Bruce Wolff - Academia.edu (original) (raw)

Papers by Bruce Wolff

Research paper thumbnail of Alvimopan, a Novel, Peripherally Acting μ Opioid Antagonist

Research paper thumbnail of Desmoid tumours in familial adenomatous polyposis

Research paper thumbnail of Ileal Pouch–Anal Anastomosis

Archives of Surgery, 2005

Hypothesis: Functional outcome and quality of life in older patients (Ͼ55 years) undergoing ileal... more Hypothesis: Functional outcome and quality of life in older patients (Ͼ55 years) undergoing ileal pouch-anal anastomosis (IPAA) for ulcerative colitis or familial adenomatous polyposis have been incompletely studied. Our aim was to update our understanding on how the age of the patient at the time of surgery influences functional outcome and quality of life after IPAA.

Research paper thumbnail of Hospitalization for Acute Diverticulitis Does Not Mandate Routine Elective Colectomy

Archives of Surgery, 2005

Background: Previous studies suggest that elective colectomy is often required after an episode o... more Background: Previous studies suggest that elective colectomy is often required after an episode of acute diverticulitis. Hypothesis: Acute diverticulitis initially treated nonoperatively does not require elective colectomy.

Research paper thumbnail of Surgical Treatment of Appendiceal Mucocele

Archives of Surgery, 2003

All cases of primary appendiceal mucoceles (simple mucocele, cystadenoma, cystadenocarcinoma) dia... more All cases of primary appendiceal mucoceles (simple mucocele, cystadenoma, cystadenocarcinoma) diagnosed between 1976 and 2000 were reviewed. There were 135 patients, 74 of whom were female. Mean age at diagnosis was 59 years. Mean follow-up was more than 6 years. Interventions: A total of 129 patients underwent surgery, consisting of appendectomy (22 patients), right hemicolectomy (25 patients), or more extensive procedures (82 patients). Main Outcome Measures: Clinical, diagnostic, and surgical variables were statistically compared with post-operative morbidity and mortality and the presence of malignancy. PϽ.05 was considered significant. Results: The presence of symptoms was associated with malignancy (58% vs 15%, PϽ.001), particularly abdominal pain (56% vs 29%, P=.005) and weight loss (77% vs 31%, P=.002). Abdominal mass was also associated with malignancy (86% vs 25%, PϽ.001). Moreover, pseudomyxoma peritonei and mucocele extravasation were associated with malignancy (95% vs 13%, PϽ.001, and 83% vs 15%, PϽ.001, respectively). The lesion size was not associated with malignancy; however, cystadenomas were significantly larger than simple mucoceles (8.1 cm vs 4.1 cm, PϽ.001), and no cystadenoma was less than 2 cm in largest diameter. Conclusions: A number of clinical, diagnostic, and intraoperative findings are associated with malignant mucoceles. All mucoceles greater than 2 cm should be excised to remove premalignant lesions.

Research paper thumbnail of Alvimopan, for Postoperative Ileus Following Bowel Resection

Annals of Surgery, 2007

To obtain further analysis regarding specific outcomes and alvimopan doses in bowel resection (BR... more To obtain further analysis regarding specific outcomes and alvimopan doses in bowel resection (BR) patients. Summary Background Data: Although postoperative ileus (POI) is common after BR, there is currently no recognized treatment or prevention available. Alvimopan, a novel, peripherally active muopioid receptor antagonist, accelerated GI recovery after BR or hysterectomy in 3 phase III trials. Methods: A pooled retrospective subset analysis of BR patients in alvimopan phase III trials was performed. Randomized BR patients received alvimopan 6 mg (n ϭ 397), 12 mg (n ϭ 413), or placebo (n ϭ 402) Ն2 hours before surgery and twice daily until hospital discharge for Յ7 days. The primary endpoint of each trial was time to recovery of GI function. Hospital discharge order (DCO) written, readmission, and morbidities were also assessed. Cox proportional hazard models were used to analyze treatment effects on time-to-event endpoints. Results: Alvimopan (6 or 12 mg) significantly accelerated GI recovery (GI-3; hazard ratio ϭ 1.28 and 1.38, respectively; P Յ 0.001 for both). Alvimopan significantly accelerated time to DCO written by 16 hours for 6 mg and 18 hours for 12 mg (P Ͻ 0.001 for both) from a mean of 147 hours for placebo. Alvimopan-treated patients had reduced postoperative morbidity compared with placebo, and incidence of prolonged hospital stay or readmission was significantly reduced (P Ͻ 0.001). Tolerability profiles were similar among groups. Conclusions: Alvimopan significantly accelerated GI recovery in BR patients. A 12-mg dose provided more consistent benefits across both sexes and all ages. Postoperative morbidity rates, prolonged hospital stay, and rates of hospital readmission were significantly reduced. Alvimopan reduces the consequences of POI after BR.

