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    Perioperative topical nitrate and sphincter function in patients undergoing transanal stapled anastomosis: a randomized, placebo-controlled, double-blinded trial.

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    Authors
    Winter, D C
    Murphy, A
    Kell, M R
    Shields, C J
    Redmond, H P
    Kirwan, W O
    Affiliation
    Academic Department of Surgery, National University of Ireland, Cork University, Hospital, Wilton, Ireland. winterd@indigo.ie
    Issue Date
    2012-02-03T15:08:30Z
    MeSH
    Administration, Topical
    Aged
    Anal Canal/drug effects/*physiopathology/*surgery
    Anastomosis, Surgical
    Double-Blind Method
    Female
    Humans
    Male
    Manometry
    Middle Aged
    Nitroglycerin/*administration & dosage
    Ointments
    *Surgical Stapling
    Vasodilator Agents/*administration & dosage
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    Metadata
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    Citation
    Dis Colon Rectum. 2004 May;47(5):697-703. Epub 2004 Mar 25.
    Journal
    Diseases of the colon and rectum
    URI
    http://hdl.handle.net/10147/208959
    DOI
    10.1007/s10350-003-0120-8
    PubMed ID
    15037937
    Abstract
    PURPOSE: The use of transanal stapling devices may impair continence because of digital dilatation and/or instrumentation. This study assessed the effect of pharmacological dilatation of the sphincter prior to stapler insertion. METHODS: A randomized, placebo-controlled, double-blinded study of 60 patients undergoing transanal stapled anastomosis was undertaken. Consenting patients were randomly assigned to receive a single intraoperative dose of topical 0.2 percent nitroglycerin (glyceryl trinitrate) ointment or nitroglycerin-free placebo. All patients were assessed preoperatively and postoperatively by clinical methods (Wexner incontinence scores and examination), anorectal manometry by a station pull-through technique, and endoanal ultrasonography. RESULTS: Intraoperative mean (+/-SEM) resting pressures (mmHg) were significantly reduced by nitroglycerin compared with prenitroglycerin levels (9.9 +/- 0.9 vs. 50.5 +/- 2.7; P = 0.002) or controls (56.0 +/- 3.2; P = 0.001). Twenty-one of the 28 controls (75 percent) but only 4 of the 32 patients in the nitroglycerin group (12.5 percent) required digital dilatation to insert the stapling instrument ( P = 0.003). Squeeze pressures were unaltered by the intervention but mean resting pressures were higher in the nitroglycerin group postoperatively (52.9 +/- 3.2 - 31.6 +/- 1.3 = 21.3 mmHg; 95 percent confidence interval, 14-27). Incontinence scores were lower in the nitroglycerin group at the 3-month (1.1 +/- 0.2 vs. 4.6 +/- 0.3; P = 0.003) and 12-month (0.9 +/- 0.1 vs. 4.4 +/- 0.3; P = 0.002) clinic visits. CONCLUSION: Preoperative nitroglycerin dilatation protects sphincter function in patients undergoing transanal stapled anastomoses.
    Language
    eng
    ISSN
    0012-3706 (Print)
    0012-3706 (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1007/s10350-003-0120-8
    Scopus Count
    Collections
    Cork University Hospital

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