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Biomedical subjects

R R Dozois

Publications and source records attributed to R R Dozois.

At least 55 records · Page 3Linked to original sources
PubMed1995

Indeterminate colitis. Long-term outcome in patients after ileal pouch-anal anastomosis.

UNLABELLED: Uncertainty persists concerning the long-term results of ileal pouch-anal anastomosis performed for indeterminate colitis. PURPOSE: This study was designed to compare functional outcomes of ileal pouch-anal anastomosis in patients with typical chronic ulcerative colitis and indeterminate colitis. METHOD: Seventy-one ileoanal pouch patients were identified with a diagnosis of indeterminate colitis. Mean follow-up was 56 months. Outcomes were compared with 1,232 chronic ulcerative colitis patients after ileal pouch-anal anastomosis. Mean follow-up was 60 months. RESULTS: (mean +/- SD) There was no difference in the frequency of daily bowel movements (indeterminate colitis, 7 +/- 3, vs. chronic ulcerative colitis, 7 +/- 2). Daytime and nighttime incontinence rates were likewise similar. Prevalence of pouchitis was identical (33 percent). However, failure rate was higher in the indeterminate colitis group (indeterminate colitis, 19 percent, vs. chronic ulcerative colitis, 8 percent; (P = 0.03)). CONCLUSIONS: At a mean of nearly five years after surgery, failure appears to occur more frequently in patients with indeterminate colitis than in patients with chronic ulcerative colitis. However, the great majority of indeterminate colitis patients (> 80 percent) have long-term functional results identical to those of patients with chronic ulcerative colitis.

Adolescent↗
PubMed1995

Pouchitis disease course after orthotopic liver transplantation in patients with primary sclerosing cholangitis and an ileal pouch-anal anastomosis.

OBJECTIVE: Primary sclerosing cholangitis is associated with the development of pouchitis after ileal pouch-anal anastomosis for ulcerative colitis. This study determined the effect of liver transplantation for primary sclerosing cholangitis on the disease course of pouchitis. METHODS: Seven patients with an ileal pouch-anal anastomosis for ulcerative colitis underwent liver transplantation for primary sclerosing cholangitis. The medical record was reviewed to determine the pouchitis activity and pattern (no pouchitis, single acute, recurrent acute, chronic) before and after transplantation. RESULTS: Five of seven patients had pouchitis before transplant [recurrent acute (n = 3), chronic (n = 2)], and four of those five continued to have pouchitis after transplant (all chronic). Pretransplant sera were positive for antineutrophil cytoplasmic antibody in 6/6 patients, compared to 5/6 patients posttransplant. One patient with pouchitis pretransplant became negative for antineutrophil cytoplasmic antibody posttransplant but continued to have pouchitis. CONCLUSION: Pouchitis occurs frequently in patients with primary sclerosing cholangitis and an ileal pouch-anal anastomosis for ulcerative colitis. Liver transplantation does not alter the disease course of pouchitis for most of these patients.

Adult↗
PubMed1995

[Surgical treatment of ulcero-hemorrhagic rectocolitis].

When surgical treatment is indicated in the course of ulcerative colitis, several operations may be performed. In the vast majority of patients, total proctocolectomy and ileal pouch-anal anastomosis is the procedure of choice. Other operations (total proctocolectomy with Brooke ileostomy, total colectomy with ileorectal anastomosis or with Kock pouch) can also be used in certain circumstances. Postoperative quality of life must be considered before any decision is finalized.

Colectomy↗
PubMed1994

Comparing functional results one year and ten years after ileal pouch-anal anastomosis for chronic ulcerative colitis.

