title: A surgeon's help with the management of bowel problems related to gynecology is truly needed - comparison of two periods spanning 24 years.
abstract: OBJECTIVE
  Colorectal surgeons are frequently on call to provide help to gynecologists who are managing bowel problems that occur either during or following gynecological surgery. This is a retrospective analysis of a single surgeon's experiences associated with such instances. The analysis focuses on whether there have been any changes in referral patterns, surgical techniques and/or results.
  
  
  METHODS
  From July 1984 to June 2008, 282 patients were operated on by a single colorectal surgeon, for problems that were related to gynecology. These consisted of 137 patients operated on during the first 12-year period, from July 1984 to June 1996. During this first period, 85 patients were operated on for cervical cancer related problems, 39 patients were operated on for problems related to other gynecological malignancies and nine patients were operated on for iatrogenic bowel injury during surgery. During the second 12-year period, from July 1996 to June 2008, 145 patients were operated on. Of these, 85 patients were operated on for cervical cancer related problems, 44 patients were operated on for problems related to other gynecological malignancies and eight patients were operated on for iatrogenic bowel injury during surgery.
  
  
  RESULTS
  During the first 12-year period, six operations were pelvic exenterations for primary gynecological malignancies or recurrences. One hundred and one patients received stomas during their first operation. Twenty-five patients encountered various complications. Postoperative death occurred in five patients. During the second 12-year period, 12 operations were pelvic exenterations for primary gynecological malignancies or recurrences. Eighty-seven patients received stomas during their first operation. Thirty-seven patients encountered various complications. Postoperative death occurred in six patients.
  
  
  CONCLUSIONS
  Gynecological problems frequently involve the colon or rectum. Cervical cancer related problems remain the most common type necessitating help from a colorectal surgeon. In spite of advances in surgical management, stomas are still frequently unavoidable in order to cure a patient or improve the patient's quality of life. Appropriate management of problems by a colorectal surgeon in relation to gynecology is important and in the best interests of the patient.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Taipei Mackay Memorial Hospital, Taipei, Taiwan. tzuchi@ms2.mmh.org.tw
authors.forename: Tzu-Chi
authors.initials: TC
authors.lastname: Hsu
authors.forename: Ting-Ming
authors.initials: TM
authors.lastname: Huang
authors.forename: Yuh-Cheng
authors.initials: YC
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D003107:Colorectal Surgery / Q000639:trends*; D004766:Enterostomy / Q000009:adverse effects; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications / Q000473:pathology / Q000601:surgery; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010385:Pelvic Exenteration / Q000009:adverse effects; D012002:Rectal Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D012006:Rectovaginal Fistula / Q000209:etiology / Q000601:surgery; D012017:Referral and Consultation / Q000639:trends*; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult