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- Danielson, Johan, 1975-
(författare)
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Anorectal Malformations : Long-term outcome and aspects of secondary treatment
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Faecal incontinence (FI) is defined as the inability to control bowel movements. The causes of FI are many and diverse. One of the more uncommon reasons for FI is Anorectal Malformations (ARMs). An ARM is a congenital anomaly that affects somewhere between 1/2500 and 1/5000 live born babies. Many ARM patients have persistent FI. Several different procedures have been utilised to address this issue. This thesis aims to evaluate (1) the long-term outcome in adulthood of ARMs in relation to the modern Krickenbeck classification, and (2) scope for treating FI with transanal injection with dextranomer in non-animal stabilised hyaluronic acid (NASHA/Dx), in patients both with and without ARMs.All patients treated for ARMs in Uppsala up to 1993 were invited to participate in a questionnaire study of quality of life and function. The study included 136 patients and compared them with 136 age- and sex-matched controls. The Krickenbeck classification was found to predict functional outcome, and ARM patients had more problems with incontinence and obstipation, as well as inferior Quality of Life (QoL), compared with controls. Thirty-six patients with FI, owing to causes other than ARMs, were treated with transanal submucous injection of NASHA/Dx. The patients were monitored for two years after treatment. Significant reductions in both their incontinence score and the number of their incontinence episodes were achieved. A significant improvement in QoL was observed in patients who had at least a 75% reduction in incontinence episodes. No serious complications occurred.A prospective study of transanal injection of NASHA/Dx was conducted on seven patients with persistent FI after ARMs. After six months a significant reduction in the number of incontinence episodes was obtained. A significant improvement in QoL was also found. No serious complications occurred.In conclusion, adult patients with ARMs have inferior outcome of anorectal function and QoL compared with controls. NASHA/Dx is effective and appears to be safe in treating FI in general. This effect seems to be the same in selected patients with persistent FI after ARMs.
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| 2. |
- Danielson, Johan, 1975-, et al.
(författare)
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Injectable bulking treatment of persistent faecal incontinence after anorectal malformations. A preliminary report.
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background/PurposeDuring the last decades injectable bulking therapy has emerged as a promising treatment option for fecal incontinence (FI). Very little has been published on the use of injectable bulking therapy on patients with persistent FI after anorectal malformations (ARM). This study aimed to evaluate non-animal stabilized hyaluronic acid with dextranomer (NASHA/Dx) for the treatment of adult ARM patients with persistent FI.MethodsSeven adult patients with persistent FI after ARM were treated with perianal submucuos injection of NASHA/Dx. They were evaluated preoperatively and at three and six months after treatment with a validated bowel function questionnaire and a two-week bowel diary as well as FIQL and SF-36 quality of life questionnaires.ResultsBefore treatment mean Miller incontinence score was 13,7 and the mean number of incontinence episodes over two weeks was 20,7. At 6 months after treatment the corresponding figures were 10,7 (P=0,1088) and 5,3 (P=0,0180) respectively. No significant changes could be found in either FIQL or SF-36 scores. No serious adverse events occurred during the study.ConclusionsNASHA/Dx is a promising treatment option for selected adult patients with persistent FI after ARM. Long-term follow up of larger patient series as well as studies on patients in adolescence are needed.
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| 4. |
- Lundin, Erik, 1963-
(författare)
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Slow Transit Constipation : Aspects of Diagnosis and Treatment
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Oral 111-Indium-DTPA colonic scintigraphy was used to assess segmental transit in 23 patients with slow transit constipation (STC) and 13 controls. The transit time did not differ between patients and controls in the right colon, whereas the patients had a consistent delay from the transverse colon and distally (P<0.05–0.001). Two individual patients had a delay in the right colon.Twenty-eight patients underwent a left- (n=26) or a right (n=2) hemicolectomy for STC, after evaluation including colonic scintigraphy. Twenty-three patients (80%) were satisfied with the outcome after a median of 50 months. The median stool frequency increased from one to seven per week (P<0.001). The number of patients with bloating, excessive straining and painful defecation decreased (P<0.05). The laxative use decreased (P<0.01) and faecal continence was unchanged. A blunted rectal sensation correlated to a poor outcome.Fifty constipated patients with slow colonic transit and 28 controls were investigated with anorectal manovolumetry. Anal resting pressure was lower (P<0.05), and squeeze pressure tended to be lower (P=0.09) in patients. Rectal sensation was not different between groups, although ten patients had a threshold for filling sensation above the 95th percentile of controls. The rectal compliance was increased in patients (P<0.05–0.01).Total and segmental colonic transit was assessed with radio-opaque marker study and scintigraphy in 35 constipated patients, and related to normal values. Twenty-seven of 31 female patients had a prolonged total transit time on marker study, and 26 on scintigraphy. Of those 31 patients, 29 had prolonged segmental transit only in one or two segments on marker study. The two methods gave a similar result, except in the descending colon (P<0.05). However, the results varied considerably for individual patients.In conclusion, patients with STC often benefit from a segmental colonic resection, following assessment including scintigraphy. Anorectal physiology testing may predict surgical results.
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| 6. |
- Sakari, Thorbjörn B.
(författare)
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Adhesive small bowel obstruction: aspects on epidemiology, treatment, costs and prevention
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Small bowel obstruction (SBO) is a common and sometimes life-threatening clinical condition, usually caused by post-operative adhesions. The aims of this thesis were to investigate the outcome after SBO surgery (Paper I), cost of SBO surgery including follow-up (Paper II), incidence of SBO after colorectal cancer (CRC) surgery (Paper III), and to assess the safety of using the adhesion preventing substance icodextrin in CRC surgery (Paper IV).Paper I, a population-based retrospective study on all patients operated for adhesive SBO (n=402) in the Uppsala and Gävleborg counties between 2007 and 2012. The SBO mechanism was a fibrous band in 56%. Complications and reoperations were recorded in 48% and 10% of patients, respectively. Complications, ICU care and early mortality were associated with age and ASA class. Seventy two patients had a recurrence of SBO, 26 of whom were re-operated. Previous laparotomies, diffuse adhesions, and complicated surgery (bowel injury, longer operation times and bleeding) were predictors of recurrent SBO. Paper II used the same cohort as in Paper I with an extended follow-up (8 years in median). Mean total cost estimates per patients were €40,467 during the study period. Diffuse adhesions and complications were associated with increased costs for SBO in a multivariable analysis (p<0.001).Paper III is a population-based register study based on all CRC cancer patients in Sweden 2007–2017. Among 33,632 CRC patients operated for stage I–III disease, the 5-year cumulative incidence was 7.6% for SBO and 2.2% for SBO surgery. In 198,649 matched CRC-free comparators the corresponding incidences were 0.6% and 0.2%, respectively. Open surgery and radiotherapy were associated with an increased incidence of SBO and SBO surgery. Paper IV is an interim analysis regarding morbidity and mortality, of a randomized controlled multicenter study assessing whether the adhesion preventing substance icodextrin can reduce the risk of postoperative SBO in stage I–III CRC patients. Randomization, to standard treatment with or without icodextrin, was blinded to the authors. Demographic data and overall complications were similar in the groups. Mortality, ICU care, anastomotic leaks and reoperations did not differ.
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