cannot be based on QoL.
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Affiliation(s)
- P Van Duijvendijk
- Departments of Surgery and Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands
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van Duijvendijk P, Slors JF, Taat CW, Bemelman WA, van Lochem LT. [Proctocolectomy with an ileal pouch-anal anastomosis; results from 100 consecutive patients in the Academic Medical Center at Amsterdam, 1994-1999]. Ned Tijdschr Geneeskd 2000; 144:612-6. [PMID: 10761550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To evaluate the results of proctocolectomy with creation of an ileac pouch anal anastomosis (IPAA). DESIGN Retrospective. METHOD Of the 100 patients in whom an IPAA procedure was performed in the period 1994/'99 in the Department of Surgery of the Academic Medical Centre, Amsterdam, the Netherlands, data were collected on the complications: in the patients with a follow-up of over 12 months the functional results were studied. RESULTS The group comprised 48 males and 52 females with a mean age of 36.3 years (range: 15-62). Preoperative diagnoses were ulcerative colitis (n = 84), familial polyposis coli (12), slow transit obstipation (2), Hirschsprung's disease (1) and Muir-Torre syndrome (1). Median operating time was 2.3 h, peroperative blood and fluid loss 500 ml and median hospital stay 15 days. There was no mortality. Ten patients had a loop ileostomy formation, in 6 because of postoperative complications. A total of 30 patients developed postoperative complications, peroperatively or during follow-up 10 of those patients needed a relaparotomy. After 12 months 1 pouch had to be excised and 2 patients still had a loop ileostomy due to postoperative complications. In 56 patients with at least 12 months follow-up, median 24-hour stool frequency was 6. Eighty-nine per cent of these patients were satisfied or highly satisfied with the overall outcome. CONCLUSION A proctocolectomy with IPAA formation is a safe procedure with good functional results.
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van Duijvendijk P, Slors JF, Taat CW, Oosterveld P, Vasen HF. Functional outcome after colectomy and ileorectal anastomosis compared with proctocolectomy and ileal pouch-anal anastomosis in familial adenomatous polyposis. Ann Surg 1999; 230:648-54. [PMID: 10561088 PMCID: PMC1420918 DOI: 10.1097/00000658-199911000-00006] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare the long-term functional results of ileorectal anastomosis (IRA) with those of ileal pouch-anal anastomosis (IPAA) in patients with familial adenomatous polyposis (FAP). SUMMARY BACKGROUND DATA In patients with FAP, hundreds of colorectal adenomas develop, and the patient will die of colorectal cancer if left untreated. The surgeon must choose between colectomy with IRA and restorative proctocolectomy with IPAA. One factor crucial to decision making is the functional outcome after either procedure. To date, studies on this issue have reported conflicting results and have been based on small series of patients. METHODS To assess various functional variables, a questionnaire was sent to 323 patients with FAP who underwent either IRA or IPAA and who were registered at the Netherlands Foundation for the Detection of Hereditary Tumors. The overall response rate was 86%; the responders comprised 161 patients who underwent IRA and 118 patients who underwent IPAA. RESULTS Patients who underwent IRA scored significantly better for daytime and nighttime stool frequency, soiling, occasional passive incontinence, flatus and feces discrimination, stool consistency, and need for antidiarrheal medication. There was no difference with regard to perianal irritation, episodes of bowel discomfort, or dietary restrictions. The functional results according to the aggregate score of the Gastro-Intestinal Functional Outcome Scale, where the items specified above were integrated (0 indicating a poor and 100 a good overall function), were significantly better in patients with an IRA (74.5) than in patients with an IPAA (66.0) (p < 0.01). CONCLUSION The functional outcome after IRA is significantly better than after IPAA. On the basis of these results, IRA might still be considered in patients with a mild phenotypic expression of the disease in the rectum.
