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dc.contributor.authorWinter, D C
dc.contributor.authorMurphy, A
dc.contributor.authorKell, M R
dc.contributor.authorShields, C J
dc.contributor.authorRedmond, H P
dc.contributor.authorKirwan, W O
dc.date.accessioned2012-02-03T15:08:30Z
dc.date.available2012-02-03T15:08:30Z
dc.date.issued2012-02-03T15:08:30Z
dc.identifier.citationDis Colon Rectum. 2004 May;47(5):697-703. Epub 2004 Mar 25.en_GB
dc.identifier.issn0012-3706 (Print)en_GB
dc.identifier.issn0012-3706 (Linking)en_GB
dc.identifier.pmid15037937en_GB
dc.identifier.doi10.1007/s10350-003-0120-8en_GB
dc.identifier.urihttp://hdl.handle.net/10147/208959
dc.description.abstractPURPOSE: 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.
dc.language.isoengen_GB
dc.subject.meshAdministration, Topicalen_GB
dc.subject.meshAgeden_GB
dc.subject.meshAnal Canal/drug effects/*physiopathology/*surgeryen_GB
dc.subject.meshAnastomosis, Surgicalen_GB
dc.subject.meshDouble-Blind Methoden_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshMaleen_GB
dc.subject.meshManometryen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshNitroglycerin/*administration & dosageen_GB
dc.subject.meshOintmentsen_GB
dc.subject.mesh*Surgical Staplingen_GB
dc.subject.meshVasodilator Agents/*administration & dosageen_GB
dc.titlePerioperative topical nitrate and sphincter function in patients undergoing transanal stapled anastomosis: a randomized, placebo-controlled, double-blinded trial.en_GB
dc.contributor.departmentAcademic Department of Surgery, National University of Ireland, Cork University, Hospital, Wilton, Ireland. winterd@indigo.ieen_GB
dc.identifier.journalDiseases of the colon and rectumen_GB
dc.description.provinceMunster
html.description.abstractPURPOSE: 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.


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