UNLABELLED: Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice for most patients with chronic ulcerative colitis. Long-term results, however remain undefined; the major concern is that function may deteriorate. PURPOSE: The aim of this study was to assess functional outcome in a subgroup of patients who have an IPAA for chronic ulcerative colitis for > 10 years. METHODS: Among 1400 IPAA patients, 75 consecutive subjects (31 females and 44 males; median age 31 at operation) were identified who had the procedure prior to 1982. All patients had functional results recorded 1 year and 10 years following ileostomy closure. RESULTS: There were four deaths during the follow-up period; none were pouch related. Two patients refused ileostomy closure. Of the remaining 69 patients, there were 8 (11 percent) failures, leaving 61 subjects available for study. Stool frequency (7 +/- 3, mean +/- SD) remained unchanged. Of the 50 subjects with initially excellent daytime continence, 39 (78 percent) remained the same, 10 (20 percent) developed minor incontinence, and 1 developed poor control after 10 years. Four of 10 subjects (40 percent) with initial minor daytime incontinence remained unchanged, 4 (40 percent) improved, and 2 (20 percent) worsened. The one subject with poor control at one year was unchanged. Nocturnal fecal spotting increased over the 10-year period but not significantly (38 percent vs. 52 percent; P = 0.08). CONCLUSIONS: After IPAA, functional results in terms of stool frequency and rate of fecal incontinence did not deteriorate with time.

Adolescent↗
PubMed1994

Strictureplasty for obstructive Crohn's disease: the Mayo experience.

BACKGROUND: Strictureplasty for obstructive Crohn's disease of the small bowel continues to gain favor throughout the world. Although the potential advantages of preserving intestinal length are obvious, the optimal clinical setting for performing strictureplasty remains to be determined. PATIENTS: Of 244 patients who underwent abdominal exploration for complications of Crohn's disease between Jan. 1, 1985, and Jan. 1, 1991, at the Mayo Clinic, 35 had a total of 71 strictureplasties. Concomitant resection of bowel with active disease was performed in 67% of the procedures. RESULTS: In this series, no perioperative deaths occurred, and no anastomotic leaks, enteric fistulas, or intra-abdominal abscesses were noted during a 3-year follow-up. The overall perioperative complication rate was 14%. Postoperatively, 33 of the 35 patients were able to resume enteral nutrition and discontinue medical treatments. The symptomatic recurrence rate at 3 years was 20%; six patients have required reoperation. CONCLUSION: These findings support the use of strictureplasty for isolated, quiescent, stenotic bowel lesions associated with Crohn's disease.

Adult↗
PubMed1993

The histological pattern and pathological involvement of the anal transition zone in patients with ulcerative colitis.

BACKGROUND: The aim was to determine whether the transitional epithelium (TE) of the anal transition zone (ATZ) was involved by chronic ulcerative colitis (CUC) and whether preserving the ATZ preserves the disease. METHODS: Proctocolectomy specimens from 50 CUC patients and 50 patients with rectal cancer serving as controls were stained with alcian-blue to map the ATZ, and biopsy specimens containing adjacent TE and rectal mucosa were examined. RESULTS: The mean inflammation score (0, none; 4, severe) in TE of controls was 0.4, whereas in CUC it was 0.5. However, the mean inflammation score of the rectal mucosa within the ATZ was 0.2 in controls and 2.6 in CUC (P < 0.001). Rectal columnar epithelium extended past half of the maximum length of TE in 75% of patients (65-83%; 95% CI) and was within 1 cm of the dentate line in 89% (81%-94%). CONCLUSIONS: Although the TE of the ATZ was not inflamed, the rectal mucosa within the ATZ was. Moreover, rectal mucosa traversed half of the length of the ATZ in 75% of patients and was within 1 cm of the dentate line in fully 89%. Preserving the ATZ may preserve the disease in the majority of patients with CUC.

Aged↗
PubMed1993

Complications and risk factors after ileal pouch-anal anastomosis for ulcerative colitis associated with primary sclerosing cholangitis.

OBJECTIVE: This study determined predictive factors for postoperative complications and outcome after ileal pouch-anal anastomosis in patients with ulcerative colitis and primary sclerosing cholangitis. SUMMARY BACKGROUND DATA: Patients with ulcerative colitis and primary sclerosing cholangitis treated by colectomy and ileostomy are at high risk of troublesome bleeding from peristomal varices. METHODS: Postoperative complications and outcome were assessed in 40 patients with ulcerative colitis and sclerosing cholangitis who received an ileal pouch-anal anastomosis between January 1981 and February 1990. RESULTS: Immediate postoperative and remote ileoanal anastomosis-related complications were high but related directly to the severity of liver disease. No patient had perianastomotic anal bleeding. CONCLUSIONS: In patients with both ulcerative colitis and primary sclerosing cholangitis, ileal pouch-anal anastomosis is safe and is not associated with perianastomotic bleeding.