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Affiliation(s)
- P van Duijvendijk
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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Keulemans YC, Mok KS, Slors JF, Brink MA, Gouma DJ, Tytgat GN, Groen AK. Concanavalin A-binding cholesterol crystallization inhibiting and promoting activity in bile from patients with Crohn's disease compared to patients with ulcerative colitis. J Hepatol 1999; 31:685-91. [PMID: 10551393 DOI: 10.1016/s0168-8278(99)80349-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND/AIMS Crohn's disease is a risk factor for gallstone formation. In contrast, patients with ulcerative colitis have an incidence of gallstone formation comparable to the general population. The reason for this difference is not known. The aim of this study was to elucidate the factors controlling cholesterol crystallization in gallbladder bile of Crohn's disease and ulcerative colitis patients. METHODS Gallbladder bile was obtained by aspiration during bowel resections (26 Crohn's disease patients, 20 ulcerative colitis patients). Biliary lipid composition, crystal detection time and the effect of extraction of the concanavalin A-binding fraction on crystal formation were determined. RESULTS Cholesterol crystals were present in seven of the 26 bile samples of Crohn's disease-patients and one of the 20 ulcerative colitis patients. Four of the bile samples of Crohn's disease patients were fast nucleating. None of the 20 ulcerative colitis patients had fast nucleating bile. Lipid composition, total lipid concentration and CSI were not significantly different between the two groups. In Crohn's disease patients extraction of concanavalin A-binding fraction decreased crystallization in 10 bile samples but accelerated crystallization in one bile sample. In eight bile samples from ulcerative colitis patients crystallization increased after concanavalin A-binding fraction extraction. CONCLUSIONS Compared to ulcerative colitis patients, gallbladder bile of Crohn's disease patients showed increased cholesterol crystallization despite comparable lipid composition and cholesterol saturation index. This difference is caused by increased cholesterol crystallization-promoting activity. Bile from ulcerative colitis patients contains a Con A-binding factor which inhibits cholesterol crystallization.
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Affiliation(s)
- Y C Keulemans
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Slors JF, Bemelman WA, van Duijvendijk P. [Surgical treatment of ulcerative colitis and familial adenomatous polyposis: recent developments]. Ned Tijdschr Geneeskd 1999; 143:1490; author reply 1491. [PMID: 10443265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Brink MA, Slors JF, Keulemans YC, Mok KS, De Waart DR, Carey MC, Groen AK, Tytgat GN. Enterohepatic cycling of bilirubin: a putative mechanism for pigment gallstone formation in ileal Crohn's disease. Gastroenterology 1999; 116:1420-7. [PMID: 10348826 DOI: 10.1016/s0016-5085(99)70507-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Patients with ileal disease, bypass, or resection are at increased risk for developing gallstones. In ileectomized rats, bilirubin secretion rates into bile are elevated, most likely caused by increased colonic bile salt levels, which solubilize unconjugated bilirubin, prevent calcium complexing, and promote its absorption and enterohepatic cycling. The hypothesis that ileal disease or resection engenders the same pathophysiology in humans was tested. METHODS Sterile gallbladder bile samples were obtained intraoperatively from 29 patients with Crohn's disease and 19 patients with ulcerative colitis. Bilirubin, total calcium, biliary lipids, beta-glucuronidase activities, and cholesterol saturation indices in bile were measured, and markers of hemolysis and ineffective erythropoiesis in blood were assessed. RESULTS Bilirubin conjugates, unconjugated bilirubin, and total calcium levels were increased 3-10-fold in bile of patients with ileal disease and/or resection compared with patients with Crohn's colitis or ulcerative colitis. Biliary bilirubin concentrations correlated positively with the anatomic length and duration of ileal disease. Endogenous biliary beta-glucuronidase activities were comparable in all groups, and both the hemogram and serum vitamin B12 levels were normal. CONCLUSIONS This study establishes that increased bilirubin levels in bile of patients with Crohn's disease are caused by lack of functional ileum, supporting the hypothesis that enterohepatic cycling of bilirubin occurs.
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Affiliation(s)
- M A Brink
- Department of Gastrointestinal and Liver Diseases, Academic Medical Center, Amsterdam, The Netherlands.
