Leif Hultén

• MD, PhD.Professor of Surgery
• Professor at Dept.Surgery.

In this study, a soft-tissue-anchored, percutaneous port used as a mechanical continence-preserving valve in reservoir ileo-and urostomies was functionally and morphologically evaluated in eight dogs. During follow-up, the skin failed to attach to the implant, but the intestine inside the stoma port appeared to be attached to the mesh. After reachi...

The evolution of the continent ileostomy –“ The Kock pouch” - demonstrates that the education in basic research with its technical applications is an important prerequisite for the progress and success of clinical experiments.

Acupuncture was not accepted by physicians for a long time, in part due to the mysterious and unexplainable mechanisms of traditional Chinese acupuncture. Subsequently the neurophysiological mechanism of acupuncture has been clarified. The technology has become scientifically approved and has been considered on par with other medical treatments. In...

Somatic mutations in the POLE gene encoding the catalytic subunit of DNA polymerase ε have been found in sporadic colorectal cancers (CRCs) and are most likely of importance in tumour development and/or progression. Recently, families with dominantly inherited colorectal adenomas and colorectal cancer were shown to have a causative heterozygous ger...

In 1969, N. G. Kock published preliminary results of an intra-abdominal reservoir as an alternative to the conventional ileostomy. For patients needing proctocolectomy for ulcerative colitis or familial polyposis, the continent ileostomy still serves as a viable alternative to both the conventional Brooke ileostomy and ileoanal pouch. This chapter...

Sacral nerve stimulation (SNS) has become an established therapy worldwide for the treatment for fecal incontinence. A large number of papers have been published over the years, and SNS is generally considered very effective with improved continence and quality of life for most patients. However, the results are mostly expressed in the semi-quantit...

Inflammatory bowel diseases, cancer or trauma may require removal of all or part of the intestines, leaving the patient with a need to wear external stoma appliances for collection of bowel contents. By connecting the small bowel to a percutaneous port, equipped with a sealing lid, a fully continent and leak proof stoma can be created without a nee...

Background: In most families with familial cancers, mutations have not been demonstrated; thus, healthy individuals cannot be tested for mutation status. As a consequence, many persons at risk of familial cancer live with an unknown, but presumably high, risk of developing cancer. Aim: The aim of this study was to describe individuals' perceptio...

In patients undergoing ‘cold appendectomy’ three open-tip tubes were placed into the colon via the base of the appendix with the recording tips at different levels. In one patient with a caecal fistula the tubes were introduced via the fistula. Three to seven days after the operation, recordings of the pressure activity in the different parts of th...

Acupuncture has been used successfully for the treatment of urinary bladder dysfunction. The aim of this study was therefore to investigate if manual acupuncture might also affect fecal incontinence favorably. The study comprises 15 female patients, median age 60 years (39 -75). Before treatment and at regular intervals after acupuncture sessions t...

Failure after ileal pouch-anal anastomosis (IPAA) is reported with a frequency of 10-20%. The failed IPAA can be excised or defunctioned. Indications for excision and further management of an indefinitely diverted pouch are poorly described. The aim of the present investigation was to investigate pouch-related problems and the histopathological pat...

Patients with longstanding chronic ulcerative proctocolitis are at risk to develop colorectal cancer Conflicting views as regards surveillance, the indications for surgery and type of preventive procedure exist. For permanent prevention of cancer development complete removal of all potential malignant colorectal mucosa has to be done. Panprocto-col...

Conflicting views regarding the use of ileorectal anastomosis (IRA) in ulcerative colitis (UC) exist and this controversy prompted us to review our experience, especially against the background of the current tendency to choose the ileal pouch-anal procedure (IPAA). Thirty-two consecutive patients with IRA were studied. Complications, failure rate,...

Colorectal cancer is far from being the most common complication of ulcerative colitis (UC), but it is the one that has been most extensively studied, and the literature on the subject exceeds that dealing with other complications of the disease. Many groups of workers have investigated the complex relationship between ulcerative proctocolitis and...

Colonic diverticulosis is an increasingly common condition. About a third of the population is affected by the sixth decade and a half by the ninth decade. The estimated incidence of diverticulitis is approximately ten patients! 100,000!year [3, 8]. In the USA, approximately 200,000 admissions to hospital annually are due to diverticular disease. O...

Most surgeons consider Crohn's colitis to be an absolute contraindication for a continent ileostomy, due to high complication and failure rates. This opinion may, however, be erroneous. The results may appear poor when compared with those after pouch surgery in patients with ulcerative colitis (UC), but the matter may well appear in a different lig...

