A1218 SSAT ABSTRACTS GASTROENTEROLOGY~ Vol. 108, No. 4

• FUNCTIONAL RESULTS AFTER COLECTOMY FOR COLONIC INERTIA (CI). M.T. Dayton, M.D., Department of Surgery, University of Utah School o! Medicine. Salt Lake City, Utah.

Colonic inertia (CI) is a poorly understood disturbance of colonic motility characterized by severe, unremitting constipation, abdominal distention, and abdominal pain. CI usually responds poorly to laxative administration and in its severe stages does not respond to any conservative treatment modality. This study was conducted to assess the functional results of total colectomy as definitive treatment in the management o! this debilitating condition. Some 21 patients underwent total abdominal colectomy (TAC) with ileoproctostomy (18) or Brooke ileostomy (3) as treatment for CI between 1984 and 1994 at the Univ. of Utah. All 21 patients (100%) were female with an average age ct 41, ranging from 18 to 63. Mild to moderate constipatign existed for a mean 20 years while severe constipation was present for 15 months prior to surgical therapy. Presenting symptoms included severe constipation (100%), bloating (87%), and abdominal pain (78%). Without laxatives, mean interval between stooling was 13 days, while it was 5 days with laxatives. Diagnostic workup included sitz marker transit study, barium enema and anal manometry in all patients. Grossly, the resected colon was characterized as redundant and floppy in 77% while microscopically, melanosis coil was present in 50%; no patient had absence of neuroentedc plexuses. The most common postoperative complications included paralytic Ueus (64%) and small bowel obstruction (22%). Stool frequency at discharge was 7.8, while it was 4.9 at 1 month and 4 at 6 months. Incontinence occurred in 2 patients (9%) while recurrent intestinal inertia was noted in 2 (9%). Some 18 (86%) patients surveyed described their results as "good" or "excellent" while 2 had "poor" results and are considered failures. We conclude that TAC is an effective treatment modality in the management ol selected patients with constipation who meet the criteria for CI.

THE PROGNOSTIC VALUE OF DNA CONTENT IN COLORECTAL CANCER D. B. Ding and J. Li, Department of General Surgery, Affiliated Hospital, Shandong medical University, Jinan, Shandong, P.R. China

To assess the prognostic value of DNA content in colorectal cancer, 55 patients who underwent radical surgery were retrospectively studied. DNA content was analyzed by image analysis of paraffin-embedded colorectal cancer tissue in all patients. In a slide integrated optical density of 100 to 150 nuclei of tumor cells was measured, and that of more than 80 peripheral lymphocytes as diploid standard. The ratio of mean optical density of tumor ceils to that of lymphocytes was determined ~is DNA index (DI). DI less than 1.25 (including 1.25) was considered as diploid, more than 1.25 as heteroploid. From 0.75 to 3.5 was distribution of DI, in which 13 cases were diploid(23.6%), 42 cases heteroploid(76.4%). The five-year survival rate in the patients with diploid DI (76.9%) was significantly higher than that in the patients with heteroploid DI (45.2%) (p=0.045). DI in the patients with a survival of 5 years (1.573+ 0.109, mean+ SE) was lower than that in the patients with a survival of less 5 years (2.037+ 0.181, mean+ SE) (p=0.008). No significant correlation was found between DNA content and age, sex, tumor size, Duke stage, histological differentiation. Our conclusions are: 1). There is a negative correlation between DNA content of tumor cell and five-year survival rate. 2).DNA content is an independent prognostic factor in colorectal cancer.

THE VALUE OF PREOPERATIVE ANGIOGRAPHY IN ELECTIVE HEPATIC RESECTIONS. E. G. Elias and S, 0. Pals, University of Maryland, Baltimore, Maryland.

Major liver resections for benign and malignant tumors is becoming an increasingly common procedure. It provides significant survival advantage and palliation. However, the operative mortality has been reported to range from 3-17%. The preoperative evaluation of the patients by CT scans of the abdomen followed by MRI of the liver, as well as intraoperative sonogram, added valuable information with regard to the extent of the disease add resectability. Carefulstudy of the preoperative angiography of the celiac axis and superior mesenteric artery with venous phase in 53 consecutive patients have yielded extremely important information with regard to anomalies of the hepatic artery. Some of these anomalies indicated easier and safer resections while others suggested unresectability. Thirty two patients underwent hepatic resections without mortality. Included in the resected group were 3 patients who required right hepatic lobectomy with a dominant right hepatic artery and almost nonexistent left hepatic artery. These patients underwent preoperative embolization of their right hepatic arteries, with transient rise in the transaminases, six weeks later, they underwent safe right lobectomies. Intraoperative sonogram findings converted 2 cases from resectable to nonresectable. Conclusions: Preoperative angiographic evaluations allow for patient selection for hepatic resection. Embolization of the dominant hepatic artery, 6 weeks prior to surgery, allowed sufficient collaterization to the remaining lobe and sa~e resection.

SAFETY OF INTRACORPOREAL ANASTOMOSIS IN LAPAROSCOPIC COLORECTAL RESECTIONS. K. W. EU, M.D.. J. W. Milsom. M.D.. and V. W. Fazio, M.D., Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio

Most laparoscopic intestinal resections (LIR) reported thus far are laparoscopic-assisted pro- cedures, in which the anastomosis is performed extracorporeally. An intracorporeal LIR entails mobilization of the colon, intraperitcneal lig- ation of vessels and an anastomosis all performed entirely within the abdominal cavity. Purpose of this study was to determine the safety of per- forming stapled intracorporeal anastomosis (ICA) following LIR. Procedures were performed by a surgical team trained in laparoscopic intestin- al surgery. Our hypothesis was ICA in LIR is safe. Data on 31 prospectively accumulated patients (14 men, 17 women, median age 46) with LIR and ICA performed over 29 months was review- ed. Diagnoses were: Cancer(12), Diverticular Disease (8), Crohn's(3), Previous Hartmanns'(3), Familial Polyposis(2), and others(3). Procedures were proctosigmoidectomy(14), right colectomy(7), total colectomy(4) and Hartmanns' closure(3). Anastomoses were performed with either a circular stapler (size 29or33) inserted transanally or a functional end-to-end anastomoses with the lap- aroscopic EndoGIA stapler. Intraoperative comp- lications (Cx) were seen in one patient with trocar site bleeding. Early postop Cx included flank hematoma(1), DVT(1), urinary retention(l), small bowel obstruction(l) and left colon ischem- ia requiring laparotomy(1). The final patient expired from sepsis unrelated to the anastomosis. No cases of anastomotic leak or pelvic sepsis were noted. One patient developed mild stenosis of the colorectal anastomosis which responded to simple dilation. Creation of a stapled ICA under laparoscopic guidance is safe during LIR.