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van Duijvendijk P, Vasen HF, Bertario L, Bülow S, Kuijpers JH, Schouten WR, Guillem JG, Taat CW, Slors JF. Cumulative risk of developing polyps or malignancy at the ileal pouch-anal anastomosis in patients with familial adenomatous polyposis. J Gastrointest Surg 1999; 3:325-30. [PMID: 10481126 DOI: 10.1016/s1091-255x(99)80075-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Restorative proctocolectomy with an ileal pouch-anal anastomosis is performed in an increasing number of patients with familial adenomatous polyposis (FAP). Two techniques are currently used to construct an ileal pouch-anal anastomosis: (1) a double-stapled anastomosis between the pouch and the anal canal and (2) mucosectomy with a hand-sewn ileoanal anastomosis at the dentate line. Although this procedure is thought to abolish the risk of colorectal adenoma, an increasing number of case reports have been published concerning the development of adenoma at the anastomotic site. The purpose of this study was to evaluate the overall cumulative risk of developing adenomatous polyps after ileal pouch-anal anastomosis and to compare the cumulative risk after either anastomotic technique. A total of 126 consecutive FAP patients undergoing a restorative proctocolectomy were identified from polyposis registries in The Netherlands, Denmark, Italy, Germany, and New York. Life-table analysis was used to calculate the cumulative risk of developing polyps in 97 patients with at least 1 year of endoscopic follow-up (median 66 months, range 12 to 188 months). A double-stapled anastomosis was used in 35 patients, whereas in 62 patients a hand-sewn anastomosis with a mucosectomy was performed. In 13 patients polyps developed at the anastomotic site, four with severe and four with moderate dysplasia. None of the patients developed a carcinoma at the anastomotic site. The cumulative risk of developing a polyp at the anastomotic site was 8% (95% confidence interval 2% to 14%) at 3.5 years and 18% (95% confidence interval 8% to 28%) at 7 years, respectively. The risk of developing a polyp at the anastomotic site within 7 years was 31% for patients with a double-stapled vs. 10% for patients with a hand-sewn anastomosis with mucosectomy (P = 0.03 [log-rank test]). Because FAP patients undergoing a restorative proctocolectomy with either a double-stapled or hand-sewn anastomosis have a substantial risk of developing adenomatous polyps at the anastomotic site, lifelong endoscopic surveillance is mandatory in both groups.
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Affiliation(s)
- P van Duijvendijk
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
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Vasen HF, Bülow S, Myrhøj T, Mathus-Vliegen L, Griffioen G, Buskens E, Taal BG, Nagengast F, Slors JF, de Ruiter P. Decision analysis in the management of duodenal adenomatosis in familial adenomatous polyposis. Gut 1997; 40:716-9. [PMID: 9245923 PMCID: PMC1027194 DOI: 10.1136/gut.40.6.716] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients with familial adenomatous polyposis are not only at high risk of developing adenomas in the colorectum but a substantial number of patients also develop polyps in the duodenum. Because treatment of duodenal polyps is extremely difficult and it is unknown how many patients ultimately develop duodenal cancer, the value of surveillance of the upper digestive tract is uncertain. AIMS (1) To assess the cumulative risk of duodenal cancer in a large series of polyposis patients. (2) To develop a decision model to establish whether surveillance would lead to increased life expectancy. METHODS Risk analysis was performed in 155 Dutch polyposis families including 601 polyposis patients, and 142 Danish families including 376 patients. Observation time was from birth until date of last contact, death, diagnosis of duodenal cancer, or closing date of the study. RESULTS Seven Dutch and five Danish patients developed duodenal cancer. The lifetime risk of developing this cancer by the age of 70 was 4% (95% confidence interval 1-7%) in the Dutch series and 3% (95% confidence interval 0-6%) in the Danish series. Decision analysis showed that surveillance led to an increase in life expectancy by seven months. CONCLUSIONS Surveillance of the upper digestive tract led to a moderate gain in life expectancy. Future studies should evaluate whether this increase in life expectancy outweighs the morbidity of endoscopic examination and proximal pancreaticoduodenectomy.