Research paper thumbnail of Alvimopan for the Management of Postoperative Ileus

Annals of Pharmacotherapy, 2005

OBJECTIVE:To review the pharmacology, pharmacokinetics, clinical efficacy, safety, dosage, and ad... more OBJECTIVE:To review the pharmacology, pharmacokinetics, clinical efficacy, safety, dosage, and administration of alvimopan, a peripherally acting μ-opioid receptor antagonist, in the management of postoperative ileus (POI).DATA SOURCES:A literature search (1980–October 2004%) applying the terms alvimopan, ADL 8–2698, and LY246736 was conducted using MEDLINE. Information was also obtained from scientific congress abstracts and data on file with the manufacturer.STUDY SELECTION AND DATA EXTRACTION:Studies and abstracts investigating alvimopan and POI were considered for inclusion; however, they were restricted to English-language articles.DATA SYNTHESIS:Alvimopan is a novel, peripherally acting μ-opioid receptor antagonist that is currently under evaluation for the management of POI. POI presents significant clinical challenges that can delay patient recovery and contribute to increased morbidity and prolonged hospitalization after surgery. Clinical trials have demonstrated that alvim...

Research paper thumbnail of Complicated Diverticulitis

Annals of Surgery, 2006

The majority of patients presented with one form of complicated diverticulitis, but 25.7% had mor... more The majority of patients presented with one form of complicated diverticulitis, but 25.7% had more than one complication of diverticular disease and 7.6% had 3 or more.

Research paper thumbnail of Long-Term Functional and Quality of Life Outcomes After Coloanal Anastomosis for Distal Rectal Cancer

Diseases of The Colon & Rectum, Sep 1, 2006

BACKGROUND: the impact of iPaa on long-term outcomes in adults is favorable. studies on functiona... more BACKGROUND: the impact of iPaa on long-term outcomes in adults is favorable. studies on functional outcome and quality of life in children are sparse. OBJECTIVE: the aim of this study was to evaluate the functional and quality-of-life outcomes after iPaa in children and to investigate the possible correlations between the two. DESIGN: standardized validated questionnaires of bowel/psychosocial functioning and quality of life were used to assess outcome. SETTING: this study was conducted at a tertiary medical center. PATIENTS: all children who had surgery at <18 years of age and were followed up at our institute were included. Global assessment of function scale questionnaires were used to evaluate functional outcome. Quality of life in patients >18 years at the time of follow-up was scored by using the short form 36 questionnaire completed by the patients. Quality of life in the younger patients at the time of follow-up was scored using the Child health Questionarie-28 filled by the parents. RESULTS: Data were obtained in 26 patients (25 with a preoperative diagnosis of ulcerative colitis) at a median follow-up of 6 years. the median age at surgery was 15 years. Quality of life was comparable to the general population for children >18 at the time of follow-up in 7 of 8 items, but was lower than in the general population in 7 of 12 items for those who were younger at the time of follow-up. the mean functional score was found to be negatively correlated to all 8 short form 36 parameters (r > 0.5; p < 0.005), but only to one of the Child health Questionarie-28 parameters. LIMITATIONS: this study was limited by its small sample size. CONCLUSIONS: the functional outcomes among pediatric patients undergoing iPaa are good. Parents' perception of their child's quality of life is poorer in comparison with the perception by patients themselves when older and with no correlation to the functional results.

Research paper thumbnail of Anastomotic technique – suture

Operative Surgery of the Colon, Rectum and Anus, Sixth Edition, 2015

Research paper thumbnail of Impact of Pelvic Radiotherapy on Morbidity and Durability of Sphincter Preservation After Coloanal Anastomosis for Rectal Cancers

