Surgical considerations in cystic fibrosis: A 32-year evaluation of outcomes

Escobar, Mauricio A.; Grosfeld, Jay L.; Burdick, Justin J.; Powell, Robert L.; Jay, Colleen L.; Wait, Alyssa D.; West, Karen W.; Billmire, Deborah F.; Scherer, L.R.; Engum, Scott A.; Rouse, Thomas M.; Ladd, Alan P.; Rescorla, Frederick J.

doi:10.1016/j.surg.2005.06.049

Cited by 71 publications

(52 citation statements)

References 54 publications

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“…Our DIOS incidence of one in ten patients is comparable with most studies' estimates of 10-20%, [13][14][15][16] although the reported range is wide (2-41.3%). 5,[17][18][19] Similar to the reports by Minkes et al and Gilljam et al, this study confirms that pretransplantation abdominal operation is a significant risk factor for developing DIOS. 4,14 Whether a past history of meconium ileus is a risk factor for DIOS in nontransplant patients has been disputed, with conflicting findings in previous reports, 4,5,13,20-23 but we found that previous meconium ileus was the strongest predictor of developing DIOS; patients with this history had a 12.8 times increased risk of DIOS compared to patients with no history of meconium ileus (Table 1).…”

Section: Discussionsupporting

confidence: 91%

“…12 As perforations were occurring despite low infusion pressures, it was hypothesized that the osmotic properties of undiluted Gastrografin were responsible, and trials have subsequently shown that diluted Gastrografin is safer and equally effective. 19,29 Enema protocols include 100 ml diluted four times with water and administered up to twice daily. Oral Gastrografin can be considered in those not vomiting.…”

Section: Discussionmentioning

confidence: 99%

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Distal Intestinal Obstruction Syndrome (DIOS) in Patients with Cystic Fibrosis After Lung Transplantation

Morton

Ansari

Glanville

et al. 2009

Journal of Gastrointestinal Surgery

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Distal Intestinal Obstruction Syndrome (DIOS) in Patients with Cystic Fibrosis After Lung Transplantation

Morton

Ansari

Glanville

et al. 2009

Journal of Gastrointestinal Surgery

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“…They stated that in cases of atresia or volvulus, RA was their operative treatment of choice after distal irrigation. The authors later added two more patients to their RA series making a total of 17 patients in their centre [11]. Unfortunately, the authors did not mention specific complications and outcomes of the patients in their series that underwent RA.…”

Section: Discussionmentioning

confidence: 99%

Primary resection and anastomosis for complicated meconium ileus: a safe procedure?

et al. 2007

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Various options are available for the surgical treatment of meconium ileus (MI). This paper examines the use of resection and primary anastomosis as the favoured option for the treatment of complicated meconium ileus. This was a retrospective study. All patients (13 children) with MI treated with primary resection and anastomosis (RA) in the 10-year period (1996-2005) at St Mary's Hospital in Manchester were identified. The case notes were retrieved. The gestational age, type of surgery, length of bowel resection and complications were recorded. Out of 13 (3 males, 10 females), 7 had severely dilated bowels, 5 had perforation and 1 had volvulus. Mean length of bowel resection was 33.8 cm (range 20-50 cm). Overall survival in this group was 85%. Seven patients (54%) developed complications. Four (31%) had surgical complications: two anastomotic strictures with adhesions, one adhesive intestinal obstruction and one intra-abdominal drain retraction. Primary resection and anastomosis is a safe option in the treatment of complicated meconium ileus. It has the advantage of less hospital stay and avoids a secondary laparotomy for closure of the stoma.

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“…As expected, pulmonary complications following these surgical interventions were the biggest source of morbidity and mortality. The overall mortality rate was 11%, with 91% of the deaths attributed to postoperative pulmonary complications [8].…”

Section: Discussionmentioning

confidence: 97%

“…Postoperative complications are frequent in patients with CF. In a retrospective review, Escobar et al reported that 33 of 213 patients, 15.5%, suffered adhesive bowel obstruction with the majority of these obstructions occurring within the first postoperative year [8]. Eleven of the 33 patients with obstruction were managed conservatively, while the remaining 22 patients underwent a variety of operative procedures.…”

Section: Discussionmentioning

confidence: 99%

Radiographic reduction of intussusception in patients with cystic fibrosis

et al. 2007

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Cystic fibrosis (CF) is a genetic disorder affecting approximately one in 2,500 births in the United States. Nearly 1% of patients with CF will develop intussusception, which is commonly ileocecal and felt to be secondary to inspissated feces. These patients generally present before the age of ten. Once the diagnosis of intussusception is confirmed on ultrasound or CT, surgery has been the mainstay of treatment in this patient group. We propose the use of air and contrast enemas as effective and beneficial non-operative approach in these patients. Clinical and imaging findings in four children with known CF who presented with intestinal intussusception, average age 13.25 +/- 5.3 years (range 8-18 years) were reviewed. Patients were diagnosed using ultrasound (n = 3) or abdominal CT (n = 1). All patients suffered from an ileocolic intussusception. Air and Gastrografin(R) enemas were used in an attempt to reduce the intussusception. There were six separate successful intussusception reductions in four patients. Three patients required multiple attempts (2.3 +/- 0.6). Air enemas were used initially in all cases. Gastrografin(R) was used successfully following the failure of air enema in one patient. One patient suffered three separate intussusceptions over a period of 18 months, which were all successfully reduced using air. There were no complications and the patients tolerated the procedure well. Intussusception is an uncommon but serious complication in children with CF. While surgical reduction has been the mainstay of treatment for these patients, we demonstrated that reduction of an intussusception using air or contrast can be accomplished safely, without anesthesia, and should be the initial treatment option.

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Surgical considerations in cystic fibrosis: A 32-year evaluation of outcomes

Cited by 71 publications

References 54 publications

Distal Intestinal Obstruction Syndrome (DIOS) in Patients with Cystic Fibrosis After Lung Transplantation

Distal Intestinal Obstruction Syndrome (DIOS) in Patients with Cystic Fibrosis After Lung Transplantation

Primary resection and anastomosis for complicated meconium ileus: a safe procedure?

Radiographic reduction of intussusception in patients with cystic fibrosis

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