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Affiliation(s)
- H F Vasen
- The Netherlands Foundation for the Detection of Hereditary Tumours, Leiden, The Netherlands
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Vasen HF, van der Luijt RB, Slors JF, Buskens E, de Ruiter P, Baeten CG, Schouten WR, Oostvogel HJ, Kuijpers JH, Tops CM, Meera Khan P. Molecular genetic tests as a guide to surgical management of familial adenomatous polyposis. Lancet 1996; 348:433-5. [PMID: 8709782 DOI: 10.1016/s0140-6736(96)01340-2] [Citation(s) in RCA: 131] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In familial adenomatous polyposis the only curative treatment is colectomy, and the choice of operation lies between restorative proctocolectomy (RPC) and colectomy with ileorectal anastomosis (IRA). The RPC procedure carries a higher morbidity but, unlike IRA, removes the risk of subsequent rectal cancer. Since the course of familial adenomatous polyposis is influenced by the site of mutation in the polyposis gene, DNA analysis might be helpful in treatment decisions. METHODS We evaluated the incidence of rectal cancer in polyposis patients who had undergone IRA, and examined whether the requirement for subsequent rectal excision because of cancer or uncontrollable polyps was related to the site of mutation. FINDINGS Between 1956 and mid-1995, 225 patients registered at the Netherlands Polyposis Registry had undergone IRA. In 87 of them, a pathogenetic mutation was detected. 72 patients had a mutation located before codon 1250 and 15 patients after this codon. The cumulative risk of rectal cancer 20 years after surgery was 12%, and at that time 42% had undergone rectal excision. The risk of secondary surgery was higher in patients with mutations in the region after codon 1250 than in patients with mutations before this codon (relative risk 2.7, p < 0.05). INTERPRETATION On this evidence, IRA should be the primary treatment for polyposis in patients with mutations before codon 1250, and RPC in those with mutations after this codon.
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Affiliation(s)
- H F Vasen
- The Netherlands Foundation for the Detection of Hereditary Tumours, University Hospital, Leiden, Netherlands
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17
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Consten EC, Slors JF, Danner SA, Sars PR, Obertop H, Van Lanschot JJ. Severe complications of perianal sepsis in patients with human immunodeficiency virus. Br J Surg 1996; 83:778-80. [PMID: 8696738 DOI: 10.1002/bjs.1800830616] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Fifty human immunodeficiency virus (HIV)-infected patients with perianal sepsis were studied. Seven (14 per cent) had serious septic complications, four patients with severe necrotizing gangrene, and three with abscesses in the mediastinum, liver and brain respectively. CD4+ lymphocyte counts were significantly lower in patients with severe septic complications as compared with those with uncomplicated perianal sepsis (P < 0.05). In patients with HIV presenting with rare (metastatic) abscesses, perianal sepsis must always be kept in mind as a possible focus. Although HIV-infected patients have a limited life expectancy perianal fistulas and abscesses should be aggressively treated, because of the high risk of severe complications.
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Affiliation(s)
- E C Consten
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
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18
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de Jong E, van Dullemen HM, Slors JF, Dekkers P, van Deventer SJ, Tytgat GN. Correlation between early recurrence and reoperation after ileocolonic resection in Crohn's disease: a prospective study. J Am Coll Surg 1996; 182:503-8. [PMID: 8646350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The medical and surgical treatment of patients with Crohn's disease is directed at reducing symptoms and postponing recurrence. In the determination of high-risk groups for surgical recurrence after ileocolonic resection, the role of early endoscopic evaluation is unclear. STUDY DESIGN We investigated the relationship between early recurrence detected endoscopically and recurrence detected by operation in a prospective study of 60 patients, who underwent ileocolonic resection for Crohn's disease. RESULTS Recurrence detected endoscopically was found in 44 patients (73 percent) according to definition I (presence of any lesion detected endoscopically that was compatible with Crohn's disease) and in 21 patients (35 percent) according to definition II (five or more aphthous lesions present in the neoterminal ileum or at the anastomotic site, or 25 percent or more of the intestinal circumference inflamed). Recurrence detected surgically was found in 14 patients (23 percent). No correlation between early recurrence detected endoscopically and recurrence detected surgically was evident. CONCLUSIONS Early recurrence detected endoscopically did not predict recurrence detected surgically.