Adult↗
PubMed1993

[Colorectal cancers associated with ulcero-hemorrhagic rectocolitis. Detection of and prognosis for postoperative patients].

Between January 1976 and December 1986, 86 patients underwent surgery for colorectal adenocarcinoma (AC) complicating ulcerative colitis (UC) at Mayo Medical Center in Rochester, Minnesota. Seventy-two percent were men, contrasting with only 55% in the population operated for UC without AC during the same time period at the same institution (p = 0.001). The mean duration of UC symptoms was 19.2 years. The diagnosis of cancer was established preoperatively in 65% of patients, while the remainder of patients, except for three (n = 30, 35%) were at high risk for cancer. A colonoscopy performed in 16 of those 30 patients less than six months prior to the operation did not detect cancer. Overall, cancer was either proven or highly suspected preoperatively in 96.5% of patients, while the sensitivity of colonoscopy was 78%. During the study period, histological tumor features, such as number of tumors, Dukes' stage, Broder's stage, and curative/palliative ratio, remained unchanged, and the five-actuarial survival of 50% did not improve with time (p = 0.37). Multivariant analysis indicated that Dukes' stage and male gender were two poor prognosis factors. For patients with long-standing UC, we offer either proctocolectomy, possibly with ileal pouch-anal anastomosis, or surveillance colonoscopy, emphasizing their respective hazards and limitations.

Adenocarcinoma↗
PubMed1993

[Complications and risk factors of ileo-anal anastomosis with reservoir for ulcero-hemorrhagic rectocolitis associated with primary sclerosing cholangitis].

The study determined predictive factors for postoperative complications and outcome after ileal pouch-anal anastomosis in patients with ulcerative colitis and primary sclerosing cholangitis. Patients with ulcerative colitis and primary sclerosing cholangitis treated by colectomy and ileostomy are at high risk of troublesome bleeding from peristomal varices. Postoperative complications and outcome were assessed in 40 patients with ulcerative colitis and sclerosing cholangitis who received in ileal pouch-anal anastomosis between January 1981 and February 1990. Immediate postoperative and remote ileoanal anastomosis-related complications were high but related directly to the severity of liver disease. No patient had perianastomotic and bleeding. In patients with both ulcerative colitis and primary sclerosing cholangitis, ileal pouch-anal anastomosis is safe and is not associated with perianastomotic bleeding.

Adolescent↗
PubMed1993

[Sexual function after ileo-anal anastomosis].

After restorative proctocolectomy, both men and women report an improved sexual life primarily because of a better general health. Sexual dysfunction has been reported by a few men who complain of lack of or retrograde ejaculation (2%) or impotence (3%). Sexual dysfunction, especially dyspareunia, can persist in as many as 20% of women after ileoanal anastomosis, but is less severe than preoperatively in most and is less common than after ileostomy, whether continent or not. Women with an ileal pouch-anal anastomosis can conceive, and have had successful deliveries, either vaginally or by cesarean section, without long-term detrimental effects on ileal reservoir function. Indeed, stool frequency increased and continence worsened in a small group of ileoanal anastomosis women but the changes were minimal and returned to predelivery status 3 months after delivery.

Adenomatous Polyposis Coli↗
PubMed1993

[Undetermined colitis].

Indeterminate colitis combines features of chronic ulcerative colitis and Crohn's colitis and contemplates a dilemma for the patient and surgeon contemplating ileal pouch anal anastomosis. Some series have reported a high incidence of failure of pouch procedures in patients with indeterminate colitis. A series reported by the authors in 1989 reported a failure rate on approximately 9% with indeterminate colitis. In updating this series with additional patients operated on since that time, the incidence in our series approaches 20%. We feel that an 80% success rate, however, justifies performing the ileal pouch anal procedure in carefully selected patients with indeterminate colitis, knowing that the failure rate may be somewhat higher than in patients with type ordainer chronic ulcerative colitis.

