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Results for “Proctocolectomy, Restorative”

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PubMed1989

Multivariate analysis of factors influencing the results of restorative proctocolectomy.

Univariate and multivariate analysis has been used to assess the influence of 14 variables on the results of 65 consecutive ileoanal pouch procedures over 5 years. There were 9 failures requiring intubation, ileosomy or pouch excision. There was a significant association between failure and pelvic sepsis (p less than 0.05; n = 8), endoanal mucosectomy (p less than 0.05; n = 7), preservation of a long rectal cuff (p less than 0.05; n = 5) and lack of experience with the operation (p less than 0.05; n = 8). Of 49 patients with preoperative evidence of ulcerative colitis, 3 are now known to have Crohn's disease. The only factor having a significant adverse influence on complications was endoanal mucosectomy (p less than 0.01). Functional outcome was significantly impaired in patients who developed pelvic sepsis (p less than 0.001), a post-operative fistula (p less than 0.05) and who had an endoanal mucosectomy (p less than 0.05). Success with ileo-anal pouch reconstruction increases with experience. Avoidance of sepsis is associated with a lower failure rate, improved functional results and reduced hospital stay. Preliminary colectomy is also advised to exclude Crohn's disease if the diagnosis is in question.

Adult↗
PubMed1987

Modified quadruple-loop (W) ileal reservoir for restorative proctocolectomy.

Reconstructive ileal pouch procedures are well-accepted alternatives to a permanent ileostomy in select patients requiring proctocolectomy for ulcerative colitis and familial polyposis. Double-, triple-, and quadruple-loop and lateral isoperistaltic designs have been described; however, the ideal pouch capacity and configuration are still debatable. Evidence has been reported that improved functional results and lower stool frequency with less antidiarrheal medication can be achieved with larger volume reservoirs. We describe a new modification of a quadruple-loop pouch that has been successfully performed in 10 patients. This new approach to pouch construction produced excellent functional results 6 to 12 months after ileostomy takedown and was easier to construct and engage into the muscular cuff of the distal rectum than quadruple-loop pouches of equal length loops.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

Restorative proctocolectomy with ileal reservoir.

119 patients (ulcerative colitis 98, polyposis 20, Hirschsprung's disease 1) were treated between 1976 and 1985. There were 1 operative death (0.8 per cent) and 7 failures (5.9 per cent). Three- (68), two- (13) and four-loop (37) reservoirs were constructed. The ileoanal anastomotic complication rate was 25, 15 and 8 per cent respectively. Mean frequency of defaecation was 4.2 +/- 1.3. Continence was normal in 77 per cent; 4 per cent had a significant faecal leakage. Modification in reservoir design has completely avoided the need to catheterize. Quality of life after the operation was preferred to an ileostomy by 96 per cent of patients with an intact reservoir.

Adolescent↗
PubMed2004

Laparoscopic proctocolectomy with restorative ileal-anal pouch.

OBJECTIVE: The aim of the study was to analyse the outcome of restorative proctocolectomy carried out by laparoscopic surgery. METHODS: A prospectively collected electronic database of all colorectal laparoscopic procedures performed between April 2001 and July 2003 has been used to identify surgical outcomes in 14 consecutive patients who have undergone laparoscopic RPC. RESULTS: Fourteen patients (5 male), median BMI 24 kg/m(2) have undergone restorative laparoscopic proctocolectomy over a two year period: 13 (ulcerative colitis, one with cancer) and 1 (FAP). The median operation time was 260 min; time has not decreased with experience. There were no intra-operative surgical complications or deaths. Patient controlled analgesia continued for a median of 36 h. The median time to diet was 48 h and median hospital stay 7 days; three patients required nasogastric aspiration for delayed gastric emptying. Eighteen regional lymph nodes were retrieved local to the carcinoma. There was one anastomotic leak. All covering stomas were closed by 6 months (12 by eight weeks). All 14 patients are fully continent, able to suppress urgency and have a median pouch frequency of 4/24 h. None admit to having problems with potency, orgasm sensation, ejaculation, micturition. One lady reports dysparunia. All are highly satisfied with functional outcome and cosmesis. CONCLUSION: We are encouraged to continue to offer our patients the option of a laparoscopic resection.

Adult↗
PubMed2005

Pinealoblastoma in a patient with familial adenomatous polyposis: variant of Turcot syndrome type 2? Report of a case and review of the literature.

We report a case of a 23-year-old Turcot female patient who was first diagnosed as having a pinealoblastoma. Thyroid papillary carcinoma was diagnosed a few months later, and multiple colonic polyps were detected three years after that. A genetic workup revealed an APC gene mutation in her family. Long-term survival (i.e., >5 years) of pinealoblastoma is considered to be 20 percent. A review of 25 documented Turcot cases determined that the average age at death is 20.3 years, raising the difficult question of whether she should undergo restorative proctocolectomy. Restorative proctocolectomy may itself cause major morbidity but is currently the only way to prevent colon cancer.

Adenomatous Polyposis Coli↗
PubMed1994

[Technique and results of the ileoanal pouch after proctocolectomy].