Diseases of the Colon & Rectum, 2008

This study was designed to assess the impact of pelvic radiotherapy on the incidence of complicat... more This study was designed to assess the impact of pelvic radiotherapy on the incidence of complications and colostomy-free survival of patients after a coloanal anastomosis for rectal cancer. A total of 192 patients underwent a coloanal anastomosis between 1982 and 2001: 87 patients did not receive pelvic radiotherapy; 105 patients received pelvic radiotherapy (39 preoperative and 66 postoperative). Early and late complications requiring surgical intervention and the colostomy-free survival rate were assessed by retrospective review of patient records. After a median follow-up of 62 months, 151 patients were alive. The most frequent complication was development of an anastomotic stricture (5-year rate of a stricture, 16 percent; 95 percent confidence interval, 10-21). Patients receiving pelvic radiotherapy had a higher rate of complications other than anastomotic strictures, including fecal incontinence, fistulas, abscesses, and bowel obstructions compared with patients not receiving pelvic radiotherapy (5-year rate: 20 percent (95 percent confidence interval, 10-29) vs. 5 percent (95 percent confidence interval, 0-10); P = 0.001). Patients receiving pelvic radiotherapy had a lower colostomy-free survival than did patients not receiving pelvic radiotherapy (5-year colostomy-free rate: 72 percent (95 percent confidence interval, 62-84) vs. 92 percent (95 percent confidence interval, 86-98); P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). There was no significant difference in the colostomy-free survival of patients receiving preoperative and postoperative pelvic radiotherapy. After coloanal anastomosis, a significant number of patients will have complications requiring surgical intervention, and some will require a permanent colostomy. Pelvic radiotherapy, whether it is administered preoperatively or postoperatively, significantly increases the need for a permanent colostomy.

Research paper thumbnail of Complicated Diverticulitis

Annals of Surgery, 2005

Introduction:Much of our knowledge and treatment of complicated diverticulitis (CD) are based on ... more Introduction:Much of our knowledge and treatment of complicated diverticulitis (CD) are based on outdated literature reporting mortality rates of 10%. Practice parameters recommend elective resection after 2 episodes of diverticulitis to reduce morbidity and mortality. The aim of this study is to update our understanding of the morbidity, mortality, characteristics, and outcomes of CD. Methods:Three hundred thirty-seven patients hospitalized for CD were retrospectively analyzed. Characteristics and outcomes were determined using chi-squared and Fisher exact tests. Results:Mean age of patients was 65 years. Seventy percent had one or more comorbidities. A total of 46.6% had a history of at least one prior diverticulitis episode, whereas 53.4% presented with CD as their first episode. Overall mortality rate was 6.5% (86.4% associated with perforation, 9.5% anastomotic leak, 4.5% patient managed nonoperatively). A total of 89.5% of the perforation patients who died had no history of diverticulitis. Steroid use was significantly associated with perforation rates as well as mortality (P< 0.001 and P = 0.002). Comorbidities such as diabetes, collagen–vascular disease, and immune system compromise were also highly associated with death (P = 0.006, P = 0.009, and P = 0.003, respectively). Overall morbidity was 41.4%. Older age, gender, steroids, comorbidities, and perforation were significantly associated with morbidity. Conclusion:Today, mortality from CD excluding perforation is reduced compared with past data. This, coupled with the fact that the majority of these patients presented with CD as their first episode, calls into question the current practice of elective resection as a stratagem for reducing mortality. Immunocompromised patients may benefit from early resection. New prospective data is needed to redefine target groups for prophylactic resection.

Research paper thumbnail of Diverticulitis: A Progressive Disease?

Annals of Surgery, 2006

Introduction: Our understanding of complicated diverticulitis is based on outdated literature. An... more Introduction: Our understanding of complicated diverticulitis is based on outdated literature. Antecedent episodes of diverticulitis are felt to increase the risk of developing complicated diverticulitis, as well as its subsequent morbidity and mortality. Practice parameters recommend elective resection after 2 episodes of diverticulitis to reduce this morbidity and mortality. Methods: A total of 150 patients with prior episodes of diverticulitis who were hospitalized with complicated diverticulitis were retrospectively analyzed. Statistical analysis was conducted using 2 and Fisher exact test tests. Results: Patients were separated into 2 groups for analysis: group A ϭ those with 1 or 2 prior diverticulitis episodes (n ϭ 118) versus group B ϭ patients with more than 2 prior episodes (n ϭ 32). Characteristics of the groups were similar for age and preexistent comorbid conditions. The majority of patients presented with pericolonic abscess and inflammatory phlegmon. Perforated diverticulitis occurred more often in group A compared with patients with Ͼ2 episodes of diverticulitis. Because of the higher rate of perforation, patients in group A underwent surgical diversion more often than group B patients. No significant differences in operative complications, morbidity, or mortality rates were identified between the groups. Conclusion: Patients with multiple (Ͼ2) episodes of diverticulitis are not at increased risk for poor outcomes if they develop complicated diverticulitis. Morbidity and mortality rates are not significantly different between patients with multiple episodes of diverticulitis compared with those with 1 or 2 prior attacks. Reevaluation of the practice of elective resection as a strategy for reducing the mortality and morbidity from complicated diverticulitis is needed.