Colitis↗
PubMed1993

[Ileo-anal anastomosis: surgical anastomosis with mucosectomy or stapled anastomosis without mucosectomy?].

The ileal pouch-anal anastomosis procedure has become the procedure of choice for many patients with chronic ulcerative colitis and with familial adenomatous polyposis. The results in several thousand patients from many institutions are excellent. In an attempt to reduce the number of bowel movements and to improve continence, a modification of the original hand-sewn anastomosis has been proposed in which and ileal pouch distal rectal anastomosis is performed which, in turn, leaves from 1 to 3 cm of diseased rectal mucosa above the anal canal. Advocates of this modification state that resting pressure is higher and that continence, particularly nighttime continence, is significantly improved. Despite some apparent advantage, with less of a decrease in resting pressure and an advantage in ease of operation, no advantage over hand-sewn ileal pouch-anal anastomosis has been shown to-date in two prospective randomized trials in functional results or in complication rate. In addition, it is uncertain what the significance is of the small strip of diseased mucosa that i retained as far a recurrent disease, continuation of extra-intestinal manifestations of inflammatory bowel disease, and with risk of carcinoma. We believe that the stapled ileal pouch distal rectal anastomosis should be avoided in patients who have severe chronic ulcerative colitis low in the rectum or if there is proximal chronic ulcerative colitis with dysplasia or carcinoma. We also feel that this procedure should be avoided in patients with familial adenomatous polyposis and in patients who have extra-intestinal manifestations of inflammatory bowel disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenomatous Polyposis Coli↗
PubMed1992

Familial adenomatous polyposis: results following ileal pouch-anal anastomosis and ileorectostomy.

To compare the clinical and functional results of ileorectostomy (IR) and ileal pouch-anal anastomosis (IPAA) in patients with familial adenomatous polyposis (FAP), we reviewed the results of 94 IPAA patients and 21 IR patients who were operated upon between 1978 and 1988. The groups were similar with respect to age and sex. None of the patients died postoperatively. Postoperative complications occurred in 28 percent of the IPAA group and in 17 percent of the IR group (P greater than 0.1). Seven percent of IPAA patients described symptoms compatible with pouchitis. Sixty-one percent of IR patients required subsequent fulguration of rectal polyps at least once. IR patients had a mean (+/- SD) of 4 (+/- 2) stools per day, while IPAA patients had 5 (+/- 2) stools per day (P greater than 0.05). No significant difference in daytime soiling was present between IR (6 percent) and IPAA (4 percent). Nighttime spotting was also similar between the two groups. Nighttime soiling, however, was reported by 4 percent of IPAA patients but not by IR patients (P less than 0.05). One IPAA patient (1 percent) required pouch excision for a desmoid tumor, while two IR patients (11 percent) required proctectomy and ileostomy for recurrent dysplastic polyps (P less than 0.05). Adhesions and a shortened ileal mesentery prevented the construction of an ileoanal procedure in these latter patients. In conclusion, the postoperative complication rate and functional results are similar after IR and IPAA in patients with FAP; however, IR does not eradicate rectal polyps and may indeed preclude IPAA for those requiring subsequent proctectomy.

Adenomatous Polyposis Coli↗
PubMed1992

The fate of patients following polypectomy alone for polyps containing invasive carcinoma.

Eighty-two patients with colon and rectal polyps containing invasive adenocarcinoma treated by polypectomy alone were studied. Seven of 34 patients (21 percent) with sessile lesions had an adverse outcome, including five local recurrences and two distant metastases. They occurred from 4 to 68 months after the polypectomy. Forty-seven pedunculated polyps with invasion to the head (Level 1) or to the stalk (Level 3) and one polyp to the base of the stalk (Level 4) had no evidence of local recurrence or signs of metastasis. Twenty-eight percent of patients were found to have adenomatous polyps, and 4 percent had malignant polyps during the follow-up examinations (range, 3-119 months; mean, 53 months). The findings suggested that pedunculated polyps with invasion to the head (Level 1), neck (Level 2), or stalk (Level 3) can be safely treated with a complete polypectomy provided that the carcinoma is not undifferentiated. Sessile lesions as well as Level 4 pedunculated lesions should be treated aggressively. If resection is not performed, a long-term follow-up in these patients is essential.

