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Fistula Closure (fistula + closure)
Selected AbstractsFurther experience with the use of 6-thioguanine in patients with Crohn's diseaseINFLAMMATORY BOWEL DISEASES, Issue 10 2008Azhar Ansari MD Abstract Background: 6-Thioguanine (6-TG) is efficacious in patients with Crohn's Disease (CD) failing conventional immunosuppression but there are reports of hepatotoxicity. We report our experience of the safety and efficacy of 6-TG in a series of patients with CD. Methods: A retrospective study of patients with CD who failed thiopurines ± methotrexate between 2001 and 2006 was performed. Indications for 6-TG were; active disease, to allow infliximab withdrawal, steroid sparing, or fistula closure. Patients underwent regular review and those treated longer than 1 year were advised to have liver magnetic resonance imaging (MRI) and liver biopsy. Results: All 30 patients treated with 6-TG during the period were included. The median dose and duration of 6-TG was 40 mg daily and 21.5 months, respectively. Initial clinical response was achieved in 18/30 (60%). Eleven of 29 (38%) (1 unrelated death) remained in remission at a median 44 months follow-up. Seven of 30 (23%) discontinued 6-TG due to adverse effects; 7/30 (23%) patients developed abnormal liver function tests (LFTs) during treatment, mostly transient and mild. One patient developed a portal hypertensive syndrome resolving on cessation of 6-TG. Of 11 liver biopsies, none showed nodular regenerative hyperplasia (NRH). The median red blood cell 6-thioguanine nucleotide (6-TGN) level was 807 pmol/108. Conclusions: 6-TG has good clinical efficacy for third-line immunosuppression in CD but hepatotoxicity remains a concern. However, previous reports of NRH in 6-TG-treated inflammatory bowel disease patients have not been substantiated by this cohort. (Inflamm Bowel Dis 2008) [source] Endoscopic management of traumatic hepatobiliary injuriesJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 8 2007Virendra Singh Abstract Background:, Non-surgical treatment has become the therapeutic method of choice in hemodynamically stable patients with liver trauma. There are a few reports of endoscopic management of traumatic hepatobiliary injuries in such patients; however, the optimal intervention is not known. Methods:, Twenty patients with traumatic hepatobiliary injuries from May 1997 to November 2005 were retrospectively evaluated. Results:, There were 18 male and two female patients with a mean age of 21.45 ± 10.17 years (range 7,42 years). Seven patients were children. Patients presented 19.4 ± 17.04 days following trauma. Computed tomography (CT) revealed hepatic laceration in right lobe in 14 (70%) and in left lobe in six (30%) patients. Endoscopic retrograde cholangiopancreatography (ERCP) revealed biliary leak in right duct in 14 (70%) and in left duct in six (30%) patients. Five patients also had bilhemia and one had hemobilia. Thirteen patients (65%) were treated by endoscopic sphincterotomy with nasobiliary drainage and seven (35%) were treated by nasobiliary drainage alone, which enabled fistula closure in 15.76 ± 4.22 days and 12.14 ± 3.93 days, respectively (P > 0.05). One patient in sphincterotomy group died due to multiple bony injuries and fat embolism. Two patients developed fever following ERCP, which responded to antibiotic treatment. Conclusions:, Endoscopic treatment with nasobiliary drainage without sphincterotomy is the optimal method of management of traumatic hepatobiliary injuries in hemodynamically stable patients. [source] Prospective assessment of the effect on quality of life of anti-tumour necrosis factor therapy for perineal Crohn's fistulasALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2009S. C. NG Summary Background, Anti-tumour necrosis factor (TNF) therapy effectively treats Crohn's perineal fistulas (CPF); the effect on health-related quality of life (HRQoL) remains unknown. Aims, To evaluate the effect of anti-TNF therapy on the HRQoL of patients with CPF in daily clinical practice. Methods, Prospective evaluation of clinical and magnetic resonance imaging (MRI) responses, disease activity (Perianal Disease Activity Index , PDAI), and HRQoL assessment [Inflammatory Bowel Disease Questionnaire (IBDQ)] in patients receiving anti-TNF therapy for CPF treated up to 12 months. Results, In all, 26 patients with CPF were treated (mean age 39 years; 19 infliximab, 7 adalimumab). At baseline, 85% patients had impaired IBDQ scores (mean 137; ,normal' >170). At 12 months, mean increases in IBDQ score for infliximab and adalimumab treated patients were 40 and 41 points respectively (P < 0.05). There were significant improvements in all IBDQ subscores (bowel, emotional, systemic, social) at 12 months (all P , 0.003). Fourteen patients (74%) on infliximab and six on adalimumab (86%) achieved IBDQ score ,170. Mean increase in IBDQ score was 50, 34 and 16 points in patients with clinical fistula closure (P < 0.001), clinical response (P = 0.002) and no response (n = 1) respectively. IBDQ score increased for patients with MRI healing (P < 0.001) and MRI improvement (P = 0.016), but not for those with no MRI change (n = 2). IBDQ correlated significantly with PDAI at baseline and at 12 months. Conclusion, Anti-TNF therapy improves HRQoL in patients with CPF at 12 months and this improvement is most pronounced in patients with clinical and MRI healing. [source] Adalimumab for Crohn's disease with intolerance or lost response to infliximab: a 3-year single-centre experienceALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2009A. OUSSALAH Summary Background, Adalimumab is effective