Research paper thumbnail of Incidental Gallstones

The Permanente Journal, 2009

Research paper thumbnail of 111 In-CYT-103 scanning in recurrent colorectal cancer—Does it affect standard management?

Diseases of the colon & …, 1996

In a blinded fashion, radiolabeled B72.3 was investigated in operative cases of recurrent colorec... more In a blinded fashion, radiolabeled B72.3 was investigated in operative cases of recurrent colorectal cancer to determine if diagnostic accuracy would be improved to ultimately maximize curability and minimize interventional morbidities. METHODS: Study patients underwent conventional evaluation including history, physical examination, abdominal/pelvic computed tomographic scan (CT), colon examination, and carcinoembryonic antigen (CEA) determination, with select magnetic resonance imaging and ultrasonographic imaging as indicated. Murine monoclonal antibody B72.3 was labeled with indium-Ill (1111n_CYT_103 provided by Cytogen) and scans obtained at 48 hours and, selectively, at 72 and 96 hours. Unlike previous studies, the operating surgeon was blinded to 111In-CYT-103 abdominal scan results until surgical exploration was complete. RESULTS: Of 15 study patients (10 male; 5 female), average age was 57 years, and average CEA was 10 ng/ml (with eight elevated CEA levels). A single patient did not undergo surgery because of presence of pulmonary metastases identified on CT scan but not identified on a 1HIn-CYT-103 scan. Laparotomies included resection and intraoperative radiation (10), resection alone (1), and biopsy only (3). CT and 1HIn-CYT-103 scans were compared with operative findings. CT scans had an accuracy and positive predictive value of 47 and 100 percent, respectively, whereas those of H~In-CYT-103 scan were 60 and 82 percent, respectively. Contribution of the scan to diagnosis and management was graded by the surgeon as no effect (67 percenO, beneficial effect (13 percent), or negative effect (20 percenO. CONCLUSIONS: *~lin-CYT-103 was more accurate compared with CT scan, but when value of the scan was examined with respect to its potential contribution to patient management, it was beneficial in only 13 percent of patients. Further refinements may enhance the value of antibody imaging techniques.

Research paper thumbnail of Impact of Pelvic Radiotherapy on Morbidity and Durability of Sphincter Preservation After Coloanal Anastomosis for Rectal Cancers

Diseases of the Colon & Rectum, 2008

This study was designed to assess the impact of pelvic radiotherapy on the incidence of complicat... more This study was designed to assess the impact of pelvic radiotherapy on the incidence of complications and colostomy-free survival of patients after a coloanal anastomosis for rectal cancer. A total of 192 patients underwent a coloanal anastomosis between 1982 and 2001: 87 patients did not receive pelvic radiotherapy; 105 patients received pelvic radiotherapy (39 preoperative and 66 postoperative). Early and late complications requiring surgical intervention and the colostomy-free survival rate were assessed by retrospective review of patient records. After a median follow-up of 62 months, 151 patients were alive. The most frequent complication was development of an anastomotic stricture (5-year rate of a stricture, 16 percent; 95 percent confidence interval, 10-21). Patients receiving pelvic radiotherapy had a higher rate of complications other than anastomotic strictures, including fecal incontinence, fistulas, abscesses, and bowel obstructions compared with patients not receiving pelvic radiotherapy (5-year rate: 20 percent (95 percent confidence interval, 10-29) vs. 5 percent (95 percent confidence interval, 0-10); P = 0.001). Patients receiving pelvic radiotherapy had a lower colostomy-free survival than did patients not receiving pelvic radiotherapy (5-year colostomy-free rate: 72 percent (95 percent confidence interval, 62-84) vs. 92 percent (95 percent confidence interval, 86-98); P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). There was no significant difference in the colostomy-free survival of patients receiving preoperative and postoperative pelvic radiotherapy. After coloanal anastomosis, a significant number of patients will have complications requiring surgical intervention, and some will require a permanent colostomy. Pelvic radiotherapy, whether it is administered preoperatively or postoperatively, significantly increases the need for a permanent colostomy.