An ileo-pouch anal anastomosis (IPAA) has become the gold standard procedure for ulcerative colitis and familial adenomatous polyposis. Clinical results on the pelvic pouch procedure have often been encouraging; when confronted with the different surgical options, the majority of patients select IPAA as the best operation. However, even if IPAA is...

PURPOSE: The aim of this study was to evaluate how relatives of patients with an ostomy rated the various aspects of care, how they perceived the quality of the care provided, and how they ranked their involvement in the care. Patients' satisfaction was also sought, particularly their perception of relatives' involvement. DESIGN: Descriptive cross-...

The aim of this study was to evaluate how relatives of patients with an ostomy rated the various aspects of care, how they perceived the quality of the care provided, and how they ranked their involvement in the care. Patients' satisfaction was also sought, particularly their perception of relatives' involvement. Descriptive cross-sectional. The st...

This paper reports a study whose aim was to assess the quality of care in ostomy patients seen from a patient perspective. A stoma operation causes profound changes in a patient's life because of resulting physical damage, disfigurement, loss of bodily function, and change in personal hygiene. Such changes are a cause of major concern for patients...

Carcinoma of the upper third of the rectum is almost invariably treated with resection and end-to-end anastomosis (high anterior resection). The operation is followed by an excellent functional result. In the last few decades an increasing number of sphinctersaving procedures in rectal cancer cases have been performed. Anterior resection, popularis...

Ernest Miles [1] postulated that adequate treatment of rectal cancer, regardless of the site and apparent progress of the tumour, in all cases necessitated a wide excision of the entire anorectum and establishment of a permanent colostomy by an operation involving both an abdominal and a perineal dissection. Lloyd-Davies confirmed this statement, a...

The principal aim of this study was to assess long-term pouch durability and health-related quality of life in an original series of patients operated on with a continent ileostomy. Data from 68 of 88 patients who had a continent ileostomy performed at Sahlgrenska University Hospital between 1967 and 1974 were analyzed. Median age at follow-up was...

Aim: Some of the rare complications reported in patients with an ileopouch anal anastomosis (IPAA) after coloectomy for chronic ulcerative colitis are dysplasia and carcinoma. The supposed pathway is for the ileal pouch mucosa to go through adaptational changes then is to progress through the phases of chronic pouchitis, dysplasia and subsequently...

Excision of the ileal pouch-anal anastomosis (IPAA) with construction of a conventional ileostomy is in general the ultimate procedure after unsuccessful salvage surgery. Conversion of the IPAA to a continent ileostomy (CI) is an alternative. The clinical outcome of 13 patients operated with conversion of IPAA into CI was evaluated. Median follow-u...

The purpose of this study was to assess sexuality in patients with ulcerative colitis (UC), before and one year after an ileal-pouch anal anastomosis (IPAA). Group I comprised 14 medically treated patients (7 M) and Group II comprised 29 patients (18 M), operated with colectomy and ileostomy, with preservation of the rectum. Patients were interview...

Prolapse is a common complication in patients with a transverse loop colostomy. In most cases, the prolapse can be managed conservatively awaiting time for closure eventually. However, loop stoma may also be intentionally permanent or the patient may be too fragile to have the colostomy closed and in these cases a laparotomy is required for correct...

Formation of an ileo-anal pouch is an accepted technique following colectomy in the surgical management of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). The configuration of pouches and anastomotic techniques has varied over the last two decades. The increased use of stapling devices in formation of the pouch-anal anastomosis av...

We evaluated whether, and if so to what extent, radiotherapy applied on a series of patients with prostate cancer influenced the patient's bowel habits and anorectal function. Ten consecutive patients participated in the study. The median age of the patients was 74 years (range, 61-71) and the average follow-up period was 22 (range, 15-28) months....

Sporadic reports of epithelial dysplasia and the occasional development of adenocarcinoma in the ileal pouch mucosa have recently appeared in the literature, pointing toward yet another long-term complication of the continent ileostomy and the pelvic pouch. The incidence of dysplasia and the risk for developing cancer has not been critically evalua...

Patients with acquired immunodeficiency syndrome are often in poor general physical condition. Diarrhea and bleeding hemorrhoids frequently contribute to the morbidity, and patients with such problems cause an increasing load on many outpatient clinics. Twenty-two patients (17 males) with acquired immunodeficiency syndrome had injection treatment f...