Nowadays restorative proctocolectomy and ileal pouch-anal anastomosis represent the standard procedure in the treatment for ulcerative colitis and familial polyposis. Although various pouchdesigns are described, the J-pouch is the one most frequently used. This study reviewed 311 operations of restorative proctocolectomy and ileal pouch-anal anastomosis between January 82 and December 93. The indication was ulcerative colitis in 234 and familial polyposis in 77 cases. In 67% of the cases the standard two-stage procedure involving secondary ileostomy closure was chosen. Due to the complex nature of the operation, postoperative morbidity--which is higher for ulcerative colitis--must not be undermined. Complete exstirpation of the pouch was required in 4.2% of the patients with ulcerative colitis and in one case with familial polyposis. In 12.4% and 1.3% a severe pouchitis was found in ulcerative colitis and familial polyposis respectively. In general postoperative functional results were satisfactory. Continence was established in over 90% of the patients while the mean stool frequency was 6 per day.

Adenomatous Polyposis Coli↗
PubMed1998

[Quality of life after proctocolectomy for ulcerative colitis].

Nowadays, restorative proctocolectomy is considered the "gold standard" in the surgical therapy of ulcerative colitis. Alternative procedures such as Brooke ileostomy or Kock pouch are limited to special indications. Preservation of function is the decisive advantage of the ileoanal pouch, but preservation of function is not equal to quality of life. Quality of life is a multidimensional concept that is difficult to define and measure. Quality of life can only be assessed by standardized and validated quality-of-life questionnaires. Preoperatively, patients with ulcerative colitis have a restricted quality of life, depending on the intensity of their disease. Proctocolectomy is the curative therapy and improves quality of life. When evaluating quality of life it is not essential if patients are treated by Brooke ileostomy or restorative proctocolectomy. The advantage of restorative proctocolectomy is the improvement in some aspects such as sexuality and physical activity. The "Total Quality-of-Life Index" is not improved. Preoperatively, patients should be informed that preservation of function by restorative proctocolectomy is accompanied by an increased postoperative morbidity in comparison to other procedures. Decreased quality-of-life results when complications occur postoperatively that cannot be controlled over a long period of time. In some cases excision of the ileoanal pouch may be the most sensible way of solving the problems. On the other hand, patients without complications and good function after ileoanal pouch procedure may achieve a quality of life comparable to that of healthy controls. Preoperatively, patients should be aware of this risk-benefit relationship and should share the responsibility of the decision for or against restorative proctocolectomy.

Colitis, Ulcerative↗
PubMed2000

[Surgery of hereditary colorectal carcinoma].

Hereditary colorectal cancer syndromes account for about 7% of all colorectal carcinomas. The most frequent form is Hereditary Nonpolyposis Colorectal Cancer (HNPCC). Identification, cloning and sequence analysis of the predisposing genes enables identification of mutation carriers and non-mutation carriers, respectively. These genetic informations can be used in an individually tailored clinical surveillance program and may ultimately result in standard preventive surgical treatment. In classical FAP the surgical standard is performing a restorative proctocolectomy. It is still unclear now, if this procedure should be modified in attenuated forms (colectomy with ileorectostomy). Due to a high rate of synchronous and metachronous carcinomas a subtotal colectomy in the case of first colon cancer seems to be indicated in HNPCC patients. A proctocolectomy or a restorative proctocolectomy should be weighed in case of carcinomas in the lower rectum. These procedures should be performed under the precondition of identification of the pathogenic germline mutation in the patient, only. In addition, a synchronous prophylactic hysterectomy with oophorectomy should be recommended postmenopausal gene carriers. Intensive counseling of the patient should proceed these preventive procedures involving surgeons, gastroenterologists, geneticists, molecular biologists, gynecologists, physicians and psychologists. It is recommended to have patients treated exclusively in specialized centers. Currently, six interdisciplinary centers for cancer surveillance and early diagnosis in hereditary colorectal cancer are being sponsored in Germany by the Deutsche Krebshilfe since 1999. In the future clinical studies have to be conducted to evaluate the efficacy of extended colorectal resections versus efficacy of surveillance and conventional resections according to general oncological principles.

Adenomatous Polyposis Coli↗
PubMed2007

Long-axis rotational volvulus in a W ileoanal pouch: an unusual but potentially preventable problem. Report of a case.

PURPOSE: This study was designed to report long-axis rotational volvulus, an unusual long-term complication of restorative proctocolectomy. METHODS: A MEDLINE search using the keywords, pouch volvulus, pouch complications, ileoanal pouch volvulus, restorative proctocolectomy volvulus, restorative proctocolectomy complications, W-pouch, and early and late complications, was performed and yielded no previous reports. RESULTS: We describe pouch gangrene secondary to volvulus in a W-pouch four years after restorative proctocolectomy for ulcerative colitis. Early recognition by clinical features, pouchoscopy, and soluble contrast studies are crucial if pouch salvage by pouchpexy is to be successful. CONCLUSIONS: Acute necrosis of the ileoanal pouch caused by long-axis rotational volvulus is an important, but uncommon, cause of life-threatening acute abdomen after restorative proctocolectomy. Prophylactic pouchpexy at the time of pouch construction or salvage pouchpexy after early diagnosis of the at-risk pouch are important considerations to avoid loss of the pouch.

Adult↗