Research paper thumbnail of Alvimopan, a Novel, Peripherally Acting μ Opioid Antagonist

Research paper thumbnail of Desmoid tumours in familial adenomatous polyposis

Research paper thumbnail of Ileal Pouch–Anal Anastomosis

Archives of Surgery, 2005

Hypothesis: Functional outcome and quality of life in older patients (Ͼ55 years) undergoing ileal... more Hypothesis: Functional outcome and quality of life in older patients (Ͼ55 years) undergoing ileal pouch-anal anastomosis (IPAA) for ulcerative colitis or familial adenomatous polyposis have been incompletely studied. Our aim was to update our understanding on how the age of the patient at the time of surgery influences functional outcome and quality of life after IPAA.

Research paper thumbnail of Hospitalization for Acute Diverticulitis Does Not Mandate Routine Elective Colectomy

Archives of Surgery, 2005

Background: Previous studies suggest that elective colectomy is often required after an episode o... more Background: Previous studies suggest that elective colectomy is often required after an episode of acute diverticulitis. Hypothesis: Acute diverticulitis initially treated nonoperatively does not require elective colectomy.

Research paper thumbnail of Surgical Treatment of Appendiceal Mucocele

Archives of Surgery, 2003

All cases of primary appendiceal mucoceles (simple mucocele, cystadenoma, cystadenocarcinoma) dia... more All cases of primary appendiceal mucoceles (simple mucocele, cystadenoma, cystadenocarcinoma) diagnosed between 1976 and 2000 were reviewed. There were 135 patients, 74 of whom were female. Mean age at diagnosis was 59 years. Mean follow-up was more than 6 years. Interventions: A total of 129 patients underwent surgery, consisting of appendectomy (22 patients), right hemicolectomy (25 patients), or more extensive procedures (82 patients). Main Outcome Measures: Clinical, diagnostic, and surgical variables were statistically compared with post-operative morbidity and mortality and the presence of malignancy. PϽ.05 was considered significant. Results: The presence of symptoms was associated with malignancy (58% vs 15%, PϽ.001), particularly abdominal pain (56% vs 29%, P=.005) and weight loss (77% vs 31%, P=.002). Abdominal mass was also associated with malignancy (86% vs 25%, PϽ.001). Moreover, pseudomyxoma peritonei and mucocele extravasation were associated with malignancy (95% vs 13%, PϽ.001, and 83% vs 15%, PϽ.001, respectively). The lesion size was not associated with malignancy; however, cystadenomas were significantly larger than simple mucoceles (8.1 cm vs 4.1 cm, PϽ.001), and no cystadenoma was less than 2 cm in largest diameter. Conclusions: A number of clinical, diagnostic, and intraoperative findings are associated with malignant mucoceles. All mucoceles greater than 2 cm should be excised to remove premalignant lesions.

Research paper thumbnail of Alvimopan, for Postoperative Ileus Following Bowel Resection

Annals of Surgery, 2007

To obtain further analysis regarding specific outcomes and alvimopan doses in bowel resection (BR... more To obtain further analysis regarding specific outcomes and alvimopan doses in bowel resection (BR) patients. Summary Background Data: Although postoperative ileus (POI) is common after BR, there is currently no recognized treatment or prevention available. Alvimopan, a novel, peripherally active muopioid receptor antagonist, accelerated GI recovery after BR or hysterectomy in 3 phase III trials. Methods: A pooled retrospective subset analysis of BR patients in alvimopan phase III trials was performed. Randomized BR patients received alvimopan 6 mg (n ϭ 397), 12 mg (n ϭ 413), or placebo (n ϭ 402) Ն2 hours before surgery and twice daily until hospital discharge for Յ7 days. The primary endpoint of each trial was time to recovery of GI function. Hospital discharge order (DCO) written, readmission, and morbidities were also assessed. Cox proportional hazard models were used to analyze treatment effects on time-to-event endpoints. Results: Alvimopan (6 or 12 mg) significantly accelerated GI recovery (GI-3; hazard ratio ϭ 1.28 and 1.38, respectively; P Յ 0.001 for both). Alvimopan significantly accelerated time to DCO written by 16 hours for 6 mg and 18 hours for 12 mg (P Ͻ 0.001 for both) from a mean of 147 hours for placebo. Alvimopan-treated patients had reduced postoperative morbidity compared with placebo, and incidence of prolonged hospital stay or readmission was significantly reduced (P Ͻ 0.001). Tolerability profiles were similar among groups. Conclusions: Alvimopan significantly accelerated GI recovery in BR patients. A 12-mg dose provided more consistent benefits across both sexes and all ages. Postoperative morbidity rates, prolonged hospital stay, and rates of hospital readmission were significantly reduced. Alvimopan reduces the consequences of POI after BR.

