Publications by authors named "Kelly M Tyler"

4 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

Update: Telehealth in Colon and Rectal Surgery.

Dis Colon Rectum 2021 Jun;64(6):642-644

Division of Colorectal Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, California.

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http://dx.doi.org/10.1097/DCR.0000000000002019DOI Listing
June 2021

What Every Colorectal Surgeon Should Know About Telemedicine.

Dis Colon Rectum 2020 04;63(4):418-419

On behalf of the Healthcare Economics Committee of the American Society of Colon and Rectal Surgeons.

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http://dx.doi.org/10.1097/DCR.0000000000001635DOI Listing
April 2020

Successful sphincter-sparing surgery for all anal fistulas.

Dis Colon Rectum 2007 Oct;50(10):1535-9

Department of Surgery, Boston University School of Medicine, One Boston Medical Center Place, Boston, Massachusetts 02118, USA.

Purpose: This study was designed to evaluate the success of a sphincter-sparing treatment algorithm for patients with anal fistulas.

Methods: All patients with anal fistulas presenting to a single surgeon from 1999 to 2004 were retrospectively reviewed. Patients were treated according to a sphincter-sparing algorithm that utilized three operative approaches: subcutaneous fistulotomy, seton placement followed by fibrin glue, and/or seton placement followed by rectal advancement flap. Data analyzed included: age, gender, type of fistula, operative intervention, treatment success, and functional results.

Results: A total of 137 patients with anal fistulas were evaluated (age range, 23-74 years). Fistula etiology was cryptoglandular in 116 (85 percent), inflammatory bowel disease in 9 (7 percent), HIV in 3 (2 percent), and miscellaneous in 9 (7 percent). A subcutaneous fistulotomy was possible in 38 patients (28 percent), and all of these patients healed. The remaining 99 patients (72 percent) with transsphincteric fistulas underwent staged procedures: 89 patients (65 percent) underwent seton placement followed by fibrin glue closure (55 healed, 62 percent success rate), 9 patients had seton placement followed by flap (9 healed, 100 percent success rate), and 1 patient had seton placement alone. Of the 34 patients with fibrin glue failure, retreatment with glue was successful in 8 of 14 (57 percent success rate). The remaining 20 patients who declined glue retreatment and the 6 patients who failed glue retreatment underwent flap (26 healed, 100 percent success rate). All fistulas healed with an average of two operations per patient, and fecal continence was maintained in all patients.

Conclusions: By using staged operative procedures without any division of anal sphincter muscle, all fistulas healed with excellent functional results. A sphincter-sparing approach can successfully treat all anal fistulas.
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http://dx.doi.org/10.1007/s10350-007-9002-9DOI Listing
October 2007