Publications by authors named "Alex J Ky"

3 Publications

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Preliminary Report from the Pelvic Floor Disorders Consortium: Large Scale Data Collection through Quality Improvement Initiatives to Provide Data on Functional Outcomes Following Rectal Prolapse Repair.

Dis Colon Rectum 2021 Apr 26. Epub 2021 Apr 26.

Pelvic Floor Disorders Center, Section of Colon and Rectal Surgery, Massachusetts General Hospital, Boston, MA Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH Department of Surgery, The University of Chicago Medicine, Chicago, IL Department of Surgery, Mount Sinai School of Medicine, New York, NY Pelvic Floor Disorders Center, Section of Colon and Rectal Surgery, Massachusetts General Hospital, Boston, MA Division of Colorectal Surgery, University of Massachusetts-Baystate, Springfield, MA Department of General Surgery, Division of Colorectal Surgery, Stanford University Medical Center, Stanford, CA Pelvic Floor Disorders Center, Section of Colon and Rectal Surgery, Massachusetts General Hospital, Boston, MA.

Background: The surgical management of rectal prolapse is constantly evolving, yet numerous clinical trials and meta-analyses studying operative approaches have failed to make meaningful conclusions.

Objective: To report on preliminary data captured during a large-scale quality improvement initiative to measure and improve function in patients undergoing rectal prolapse repair.

Design: Retrospective analysis of prospectively collected surgical quality improvement data. Settings: This study was conducted at 14 tertiary centers specializing in pelvic floor disorders from 2017 to 2019.

Patients: A total of 181 consecutive patients undergoing external rectal prolapse repair.

Main Outcome Measures: Preoperative and three-month postoperative Wexner Incontinence Score and Altomare Obstructed Defecation Score.

Results: The cohort included 112 patients undergoing abdominal surgery 71 suture rectopexy /56% MIS, 41 ventral rectopexy/93% MIS). Those offered perineal approaches (N=68) were older (median age 75 vs 62, p<0.01) and had more comorbidities (ASA3-4: 51% vs. 24%, p<0.01), but also reported higher pre-intervention rates of fecal incontinence (Wexner 11.4 ± 6.4 vs. 8.6+/-5.8, p<0.01). Patients undergoing perineal procedures had similar incremental improvements in function after surgery as patients undergoing abdominal repair (change in Wexner -2.6 ± 6.4 vs. -3.1 ± 5.6, p= 0.6; change in Altomare -2.9 ± 4.6 vs. -2.7 ± 4.9, p=0.8). Similarly, posterior suture rectopexy and ventral mesh rectopexy patients had similar incremental improvements in overall scores; however, ventral mesh rectopexy patients had a higher decrease in the need to use pads after surgery.

Limitations: Retrospective data analysis and three-month follow up.

Conclusions: Functional outcomes improved in all patients undergoing prolapse surgery. Larger cohorts are necessary to show superiority amongst surgical procedures. Quality improvement methods may allow for systematic, yet practical acquisition of information and data analysis. We call for the creation of a robust database to benefit this patient population. See Video Abstract at http://links.lww.com/DCR/B581 .
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http://dx.doi.org/10.1097/DCR.0000000000001962DOI Listing
April 2021

Collagen fistula plug for the treatment of anal fistulas.

Dis Colon Rectum 2008 Jun 11;51(6):838-43. Epub 2008 Mar 11.

Mount Sinai Medical Center, 5 E. 98th St., Box 1273, New York, NY 10029, USA.

Purpose: This study was designed to evaluate the efficacy of the Surgisis (Anal Fistula Plug) in multiple patients at our institution and present early clinical results along with notable clinical observations from our experience.

Methods: This was a prospective analysis of all patients who received the Anal Fistula Plug for treatment of anorectal fistulas between April 2006 and February 2007. All tracts were irrigated with peroxide, the plug was inserted in the tract, and buried at the internal opening with 2-0 vicryl and mucosal advancement flap. Statistical analysis was performed with Fisher's exact test.

Results: Forty-five patients were treated with the Anal Fistula Plug and one patient was lost to follow-up. There were 27 males and 17 females with average age of 44.1 years treated for simple (n = 24) or complex (n = 20) fistulas. Preliminary results indicated an 84 percent healing rate by 3 to 8 weeks postoperatively, which progressively declined from 72.7 percent at 8 weeks to 62.4 percent at 12 weeks and 54.6 percent at a median follow-up of 6.5 (range, 3-13) months. Long-term Anal Fistula Plug closure rate was significantly higher in patients with simple than complex fistulas (70.8 vs. 35 percent; P < 0.02) and with non-Crohn's disease vs. Crohn's disease (66.7 vs. 26.6 percent; P < 0.02). Patients with two successive plug placements had significantly lower closure rates than patients who underwent placement of the plug once (12.5 vs. 63.9 percent; P < 0.02). No significant difference in closure rates were found between patients with one vs. multiple fistula tracts. Postoperative complications included perianal abscess in five patients (3 Crohn's disease, 2 non-Crohn's disease).

Conclusions: Anal Fistula Plug is most successful in the treatment of simple anorectal fistulas but is associated with a high failure rate in complex fistula and particularly in patients with Crohn's disease. Repeat plug placement is associated with increased failure. Given the relatively low morbidity associated with the procedure, Anal Fistula Plug should be considered as a first-line treatment for patients with simple fistulas and as an alternative in selected patients with complex fistulas.
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http://dx.doi.org/10.1007/s10350-007-9191-2DOI Listing
June 2008

One-stage laparoscopic restorative proctocolectomy: an alternative to the conventional approach?

Dis Colon Rectum 2002 Feb;45(2):207-10; discussion 210-1

Division of Colorectal Surgery and Minimally Invasive Surgery Center, Mount Sinai School of Medicine, New York, New York, USA.

Purpose: There is significant concern in the current literature over the safety of laparoscopic techniques in removal of the entire colon and rectum. The purpose of this study was to examine the results of a one-stage laparoscopic-assisted restorative proctocolectomy in patients with mucosal ulcerative colitis and familial adenomatous polyposis in a single institution experience.

Methods: All patients who underwent laparoscopic-assisted one-stage restorative proctocolectomy (29 mucosal ulcerative colitis; 3 familial adenomatous polyposis) over a 24-month period were followed up prospectively for short-term and long-term complications and functional outcome.

Results: There were 32 patients (17 males), with a median age of 32 years (range, 16-29 years). There were no conversions to open surgery. There were two intraoperative complications, an inconsequential rectal perforation during mobilization and one staple line misfire. There were 11 postoperative complications: 3 obstruction/ileus, 2 pouchitis, 2 wound infections, 2 strictures, 1 pelvic abscess, and 1 pouch leak (at the top of the "J"). Three patients required reoperation (1 temporary ileostomy, 1 lysis of adhesions, and 1 transpouch drainage). The median number of bowel movements was seven per day (range, 2-15).

Conclusion: A one-stage laparoscopic-assisted restorative proctocolectomy can be performed effectively and safely. Given that techniques in laparoscopic large-bowel surgery are still evolving rapidly, the role of this operation in the surgical treatment of patients with mucosal ulcerative colitis and familial adenomatous polyposis is likely to expand in the near future.
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http://dx.doi.org/10.1007/s10350-004-6149-5DOI Listing
February 2002