Research paper thumbnail of Alvimopan for the Management of Postoperative Ileus

Annals of Pharmacotherapy, 2005

OBJECTIVE:To review the pharmacology, pharmacokinetics, clinical efficacy, safety, dosage, and ad... more OBJECTIVE:To review the pharmacology, pharmacokinetics, clinical efficacy, safety, dosage, and administration of alvimopan, a peripherally acting μ-opioid receptor antagonist, in the management of postoperative ileus (POI).DATA SOURCES:A literature search (1980–October 2004%) applying the terms alvimopan, ADL 8–2698, and LY246736 was conducted using MEDLINE. Information was also obtained from scientific congress abstracts and data on file with the manufacturer.STUDY SELECTION AND DATA EXTRACTION:Studies and abstracts investigating alvimopan and POI were considered for inclusion; however, they were restricted to English-language articles.DATA SYNTHESIS:Alvimopan is a novel, peripherally acting μ-opioid receptor antagonist that is currently under evaluation for the management of POI. POI presents significant clinical challenges that can delay patient recovery and contribute to increased morbidity and prolonged hospitalization after surgery. Clinical trials have demonstrated that alvim...

Research paper thumbnail of Complicated Diverticulitis

Annals of Surgery, 2006

The majority of patients presented with one form of complicated diverticulitis, but 25.7% had mor... more The majority of patients presented with one form of complicated diverticulitis, but 25.7% had more than one complication of diverticular disease and 7.6% had 3 or more.

Research paper thumbnail of Long-Term Functional and Quality of Life Outcomes After Coloanal Anastomosis for Distal Rectal Cancer

Diseases of The Colon & Rectum, Sep 1, 2006

BACKGROUND: the impact of iPaa on long-term outcomes in adults is favorable. studies on functiona... more BACKGROUND: the impact of iPaa on long-term outcomes in adults is favorable. studies on functional outcome and quality of life in children are sparse. OBJECTIVE: the aim of this study was to evaluate the functional and quality-of-life outcomes after iPaa in children and to investigate the possible correlations between the two. DESIGN: standardized validated questionnaires of bowel/psychosocial functioning and quality of life were used to assess outcome. SETTING: this study was conducted at a tertiary medical center. PATIENTS: all children who had surgery at <18 years of age and were followed up at our institute were included. Global assessment of function scale questionnaires were used to evaluate functional outcome. Quality of life in patients >18 years at the time of follow-up was scored by using the short form 36 questionnaire completed by the patients. Quality of life in the younger patients at the time of follow-up was scored using the Child health Questionarie-28 filled by the parents. RESULTS: Data were obtained in 26 patients (25 with a preoperative diagnosis of ulcerative colitis) at a median follow-up of 6 years. the median age at surgery was 15 years. Quality of life was comparable to the general population for children >18 at the time of follow-up in 7 of 8 items, but was lower than in the general population in 7 of 12 items for those who were younger at the time of follow-up. the mean functional score was found to be negatively correlated to all 8 short form 36 parameters (r > 0.5; p < 0.005), but only to one of the Child health Questionarie-28 parameters. LIMITATIONS: this study was limited by its small sample size. CONCLUSIONS: the functional outcomes among pediatric patients undergoing iPaa are good. Parents' perception of their child's quality of life is poorer in comparison with the perception by patients themselves when older and with no correlation to the functional results.

Research paper thumbnail of Anastomotic technique – suture

Operative Surgery of the Colon, Rectum and Anus, Sixth Edition, 2015

Research paper thumbnail of Impact of Pelvic Radiotherapy on Morbidity and Durability of Sphincter Preservation After Coloanal Anastomosis for Rectal Cancers