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Affiliation(s)
- E de Jong
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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19
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Consten EC, Slors JF, Danner SA, Offerhaus GJ, Bartelsman JF, Van Lanschot JJ. Local excision and mucosal advancement for anorectal ulceration in patients infected with human immunodeficiency virus. Br J Surg 1995; 82:891-4. [PMID: 7648098 DOI: 10.1002/bjs.1800820710] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In patients infected with human immunodeficiency virus (HIV) no effective surgical procedure has been described for anorectal ulceration that is resistant to medical therapy. This study was designed to determine the effectiveness of surgical excision of anorectal ulcers, with or without mucosal advancement. The medical records of patients with HIV and anorectal pathology diagnosed between 1984 and 1994 were reviewed. Patients with anorectal ulcers were divided into group A which was treated only with excision and group B in which excision was combined with mucosal advancement. Surgical treatment was considered successful if relief of symptoms was achieved within 4 weeks of the operation. Excision of anorectal ulcers was successful in seven of 16 patients (44 per cent) in group A. Relief of symptoms was achieved in 12 of 13 patients (92 per cent) in group B when surgical excision was combined with mucosal advancement, which is significantly better than the results in group A (P = 0.02). This non-randomized study indicates that after unsuccessful medical treatment persistent symptomatic ulcers should be treated operatively by excision with mucosal advancement.
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Affiliation(s)
- E C Consten
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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20
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Bemelman WA, Taat CW, Slors JF, van Lanschot JJ, Obertop H. Delayed postoperative emptying after esophageal resection is dependent on the size of the gastric substitute. J Am Coll Surg 1995; 180:461-4. [PMID: 7719551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Delayed emptying of the gastric substitute is a common problem after resection and reconstruction of the esophagus. The occurrence of postoperative delayed gastric emptying in patients undergoing resection and reconstruction of the esophagus was studied with regard to the type and size of gastric substitute and the execution of a pyloroplasty. STUDY DESIGN From 1983 to 1994, one hundred fifty-five patients underwent resection of the esophagus, with a hospital mortality rate of 7 percent. The inability to resume a diet of solid food within one week after a normal esophagography was defined as delayed gastric emptying. One hundred forty patients were studied; group 1, substitution with whole stomach with (1a, n = 9) and without (1b, n = 31) pyloroplasty; group 2, substitution with distal two-thirds stomach with (2a, n = 20) or without (2b, n = 45) pyloroplasty; and group 3, tubulized stomach without pyloroplasty (n = 35). RESULTS Delayed gastric emptying was seen in 38 percent (15 of 40) of patients in group 1 (1a, 44 percent; 1b, 37 percent), in 14 percent (nine of 65) of patients in group 2 (1a, 10 percent; 2b, 15 percent), and in 3 percent (one of 35) of patients in group 3. The differences between patients in group 1 and group 2, and between patients in group 1 and group 3 were significantly different (p < 0.05). CONCLUSIONS The type of gastric remnant used for reconstruction is an important determinant of postoperative gastric emptying. Pyloroplasty does not prevent delayed gastric emptying after esophageal substitution.
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Affiliation(s)
- W A Bemelman
- Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands
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21
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Consten EC, van Lanschot JJ, Henny CP, Slors JF, Danner SA, Brummelkamp WH. General operative aspects of human immunodeficiency virus infection and acquired immunodeficiency syndrome. J Am Coll Surg 1995; 180:366-80. [PMID: 7874352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- E C Consten
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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22
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Slors JF, Ponson AE, Taat CW, Bosma A. Risk of residual rectal mucosa after proctocolectomy and ileal pouch-anal reconstruction with the double-stapling technique. Postoperative endoscopic follow-up study. Dis Colon Rectum 1995; 38:207-10. [PMID: 7851179 DOI: 10.1007/bf02052453] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE This study was designed to assess the risk of retained rectal mucosa after proctocolectomy and ileal pouch-anal anastomosis with the double-stapling technique. METHODS A total of 113 patients underwent proctocolectomy with an ileal pouch-anal reconstruction. In 57 patients the anastomosis between pouch and proximal anal canal was performed using the double-stapling technique. In 26 patients the procedure was carried out without a protecting ileostomy. Of the remaining 31 patients with a proximal ileostomy, 15 underwent endoscopy six weeks postoperatively. Circular biopsies were taken just distal from the pouch-anal anastomosis. RESULTS Histologic examination revealed rectal mucosa in at least one biopsy in 7 of 15 patients. At follow-up (mean 18 months) no (distal) pouchitis was clinically noticed. In one patient with familial polyposis, a few polyps, distal of the anastomosis, had to be endoscopically removed. CONCLUSIONS Double-stapled ileal pouch-anal anastomosis has a considerable risk of residual rectal mucosa, because of combined linear transection and circular stapling with bilateral dog-ear formation of rectal mucosa. Residual rectal mucosa did not seem to influence clinical results at follow-up.