in inducing clinical remission in patients with Crohn's disease who lost response or became intolerant to infliximab. Aim, To evaluate long-term efficacy and safety of adalimumab as a second line therapy in luminal and fistulizing Crohn's disease. Methods, We report our single-centre experience in 53 patients. We evaluated maintenance of clinical response defined as the absence of adverse events leading to drug withdrawal, no major abdominal surgery and no loss of clinical response in initial responders. Major abdominal surgery, steroid sparing, complete fistula closure and safety were also assessed. Results, The probability of maintaining clinical response was 77.2%, 67.8% and 50.8% at 26, 52 and 130 weeks respectively. The probability of remaining major abdominal surgery-free was 82.3% at 26, 52 and 130 weeks. Complete fistula closure occurred in six of 10 patients, and eight of 10 patients were able to taper steroid therapy. Adverse events occurred in 31 patients (58.5%) leading to adalimumab withdrawal in nine patients (17%). Conclusion, Adalimumab therapy may be effective in the long term in both luminal and fistulizing Crohn's disease in infliximab-failure patients, half of patients maintaining clinical response and potentially avoiding major abdominal surgery in 80% of cases. [source] Prevention of residual urinary incontinence following successful repair of obstetric vesico-vaginal fistula using a fibro-muscular slingBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2004Andrew Browning Obstetric vesico-vaginal fistula remains a significant cause of female urinary incontinence worldwide. Approximately 2 million women suffer from this condition, perhaps many more, most of whom are in Africa. Very few centres are treating these patients, and although success rate in the closure of the fistula is high, up to 92%, this does not necessarily equate to a cure. A significant proportion of women remains with urinary incontinence. Little is known about the nature of this incontinence, and even less is known about how to manage it. This article describes a new and simple surgical procedure, which, when employed at the time of fistula closure, seems to reduce the incidence of residual incontinence in those women at a higher risk of developing it. [source] Iatrogenic recto-urethral fistula: perineal repair and buccal mucosa interpositionBJU INTERNATIONAL, Issue 2 2009Martin Spahn OBJECTIVE To present a new and promising technique for repairing recto-urethral fistulae (RUF) using a perineal approach and buccal mucosa graft interposition, as RUF are rare but severe complications of rectal or urinary tract surgery, radiation treatment, trauma or inflammation, and the repair of recurrent or persistent RUF is particularly difficult when previous surgical attempts have failed, resulting in high recurrence rates. PATIENTS AND METHODS Between 2004 and 2006, five men (aged 61,67 years) with iatrogenic RUF had the perineal fistula closed using a buccal mucosa graft interposition. The RUF had developed after laparoscopic or retropubic radical prostatectomy in four patients and after radical cystectomy and ileal neobladder in the fifth. Four of the patients had had at least one failed RUF repair before their referral to our institution. RESULTS Four of the five RUF were repaired successfully using the perineal approach and buccal mucosa graft interposition. Failure occurred in one patient who had developed a RUF after laparoscopic radical prostatectomy followed by two unsuccessful attempts at closure. The failure was most probably due to a previously undetected postoperative perineal haematoma with infection. CONCLUSION Our perineal approach for repairing RUF, combined with buccal mucosa graft interposition, is a simple technique fulfilling all the requirements for successful fistula closure, especially in repeat surgery. [source] An 11-year experience of enterocutaneous fistula,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 12 2004P. Hollington Background: Enterocutaneous fistula has traditionally been associated with substantial morbidity and mortality, related to fluid, electrolyte and metabolic disturbance, sepsis and malnutrition. Methods: A retrospective review of enterocutaneous fistula in 277 consecutive patients treated over an 11-year period in a major tertiary referral centre was undertaken to evaluate current management practice and outcome. Results: Most fistulas occurred secondary to abdominal surgery, and a high proportion (52·7 per cent) occurred in association with inflammatory bowel disease. A low rate of spontaneous healing was observed (19·9 per cent). The healing rate after definitive fistula surgery was 82·0 per cent, although more than one attempt was required to achieve surgical closure in some patients. Definitive fistula resection resulted in a mortality rate of 3·0 per cent. In addition, one patient died after laparotomy for intra-abdominal sepsis and an additional 24 patients died from complications of fistulation, giving an overall fistula-related mortality rate of 10·8 per cent. Conclusion: Early recognition and control of sepsis, management of fluid and electrolyte imbalances, meticulous wound care and nutritional support appear to reduce the mortality rate, and allow spontaneous fistula closure in some patients. Definitive surgical management is performed only after restitution of normal physiology, usually after at least 6 months. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Experiences of tracheocutaneous fistula closure in children: how we do itCLINICAL OTOLARYNGOLOGY, Issue 4 2008M. Geyer No abstract is available for this article. [source] | ||||||||||