The influence of the type of abdominal incision on post-operative pain and pulmonary function was investigated in patients operated upon for a right-sided cancer of the large bowel. Fifty-three patients scheduled for a right hemicolectomy due to a right-sided colon cancer were randomized to a median vertical (M) or a transverse incision (T). Forty...

Background: With the aim of resolving the current controversy over the diagnosis and treatment of diverticular disease, this consensus development conference set out to summarize the actual state of the art. Methods: A multidisciplinary panel of international experts (n= 16) was selected to take part in the consensus process. Prior to the conferenc...

An increased awareness of anal incontinence after delivery tears has developed during the last years. The aim of this study was to compare complaints with the results of physiological methods in women with complete sphincter ruptures primarily repaired at delivery. Twenty-seven women, 16 with total rupture of the external anal sphincter and 11 who...

The development of continence-preserving and sphincter-preserving procedures for operation of ulcerative colitis has a long and interesting history. Reported clinical results on the continent ileostomy (Kock pouch) and the pelvic pouch procedure have often been enthusiastic; and when confronted with the options patients have mostly been in no doubt...

Most patients with Crohn's disease have to be operated on. Necessity to loose some amount of the intestine and time-point of the surgical intervention may be derived from the irreversible cascade of the inflammatory process and the limitations of the conservative treatment. In ileocecal disease indications for surgery are represented by stenotic an...

Surgery is needed in every second patient with pancolitis. Historically four surgical options have been developed: conventional ileostomy, ileorectostomy, continent ileostomy (Kock's pouch) and ileo-anal pouch. However, in emergent or unclear situations subtotal colectomy, ileostomy and preservation of the rectum is the most suitable operation. Aft...

Most patients with Crohn's disease have to be operated on. Necessity to loose some amount of the intestine and time-point of the surgical intervention may be derived from the irreversible cascade of the inflammatory process and the limitations of the conservative treatment. In ileocecal disease indications for surgery are represented by stenotic an...

Der Terminus Pouchitis war ursprünglich von Kock et al. [1] eingeführt worden, um das Krankheitsbild einer akuten Entzündung des Ileum Reservoirs nach Proktokolektomie mit kontinenter Ileostomie (Kock-Pouch) zu beschreiben. Häufige Symptome sind dabei kolikartige Schmerzen, vermehrt blutig-schleimige Stühle, Fieber und allgemeines Krankheitsgefühl....

Tissue specimens from the large bowel of 18 patients with long-standing slow transit constipation were investigated to determine the distribution and density of several neuropeptides and amines in the enteric nerve system, and also of endocrine cells in comparison to normal individuals. CGRP (calcitonin gene-related peptide), galanin, glucagon, GRP...

A trephine stoma may be an attractive alternative for those patients who require a stoma but not a laparotomy. Twenty-seven consecutive patients were candidates for formation of a trephine stoma. A loop ileostomy was successfully constructed in seven patients and an end sigmoid colostomy in 15, while conversion to a formal laparotomy was necessary...

Small intestinal length has a particular significance in patients with inflammatory bowel disease (IBD). A determination of intestinal length by a standardised and simple technique is of interest for surgical decision making in primary and recurrent disease and in the evaluation and management of postoperative malabsorption. The aim of the present...

Iron absorption from the whole diet, which contained a highly bioavailable form of iron, was measured for 5 d in 31 health men, including 12 blood donors. Nonheme iron in all meals was labeled with an extrinsic, inorganic radioiron tracer added in amounts to ensure uniform specific activity in all meals. Heme iron was labeled similarly by using hem...

Hysterectomy is believed to be associated with disturbed defecation, mainly constipation. This study longitudinally describes bowel function in women submitted for hysterectomy. Rectoanal manovolumetry, whole gut transit time and detailed interviews on bowel function and dyspareunia were performed preoperatively and at 3 and 11-18 months after hyst...

The relaxatory effect of acetylcholine was investigated on the feline internal anal sphincter (IAS), in vitro. Acetylcholine (10, 30, 100, and 1000 microM) caused a concentration-dependent relaxation of the same magnitude in strips from the proximal and distal IAS. The antagonist of nitric oxide synthase, N omega-nitro-L-arginine (L-NNA; 1, 10, and...

Rectal and anal motility responses to pharmacological manipulation of neuro-transmission and graded efferent electrical pelvic nerve stimulation were investigated in alpha-1-chloralose anaesthetized cats. Nω-nitro-l-arginine (l-NNA), a competitive inhibitor of nitric oxide synthase, did not influence spontaneous rectal and anal motility. No signifi...