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Affiliation(s)
- J F Slors
- Department of Surgery, University of Amsterdam, The Netherlands
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23
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Slors JF, Taat CW. Ileal pouches: technical aspects of the pouch-anal anastomosis. Ann Ital Chir 1994; 65:455-8. [PMID: 7733567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- J F Slors
- Department of Surgery, University of Amsterdam, The Netherlands
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24
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Sars PR, Slors JF, Taat CW. [Surgical treatment of anorectal disorders in 32 HIV-seropositive patients]. Ned Tijdschr Geneeskd 1994; 138:1227-30. [PMID: 8015620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To describe the presentation and surgical treatment of anorectal pathology in HIV seropositive patients. DESIGN Retrospective study. SETTING Department of surgery, University Medical Centre, Amsterdam, the Netherlands. METHODS Retrospective review of the records of 32 HIV seropositive patients surgically treated for anorectal pathology in 1985-1992. RESULTS The 32 patients, homosexual males, had a total of 46 diagnoses for which they underwent 49 surgical interventions. Sixteen patients had an anorectal ulcer (14 in the anal canal, 2 in the distal rectum); 7 were treated by local excision and 9 with additional advancement of the anal mucosa; there were 4 and 2 recurrences, respectively. Ten patients had a perianal abscess; 5 a fistula, 2 of whom initially presented with a metastatic abscess in liver and brain. Eight patients had perianal warts, which in 2 cases showed severe dysplasia and in one an infiltrating carcinoma. Five patients presented primarily with a malignancy (3 with squamous cell carcinoma of the anus, 1 with cloacogenic carcinoma, 1 with non-Hodgkin lymphoma distally in the rectum). Twelve patients died within 6 months after the first operation. CONCLUSION In choosing therapy for anorectal disorders, the limited survival of HIV seropositive patients, especially those with an advanced stage of AIDS should be considered. Surgical treatment can improve the quality of life in these patients.
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Affiliation(s)
- P R Sars
- Academisch Medisch Centrum, afd. Chirurgie, Amsterdam
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25
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Taat CW, van Toor BS, Slors JF, Bras J, Blank LE, van Coevorden F. Dermal angiosarcoma of the breast: a complication of primary radiotherapy? Eur J Surg Oncol 1992; 18:391-5. [PMID: 1521634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 70-year-old female developed recurrent disease following radiotherapy for primary inoperable breast cancer 5.5 years previously. Salvage mastectomy was performed. Pathology revealed recurrent breast cancer, along with a second primary malignancy, a dermal angiosarcoma. Radical excision of recurrent angiosarcoma failed. Irradiation combined with hyperthermia showed good palliation. The angiosarcoma's possible relation to the initial radiotherapy is discussed.
