5 research outputs found

    Quality of Life after Emergency Hartmann’s Procedure: A Single Centre Retrospective Study

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    Background: Hartmann?s Procedure (HP) is the resection of the recto-sigmoid colon and creation of an end colostomy. Quality of Life (QoL) is increasingly considered before surgical intervention. This study assesses the patient?s perspective (QoL) before the HP, while the stoma is present and after reversal. Methods: Considered were patients who underwent emergency HP at our institution, between March 2014 and September 2017. The World Health Organization quality of life abbreviated questionnaire (WHOQOL-BREF) was used. An invitation letter and a copy of the questionnaire were sent to the patients, followed by a phone interview. Each patient completed the same questionnaire in relation to three time periods: Before Hartmann?s HP (BH), after Hartmann?s HP with Stoma Present (SP) and after Stoma Reversal (SR). Twice or 3 times, if the stoma was not reversed or was reversed. Results: Eighty-seven patients underwent emergency HP; 38 (43.7%) participated in the study. Fourteen (36.8%) patients had their stomas reversed. No difference in Qol, satisfaction with health, physical health, social relationships and environment between the periods BH vs. SP and BH vs. SR. There was an improvement from SP to SR. Psychological health scores were worse from BH to SP, but better from the SP to SR periods. Complications were the only predictor of outcome, except in psychological health and only after reversal of stoma. Conclusion: Emergency HP does not lower the general QoL but has a negative impact on psychological health. Stoma reversal engenders positive changes in QoL perception, while morbidity after stoma reversal predicts poorer outcomes.The article is available via Open Access. Click on the 'Additional link' above to access the full-text.Unknow

    Early management of meconium ileus in infants with cystic fibrosis: A prospective population cohort study

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    Background: Contemporary early outcome data of meconium Ileus (MI) in cystic fibrosis (CF) are lacking on a population level. We describe these and explore factors associated with successful non-operative management. Methods: A prospective population-cohort study using an established surveillance system (BAPS-CASS) was conducted October 2012–September 2014. Live-born infants with bowel-obstruction from inspissated meconium in the terminal ileum and CF were reported. Data are described as median (interquartile range, IQR). Results: 56 infants were identified. 14/56(25%) had primary laparotomy (13/23 complicated MI, 1/33 simple), the remainder underwent contrast enema. Twelve, (12/33 (36%) with simple MI) achieved decompression. 8/12 (67%) who decompressed had &gt;1 enema vs 3/20 (15%) with simple MI who had laparotomy after enema. The number of enemas per infant (1–4), contrast agents and their concentration, were highly variable. Enterostomy was formed at 24/44(55%) of laparotomies. In infants with simple MI, time to full enteral feeds was 6 (2–10) days in those decompressing with enema vs 15 (9–19) days with laparotomy after enema. Case fatality was 4% (95% CI 0.4–12%). Two infants, both preterm died, both in the second month after birth. Conclusions: Infants with simple MI achieving successful enema decompression were more likely to have had repeat enemas than those who proceeded to laparotomy. Successful non-operative management was associated with a shorter time to full feeds. The early management of infants with MI is highly variable and not standardised across the UK and Ireland.</p
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