Diseases of the Colon & Rectum, 2008

This study was designed to assess the impact of pelvic radiotherapy on the incidence of complicat... more This study was designed to assess the impact of pelvic radiotherapy on the incidence of complications and colostomy-free survival of patients after a coloanal anastomosis for rectal cancer. A total of 192 patients underwent a coloanal anastomosis between 1982 and 2001: 87 patients did not receive pelvic radiotherapy; 105 patients received pelvic radiotherapy (39 preoperative and 66 postoperative). Early and late complications requiring surgical intervention and the colostomy-free survival rate were assessed by retrospective review of patient records. After a median follow-up of 62 months, 151 patients were alive. The most frequent complication was development of an anastomotic stricture (5-year rate of a stricture, 16 percent; 95 percent confidence interval, 10-21). Patients receiving pelvic radiotherapy had a higher rate of complications other than anastomotic strictures, including fecal incontinence, fistulas, abscesses, and bowel obstructions compared with patients not receiving pelvic radiotherapy (5-year rate: 20 percent (95 percent confidence interval, 10-29) vs. 5 percent (95 percent confidence interval, 0-10); P = 0.001). Patients receiving pelvic radiotherapy had a lower colostomy-free survival than did patients not receiving pelvic radiotherapy (5-year colostomy-free rate: 72 percent (95 percent confidence interval, 62-84) vs. 92 percent (95 percent confidence interval, 86-98); P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). There was no significant difference in the colostomy-free survival of patients receiving preoperative and postoperative pelvic radiotherapy. After coloanal anastomosis, a significant number of patients will have complications requiring surgical intervention, and some will require a permanent colostomy. Pelvic radiotherapy, whether it is administered preoperatively or postoperatively, significantly increases the need for a permanent colostomy.

Research paper thumbnail of Complicated Diverticulitis

Annals of Surgery, 2005

Introduction:Much of our knowledge and treatment of complicated diverticulitis (CD) are based on ... more Introduction:Much of our knowledge and treatment of complicated diverticulitis (CD) are based on outdated literature reporting mortality rates of 10%. Practice parameters recommend elective resection after 2 episodes of diverticulitis to reduce morbidity and mortality. The aim of this study is to update our understanding of the morbidity, mortality, characteristics, and outcomes of CD. Methods:Three hundred thirty-seven patients hospitalized for CD were retrospectively analyzed. Characteristics and outcomes were determined using chi-squared and Fisher exact tests. Results:Mean age of patients was 65 years. Seventy percent had one or more comorbidities. A total of 46.6% had a history of at least one prior diverticulitis episode, whereas 53.4% presented with CD as their first episode. Overall mortality rate was 6.5% (86.4% associated with perforation, 9.5% anastomotic leak, 4.5% patient managed nonoperatively). A total of 89.5% of the perforation patients who died had no history of diverticulitis. Steroid use was significantly associated with perforation rates as well as mortality (P< 0.001 and P = 0.002). Comorbidities such as diabetes, collagen–vascular disease, and immune system compromise were also highly associated with death (P = 0.006, P = 0.009, and P = 0.003, respectively). Overall morbidity was 41.4%. Older age, gender, steroids, comorbidities, and perforation were significantly associated with morbidity. Conclusion:Today, mortality from CD excluding perforation is reduced compared with past data. This, coupled with the fact that the majority of these patients presented with CD as their first episode, calls into question the current practice of elective resection as a stratagem for reducing mortality. Immunocompromised patients may benefit from early resection. New prospective data is needed to redefine target groups for prophylactic resection.

Research paper thumbnail of Diverticulitis: A Progressive Disease?

Annals of Surgery, 2006

Introduction: Our understanding of complicated diverticulitis is based on outdated literature. An... more Introduction: Our understanding of complicated diverticulitis is based on outdated literature. Antecedent episodes of diverticulitis are felt to increase the risk of developing complicated diverticulitis, as well as its subsequent morbidity and mortality. Practice parameters recommend elective resection after 2 episodes of diverticulitis to reduce this morbidity and mortality. Methods: A total of 150 patients with prior episodes of diverticulitis who were hospitalized with complicated diverticulitis were retrospectively analyzed. Statistical analysis was conducted using 2 and Fisher exact test tests. Results: Patients were separated into 2 groups for analysis: group A ϭ those with 1 or 2 prior diverticulitis episodes (n ϭ 118) versus group B ϭ patients with more than 2 prior episodes (n ϭ 32). Characteristics of the groups were similar for age and preexistent comorbid conditions. The majority of patients presented with pericolonic abscess and inflammatory phlegmon. Perforated diverticulitis occurred more often in group A compared with patients with Ͼ2 episodes of diverticulitis. Because of the higher rate of perforation, patients in group A underwent surgical diversion more often than group B patients. No significant differences in operative complications, morbidity, or mortality rates were identified between the groups. Conclusion: Patients with multiple (Ͼ2) episodes of diverticulitis are not at increased risk for poor outcomes if they develop complicated diverticulitis. Morbidity and mortality rates are not significantly different between patients with multiple episodes of diverticulitis compared with those with 1 or 2 prior attacks. Reevaluation of the practice of elective resection as a strategy for reducing the mortality and morbidity from complicated diverticulitis is needed.