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Affiliation(s)
- C W Taat
- Department of Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands
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26
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van Gulik TM, Taat CW, Slors JF, Bras J, Blank LE, Bakker PJ, Kromhout JG, Brummelkamp WH. Leiomyosarcoma of large and small veins: clinical findings and results of treatment in six patients. Eur J Surg Oncol 1991; 17:125-34. [PMID: 2015919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Vascular leiomyosarcomas are rare malignant tumours originating from the media of the vessel wall. Six patients (five women and one man, aged 44-66 years) have been treated for a vascular leiomyosarcoma located in the inferior vena cava (three patients), the suprarenal, the external iliac and an antecubital vein. In four patients, the tumour was large and extended beyond the vessel wall giving rise to a retroperitoneal mass. In two patients the tumour was confined to the inner wall of respectively a large and small vein, occluding the lumen; the former was in the inferior vena cava and the latter in an antecubital vein. Block resection was performed in all patients. The tumours showed mitotic indices ranging from 6-32 mitoses/10 high power fields. The five patients with retroperitoneal tumours received additional radiotherapy varying from 50.00-70.00 Gy, on the basis of either macroscopic residual tumour or indefinite radicality. One of these five patients developed distant metastases within 2.5 years without local recurrence, the other four had no evidence of recurrence at follow-up, 3-7 years (mean 4.2 years) after surgery. The results illustrate the role of adjuvant radiotherapy in the control of local recurrence, when resection in this type of tumour proves to be either non-radical or totally radical.
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Affiliation(s)
- T M van Gulik
- Department of Surgery, University of Amsterdam, The Netherlands
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27
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Slors JF, Pietroletti R, Bemelman WA, Schipper ME, Klopper PJ, Brummelkamp WH. What happens to the rectal muscular cuff? An experimental study in dogs. Eur Surg Res 1991; 23:108-13. [PMID: 1936079 DOI: 10.1159/000129142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The anatomy and histology of the rectal muscular cuff was studied in 15 dogs with an ileal pouch-anal anastomosis. Eight channel, three-dimensional anal manometry showed normal maximal squeeze pressure (128 +/- 20 mm Hg) compared to a control group (135 +/- 4 mm Hg). The rectal muscular cuff showed complete absence of the cuff in three cases. In 12 dogs, the rectal cuff was retracted to a length of less than 1 cm, the muscle fibers were degenerated and fibrotic. The results in the canine model and the clinical results of patients with an ileal pouch-anal anastomosis with a cuff demonstrated that a rectal muscular cuff is not essential to maintain continence after ileal pouch-anal anastomosis.
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Affiliation(s)
- J F Slors
- Department of Surgery, University of Amsterdam, The Netherlands
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28
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Sleeboom C, Slors JF. Spontaneous rupture of the oesophagus. Neth J Surg 1990; 42:151-4. [PMID: 2126614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Spontaneous rupture of the oesophagus or Boerhaave syndrome is a rare phenomenon which poses a surgical challenge. Without treatment a mortality has been reported of up to 100 per cent. Early diagnosis and treatment are therefore imperative. An aggressive surgical approach is described. Three patients were treated with good results by closure of the rupture, drainage of the mediastinum, a diverting oesophagostomy, gastric drainage and postoperative enteral feeding via a jejunal catheter.
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Affiliation(s)
- C Sleeboom
- Department of Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands
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29
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Slors JF, Taat CW, Brummelkamp WH. [Ileo-anal anastomosis with ileum reservoir]. Ned Tijdschr Geneeskd 1990; 134:334-7. [PMID: 2154711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Ileo-anal anastomosis with an ileal pouch is a reasonable alternative for patients with ulcerative colitis and adenomatous polyposis coli. The type of the reservoir, the length of the rectal cuff and the level of the anastomosis are still topics of discussion. This operation was performed in 41 patients. A modified J-reservoir (B-reservoir) was constructed in 34 patients in an attempt to improve the function of the neorectum. Twenty patients underwent inter-sphincteric freeing of the rectum and subsequent resection without leaving a rectal cuff. Although this procedure is associated with a considerable morbidity, the ultimate result is satisfactory.
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Affiliation(s)
- J F Slors
- Academisch Medisch Centrum, afd. Chirurgie, Amsterdam
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30
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Trum JW, Slors JF, Taat CW, Lygidakis NJ, van der Heyde MN. [Periampullary carcinoma as a second primary tumor following a previously treated adenocarcinoma of the colon]. Ned Tijdschr Geneeskd 1989; 133:1844-7. [PMID: 2552334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Three patients are presented who developed periampullary carcinoma after colectomy for adenocarcinoma. The combination of colonic carcinoma and periampullary carcinoma is rare, although wellknown in patients with colonic polyposis or Gardner's syndrome. Perhaps genetic research might help select patients with a high risk of developing multiple carcinomas in the gastrointestinal tract. The five-year survival rate for periampullary carcinoma after subtotal colectomy is higher than for pancreatic carcinoma.