Adenocarcinoma↗
PubMed1991

Prognosis of symptomatic duodenal adenomas in familial adenomatous polyposis.

The frequent association between familial adenomatous polyposis and duodenal tumors is increasingly recognized, yet many patients do not benefit from adequate diagnosis and follow-up of upper gastrointestinal polyps. A retrospective review of 14 patients with duodenal tumors associated with familial adenomatous polyposis was undertaken to assess the impact of early diagnosis by screening asymptomatic patients. Six of eight patients presenting with symptoms suggesting duodenal disease had invasive cancer. Four of these six patients died after surviving a mean of 13 months after diagnosis. In contrast, none of the six patients diagnosed after screening with upper gastrointestinal endoscopy has had invasive carcinoma. Early diagnosis and long-term surveillance of asymptomatic patients with familial adenomatous polyposis affords the opportunity to diagnose and treat duodenal tumors at an early stage, thereby, avoiding the dismal prognosis once invasive cancer has developed.

Adenoma↗
PubMed1991

Ileal pouch-anal anastomosis without ileostomy.

Thirty-seven patients underwent construction of a J-ileal pouch-anal anastomosis (IPAA) without temporary diverting ileostomy for chronic ulcerative colitis (CUC) (20 patients), familial adenomatous polyposis (FAP) (15 patients), indeterminate colitis (1 patient) and nonhereditary polyposis coli (1 patient) between 1981 and 1990. Seven of 20 CUC patients (35 percent) were on steroids at the time of hospital admission. The postoperative course of these patients was compared with that of a group of patients undergoing IPAA with ileostomy during that same time period and matched for age, sex, diagnosis, date of surgery, and steroid use. Eight patients (22 percent) in the group without ileostomy and four patients (11 percent) with ileostomy experienced one or more postoperative pouch-related complications. Complications requiring reoperation in patients without ileostomy occurred more frequently in patients either taking steroids or having previous pelvic radiation therapy. Functional results in patients undergoing one-stage procedures after a mean of 28 postoperative months were comparable to those in patients having staged procedures. Surgeons' criteria for a one-stage procedure in these patients should include absolute lack of tension on the anastomosis, good blood supply to the terminal ileum, good general health, and absence of recent intake of steroids at the time of surgery. We conclude that J-pouch construction with IPAA can be safely performed without diverting ileostomy, provided that these selection factors are taken into account.

Adenomatous Polyposis Coli↗
PubMed1991

Let sleeping dogs lie: role of the omentum in the ileal pouch-anal anastomosis procedure.

A surgical aphorism has long held that the omentum is the "watchdog of the abdomen." However, detractors believe that leaving the omentum behind after colectomy precipitates later small bowel obstruction. A retrospective comparison was made between a group of 406 patients (Group I) having omentectomy with proctocolectomy and ileoanal anastomosis and a group of 239 patients (Group II) having a similar procedure without omentectomy. Follow-up in this series of 645 patients was 4.3 +/- 2.1 years (mean +/- SEM). No difference was present in the rate of partial small bowel obstruction or complete small bowel obstruction between Group I patients (32 percent partial, 12 percent complete) and Group II patients (29 percent partial, 12 percent complete; P greater than 0.1). However, a better outcome with regard to postoperative sepsis and sepsis requiring operation was apparent in Group II patients retaining the omentum (4 percent and 3 percent, respectively) than in Group I patients (10 percent and 8 percent, respectively), in whom the omentum was removed (P less than 0.01). As this experience would support, we urge surgeons to "let sleeping dogs lie" and, when possible, retain the omentum when performing colectomy or proctocolectomy.

Adult↗