A relationship between iron stores and dietary iron absorption is wellknown. Indirect observations suggest a good physiological control of the upper limit of body iron stores. This has been challenged by recent hypotheses of relationships between iron stores (serum ferritin, SF) and risks of cancer and ischemic heart disease. We examined the effica...

Postoperative pain is often a big problem after gastrointestinal surgery. The aim of the present investigation was two‐fold; To see whether supplying of lidocaine spray in the surgical wound influences postoperative pain and to evaluate the role of patients and caring factors on the perception of postoperative pain. Sixty consecutive patients under...

It has been shown that perinuclear antineutrophil cytoplasmic antibody (P-ANCA) may be associated with pouchitis after proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). P-ANCA was studied with the indirect immunofluorescence technique in 76 UC patients after IPAA. Twenty-eight patients had had pouchitis, whereas...

Postoperative pain is often a big problem after gastrointestinal surgery. The aim of the present investigation was two-fold; To see whether supplying of lidocaine spray in the surgical wound influences postoperative pain and to evaluate the role of patients and caring factors on the perception of postoperative pain. Sixty consecutive patients under...

To compare manovolumetric results and functional outcome after restorative proctocolectomy with either mucosal proctectomy and handsewn pouch-anal anastomosis or stapling. Prospective randomised study. University hospital, Sweden. 80 Consecutive patients undergoing restorative proctocolectomy. 37 patients were randomised to have mucosectomy and a h...

To validate a new method of measuring iron absorption from the whole diet over several days, to compare iron absorption from two types of diets and to relate iron absorption to iron requirements and iron stores. Iron absorption from two diets was studied in 21 healthy young women. All non-haem iron in all meals was labelled to the same specific act...

The intrinsic recto-anal inhibitory reflex (RAIR) and the extrinsic vesico-anal excitatory reflex were studied in anaesthetized cats in order to explore the nervous components of anal pressure regulation. The magnitude of the RAIR was documented at varying levels of anal pressure. Minimal anal pressure during RAIR was positively correlated to anal...

We wanted to elucidate further the regulation of the intestinal motility response to feeding. After intraduodenal administration of an oleate solution, mimicking a meal, the distal bowel motility and the plasma levels of bile acids, cholecystokinin (CCK), and neurotensin were monitored in patients operated on with restorative proctocolectomy (n = 4...

Recto-anal motility response to bladder distension was studied under general anaesthesia in 12 patients undergoing intestinal resection for Crohn's disease of the small intestine or colonic cancer. The effect of epidural anaesthesia on anal tone and on the motility response to bladder distension was studied in six of these patients. An anal pressur...

The purpose of this study was to analyse long-term results of an active approach to surgical treatment of Crohn's disease. One hundred and thirty-six patients were studied after first resection for primary Crohn's disease during 1968-77. Mean follow-up was 16.6 years; 18 patients had died (3 of Crohn's disease). Cumulative risk for a second resecti...

The physiological and clinical effects of loperamide treatment versus placebo were investigated in a randomized, double-blind, crossover study in patients operated with restorative proctocolectomy. Sixteen patients operated with endoanal mucosectomy and a handsewn ileal pouch-anal anastomosis and 14 patients operated with abdominal proctocolectomy...

Ileostomy output and small-intestinal transport are regulated by complex mechanisms, which the present study aimed to further elucidate. The time-related ileostomy output and bile acid excretion after intraduodenal administration of a fat solution (oleic acid, 3.5 g) was studied in 29 ileostomy patients. Eighteen patients had the entire small bowel...

The neural pathways and possible transmission mechanisms of the integrated autonomic nervous control of the urinary bladder and anorectum, were investigated in chloralose anaesthetized cats. Bladder distension and spontaneous detrusor contractions increased internal anal sphincter-tone, a response which was blocked by an α-adrenoceptor antagonist....

The aim of this study was to investigate the influence of surgical technique on functional and manovolumetric results in patients treated with Marlex mesh abdominal rectopexy. The lateral ligaments were completely divided (the Wells procedure) in 16 patients and preserved (the Ripstein procedure) in 16 patients. Clinical and physiologic assessment...

During the last 10 years (1982-1992) 370 patients have had a pelvic pouch constructed in the Colorectal Unit at the Department of Surgery II, Sahlgrenska Hospital. The complications and the eventual outcome in 307 patients (median follow-up 5.5 years ranging from 1.5 to 11 years) have been analysed. The overall complication rate was 22%. Anastomoti...