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Abstract
Twenty patients underwent proctocolectomy followed by an ileal pouch-anal anastomosis. The rectum was mobilized in the intersphincteric plane and transected at the level of the dentate line. As a consequence, a rectal cuff, which is considered by some to be important for the maintenance of anal continence, was not left behind. All patients were continent. Manometric data demonstrated no difference compared to a group of 21 patients with a conventional mucosectomy. Nearly half of the patients in both groups had a positive recto-anal inhibitory reflex. As a rectal cuff is not essential for maintaining continence, the receptors of the rectoanal inhibitory reflex are probably located outside the rectal wall.
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Affiliation(s)
- J F Slors
- Department of Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands
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32
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Slors JF, den Hartog Jager FC, Trum JW, Taat CW, Brummelkamp WH. Long-term follow-up after colectomy and ileorectal anastomosis in familial adenomatous polyposis coli. Is there still a place for the procedure? Hepatogastroenterology 1989; 36:109-12. [PMID: 2543616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Forty-four patients with familial adenomatous polyposis coli treated with colectomy and ileorectal anastomosis were studied. Mean age at operation was 27 years. The mean follow-up period was 10 years (median 8 years). Three patients (7%) developed rectal cancer 1, 4, and 24 years after the initial operation, respectively. Proctectomy with ileostomy was performed in one patient, and 7 patients underwent a conversion to an ileoanal procedure for an increasing number of rectal polyps in the rectum stump. Although frequent bowel actions and episodes of diarrhea were common findings in patients after colectomy and ileorectal anastomosis, almost all patients (96%) were more or less satisfied with their quality of life after the procedure. On the basis of our results and the results reported in the literature, colectomy with ileorectal anastomosis is still the operation of choice in selected patients with familial adenomatous polyposis coli. An initial ileal pouch - anal anastomosis, or a conversion to such a procedure after colectomy and ileorectal anastomosis is indicated, depending on the number and size of rectal polyps.
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Affiliation(s)
- J F Slors
- Academic Medical Center, Department of Surgery, Amsterdam, The Netherlands
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33
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Slors JF, Taat CW, Mallonga ET, Brummelkamp WH. One-stage colectomy and ileorectal anastomosis for complete left-sided obstruction of the colon. Neth J Surg 1989; 41:1-4. [PMID: 2927697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Fourteen patients with complete left-sided obstruction of the colon were treated by a one-stage emergency colectomy and primary ileorectal anastomosis. One patient died from anastomotic leakage. In selected patients the method should be considered as an alternative to the staged procedure.
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Affiliation(s)
- J F Slors
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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34
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Slors JF, Trum JW, Taat CW. [Traumatic duodenal rupture; a diagnostic problem]. Ned Tijdschr Geneeskd 1988; 132:2247-50. [PMID: 3205350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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35
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Slors JF, Taat CW, Eeftinck Schattenkerk JK, Brummelkamp WH. [Does anal carcinoma occur more frequently in homosexual men with HIV antibodies?]. Ned Tijdschr Geneeskd 1987; 131:473-5. [PMID: 3472091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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36
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37
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Slors JF, Taat CW. [Surgical catheterization of the internal jugular vein; a safe alternative for the infraclavicular catheterization of the subclavian vein]. Ned Tijdschr Geneeskd 1985; 129:108-10. [PMID: 3982523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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38
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Slors JF, Taat CW, van Berge Henegouwen DP, Mallonga ET. Rupture of an aneurysm of the middle colic artery. Neth J Surg 1982; 34:174-6. [PMID: 7133480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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39
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Slors JF, Rasker FM, Netelenbos JC. [Proteus infection of the urine? Look for the stone!]. Ned Tijdschr Geneeskd 1982; 126:225-9. [PMID: 7057948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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