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Journal of Gastrointestinal Cancer 12/2011;
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ABSTRACT: This is the first identifiable description where internal herniation following laparoscopic left nephrectomy necessitated gangrenous small intestinal resection; similar cases and prevention are discussed.
Annals of The Royal College of Surgeons of England 09/2009; 91(8):667-9. · 1.23 Impact Factor
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ABSTRACT: Whereas Hirschsprung's disease is usually managed by surgery in infancy, late complications in adult life are rarely described. We report on a 36-year-old male presenting with an unusual complication after definitive treatment of Hirschsprung's disease as an infant.
Journal of Pediatric Surgery 04/2008; 43(3):546-8. · 1.45 Impact Factor
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ABSTRACT: Accurate preoperative assessment of fistula-in-ano is mandatory if the fistula is not to recur. In recent years, MRI has become pre-eminent for fistula assessment and recent studies have shown that not only is MRI more accurate than surgical assessment, but that surgery based on MRI can reduce further disease recurrence by approximately 75%. The main role of MRI is to alert the surgeon to fistula tracks and extensions that would otherwise have gone undetected and, thus, untreated at the time of surgical assessment under general anaesthetic.
European Journal of Radiology 09/2003; 47(2):98-107. · 2.61 Impact Factor
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ABSTRACT: The management of fistula-in-ano has been based on digital examination and operative findings. MR imaging has shown significant limitations to this approach, particularly in the management of recurrent fistula. The most cost-effective approach may be using a combination of endosonography and MR imaging. Preoperative confirmation of fistula complexity facilitates surgery planning of sphincter saving techniques and prevents sepsis being missed, which has been shown to reduce recurrence. Imaging has a significant role to play in this condition to improve patient outcome.
Radiologic Clinics of North America 04/2003; 41(2):443-57. · 2.59 Impact Factor
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ABSTRACT: Recurrent fistula-in-ano is usually due to sepsis missed at surgery, which can be identified by MRI. We aimed to establish the therapeutic effect of MRI in patients with fistula-in-ano. We did MRI in 71 patients with recurrent fistula, with further surgery done at the discretion of the surgeon. Surgery and MRI agreed in 40 patients, five (13%) of whom had further recurrence, compared with 16 (52%) of 31 in whom surgery and MRI disagreed (p=0.0005). Further recurrence in all 16 was at the site predicted by MRI. For surgeons who always acted on MRI, further recurrences arose in four of 25 (16%) operations versus eight of 14 (57%) operations for those who ignored imaging (p=0.008). Surgery guided by MRI reduces further recurrence of fistula-in-ano by 75% and should be done in all patients with recurrent fistula.
The Lancet 12/2002; 360(9346):1661-2. · 38.28 Impact Factor
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