Combined transport systems can be designed as highly specialised solutions for a limited number of customers and technologies or as open systems for all shippers and types of load units. This paper analyses the variation of commercial and technological openness of combined transport systems and discusses their influence on flexibility and controlla...

Combined transport systems can be designed as highly specialised solutions for a limited number of customers and technologies or as open systems for all shippers and types of load units. This paper analyses the variation of commercial and technological openness of combined transport systems and discusses their influence on flexibility and controlla...

Restorative proctocolectomy with an ileal pouch-anal anastomosis preserves anal sphincters, the normal route of defaecation and the normal body image and it has been suggested that the procedure might be associated with less gynaecological and sexual problems than conventional proctocolectomy. To shed further light on this subject 60 female patient...

Functional changes after posterior abdominal rectopexy for the treatment of rectal prolapse are not fully understood. We studied the effects of Wells' or Ripstein's rectopexy on functional characteristics as related to anal sphincter function, rectal volume and sensory function in 31 patients with complete or internal rectal prolapse. We have obser...

The aim of this investigation was to ascertain how the length of anal canal preserved above the dentate line in stapled end-to-end ileoanal anastomosis influenced late outcome. Two groups, high cuff group and low cuff group of nine subjects with stapled anastomosis, matched for sex, age, pouch configuration, and mean follow-up, representing the hig...

21 patients (19 women) who underwent rectal prolapse repair were prospectively studied. At the one year follow-up, 6 of the eleven incontinent patients (54 per cent) regained full continence and while three of the remaining 5 patients improved they still referred occasional imperfection of continence. Resting anal pressure and maximal squeeze press...

Abdominal incisions typically are covered with conventional gauze or not dressed at all, since it is commonly believed that dressings do not influence the healing process. Also, patient personal hygiene is not facilitated when gauze type dressings are used, and frequent changes are time consuming and sometimes painful. Following creation of an adja...

For a patient with a tumour in the anal canal or with the inferior margin 5 cm or less from the anal verge an abdominoperineal rectal excision with permanent sigmoid colostomy is the only available treatment. The Turnbull-Cutait pull-through technique involved full mobilization of the rectum, complete eversion of the anorectal stump and pull-throug...

PURPOSE: The aim of this study was to investigate the influence of surgical technique on functional and manovolumetric results in patients treated with Marlex mesh abdominal rectopexy. METHODS: The lateral ligaments were completely divided (the Wells procedure) in 16 patients and preserved (the Ripstein procedure) in 16 patients. Clinical and physi...

Efficacy of different methods in screening for iron deficiency was re-examined in a randomly selected sample of 38-year-old women (n = 203) with known iron status based on absence/presence of stainable iron in bone-marrow smears. The study was made in 1968-69. Serum ferritin (SF) was determined in 1978 in frozen sera using the Ramco IRMA and, in 19...

The prevalence of iron deficiency was determined in Göteborg, Sweden, in a sample of 15- to 16-y-old girls (n = 220) and boys (n = 207) using serum ferritin (SF). In a recent study in women on the relationship between SF and stainable bone marrow iron, it was established that at a cutoff value for SF of < 16 micrograms/L in 75% of women with no iro...

Seventy-one women who had a proctocolectomy for ulcerative colitis (n. 41) or Crohn's disease (n. 30) were interviewed in the follow-up clinic for gynaecological problems and fertility. Forty-nine per cent (35/71) of the women had a distressing vaginal discharge after proctocolectomy, compared with 9% before surgery. At the gynaecological examinati...

The incidence, the median time to first appearance, and the clinical pattern of pouchitis were prospectively studied in 180 patients operated on for ulcerative proctocolitis with a continent ileostomy (CI; 84 patients) and a pelvic pouch (PP; 96 patients). Median follow-up for CI patients was 8.5 years (range, 2-15 years) and for PP patients, 5 yea...

Peroperative manometry was performed in 12 patients operated on with endoanal proctectomy and a hand-sewn pouch-anal anastomosis and in 12 in whom proctectomy was performed entirely from above, with the ileal pouch stapled to the top of the anal canal. Results from both groups showed that division of the superior rectal artery reduced the median (9...

The ileal pouch design has been considered to be an important functional determinant. Whether reported differences are attributed to properties of a specific pouch or simply due to different length of ileum used for their construction is controversial. The pouch motility pattern has been considered to be another important functional determinator. T...

It has been suggested that incontinent patients with rectal prolapse develop a relaxation of the internal sphincter at a lower filling volume than those with the same disorder who were continent. A constant relaxation of the internal sphincter during filling before the individual experiences a need to defecate could be a contributory cause of the i...