Research paper thumbnail of Incidental Gallstones

The Permanente Journal, 2009

Research paper thumbnail of 111 In-CYT-103 scanning in recurrent colorectal cancer—Does it affect standard management?

Diseases of the colon & …, 1996

In a blinded fashion, radiolabeled B72.3 was investigated in operative cases of recurrent colorec... more In a blinded fashion, radiolabeled B72.3 was investigated in operative cases of recurrent colorectal cancer to determine if diagnostic accuracy would be improved to ultimately maximize curability and minimize interventional morbidities. METHODS: Study patients underwent conventional evaluation including history, physical examination, abdominal/pelvic computed tomographic scan (CT), colon examination, and carcinoembryonic antigen (CEA) determination, with select magnetic resonance imaging and ultrasonographic imaging as indicated. Murine monoclonal antibody B72.3 was labeled with indium-Ill (1111n_CYT_103 provided by Cytogen) and scans obtained at 48 hours and, selectively, at 72 and 96 hours. Unlike previous studies, the operating surgeon was blinded to 111In-CYT-103 abdominal scan results until surgical exploration was complete. RESULTS: Of 15 study patients (10 male; 5 female), average age was 57 years, and average CEA was 10 ng/ml (with eight elevated CEA levels). A single patient did not undergo surgery because of presence of pulmonary metastases identified on CT scan but not identified on a 1HIn-CYT-103 scan. Laparotomies included resection and intraoperative radiation (10), resection alone (1), and biopsy only (3). CT and 1HIn-CYT-103 scans were compared with operative findings. CT scans had an accuracy and positive predictive value of 47 and 100 percent, respectively, whereas those of H~In-CYT-103 scan were 60 and 82 percent, respectively. Contribution of the scan to diagnosis and management was graded by the surgeon as no effect (67 percenO, beneficial effect (13 percent), or negative effect (20 percenO. CONCLUSIONS: *~lin-CYT-103 was more accurate compared with CT scan, but when value of the scan was examined with respect to its potential contribution to patient management, it was beneficial in only 13 percent of patients. Further refinements may enhance the value of antibody imaging techniques.

Research paper thumbnail of Impact of Pelvic Radiotherapy on Morbidity and Durability of Sphincter Preservation After Coloanal Anastomosis for Rectal Cancers

Diseases of the Colon & Rectum, 2008

This study was designed to assess the impact of pelvic radiotherapy on the incidence of complicat... more This study was designed to assess the impact of pelvic radiotherapy on the incidence of complications and colostomy-free survival of patients after a coloanal anastomosis for rectal cancer. A total of 192 patients underwent a coloanal anastomosis between 1982 and 2001: 87 patients did not receive pelvic radiotherapy; 105 patients received pelvic radiotherapy (39 preoperative and 66 postoperative). Early and late complications requiring surgical intervention and the colostomy-free survival rate were assessed by retrospective review of patient records. After a median follow-up of 62 months, 151 patients were alive. The most frequent complication was development of an anastomotic stricture (5-year rate of a stricture, 16 percent; 95 percent confidence interval, 10-21). Patients receiving pelvic radiotherapy had a higher rate of complications other than anastomotic strictures, including fecal incontinence, fistulas, abscesses, and bowel obstructions compared with patients not receiving pelvic radiotherapy (5-year rate: 20 percent (95 percent confidence interval, 10-29) vs. 5 percent (95 percent confidence interval, 0-10); P = 0.001). Patients receiving pelvic radiotherapy had a lower colostomy-free survival than did patients not receiving pelvic radiotherapy (5-year colostomy-free rate: 72 percent (95 percent confidence interval, 62-84) vs. 92 percent (95 percent confidence interval, 86-98); P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). There was no significant difference in the colostomy-free survival of patients receiving preoperative and postoperative pelvic radiotherapy. After coloanal anastomosis, a significant number of patients will have complications requiring surgical intervention, and some will require a permanent colostomy. Pelvic radiotherapy, whether it is administered preoperatively or postoperatively, significantly increases the need for a permanent colostomy.