Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Proctocolectomy, Restorative”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 505 records · Page 28Linked to original sources
PubMed1995

Functional results of the double-stapled ileoanal reservoir.

BACKGROUND: The preferred method for creation of an ileoanal reservoir is still controversial. We prospectively studied the functional and physiologic outcome of our patients who underwent a double-stapled ileoanal reservoir (DSIAR). STUDY DESIGN: All consecutive patients who underwent restorative proctocolectomy with a DSIAR between 1988 and 1993 were evaluated. Functional results were assessed by questionnaires and anal manometry preoperatively and two, 12, and 24 months postoperatively. RESULTS: One hundred forty patients (90 males and 50 females) with a mean age of 40.7 (range, 12 to 71) years were evaluated. Of these, 107 patients (77 percent) had ulcerative colitis, 21 (15 percent) had familial adenomatous polyposis, six (4 percent) had indeterminate colitis, and six (4 percent) had a post-operative diagnosis of Crohn's disease. One hundred twenty-four (95 percent) of the 131 patients with closed stomas were available for functional and manometric evaluation at a mean follow-up period of 24 months. A 32 percent decline in the mean resting pressure (from 71.3 +/- 4 to 48.2 +/- 3.4 mm Hg) occurred early after DSIAR (p < 0.001) with partial recovery by 24 months. The maximal internal sphincter resting pressure showed a 39 percent decline (from 90.8 +/- 4.9 to 55.3 +/- 5.7 mm Hg, p < 0.005) with recovery after 12 months. There were no significant changes in the length of the high-pressure zone or mean or maximal squeeze pressures. A mean of 5.4 (two to 13) bowel movements occurred during the day and a mean of 1.2 (zero to four) occurred at night. Perfect or almost perfect continence was reported during the day and night, respectively, by 95 and 92 percent of the patients. Overall perioperative complications occurred in 30 patients (21 percent) including septic complications in eight (6 percent), and pouchitis in eight (6 percent). There was one postoperative death (0.7 percent). CONCLUSIONS: Double-stapled ileoanal reservoir is associated with good subjective functional and objective physiologic results and has acceptable rates of morbidity and mortality.

Adenomatous Polyposis Coli↗
PubMed1994

[Pelvic pouches].

Since Nissen performed his first ileo-anal anastomosis for a benign large bowl disease in 1933, restorative proctocolectomy has undergone substantial developments, thus especially in the last two decades. Different pouch designs (J-, S-, W- and H-pouch) obtain normal defecation in patients treated with proctocolectomy. Many groups prefer the J-Pouch for it's technical simplicity and good results.

Adenomatous Polyposis Coli↗
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

["Pouchitis"; histology].

"Pouchitis" is a well recognised complication of restorative proctocolectomy characterised by acute diarrhoea, sometimes with blood, often complicated by incontinence, malaise, arthritis, erythema nodosum and fever. The ileal mucosa is hyperaemic, there may be shallow ulcers and contact bleeding. Biopsies characteristically show villous atrophy, a poly-morphonuclear infiltrate and chronic inflammatory cells, but the histopathological features are often patchy and may be difficult to differentiate from ischaemic ileitis, colonic metaplasia or Crohn's disease. "Pouchitis" is probably due to an overgrowth of intestinal bacteria secondary to stasis but there is some evidence that there may be an ischaemic factor. Most patients respond rapidly to oral metronidazole.

Crohn Disease↗
PubMed1993

[Pouchitis: acute inflammation in the pelvic ileal reservoir. Diagnostic criteria, frequency, possible etiological factors and treatment].

Pouchitis is a significant long-term complication of restorative proctocolectomy. Pouchitis is characterized by diarrhoea, fever, malaise, abdominal pain and in few a patients a worsening of already present extraintestinal manifestations may occur. The estimated probability of pouchitis occurring within five years is approximately 35%. Standard diagnostic criteria have not yet been established, but clinical symptoms, endoscopic and histological features should be included. The cause of pouchitis is unknown, bacterial over-growth, faecal stasis, oxygen free radicals, secondary and deconjugated bile acids, shortchain fatty acids, gastrointestinal hormones and an immunologically-mediated reaction have all been suggested as possible etiological factors. Metronidazole is the most commonly used treatment and has prompt effect in more than 90% of the patients. Steroids and 5-aminosalicylic acid derivatives also seem to be effective. A diverting ileostomy is necessary in only five to seven percent of the patients, and in less than one percent does pouchitis result in excision of the pouch. Controlled trials with uniform diagnostic criteria are required to assess the effectiveness of the individual regimens.

Acute Disease↗
PubMed1993

[Usefulness of subtotal colectomy with colorectal anastomosis for chronic ulcerative colitis].

Recently in Japan, most of surgeons have been performing restorative proctocolectomy with ileoanal anastomosis for ulcerative colitis, leaving unsolved problems with regard to postoperative complications. Analysis was made on subtotal colectomy with colorectal anastomosis with the following policies. Firstly, the inflammation of the remnant intestine could be easily and correctly controlled by medication in outpatient. Secondly, carcinomas associated with ulcerative colitis can be discovered by postoperative colonoscopic examinations. Operations were carried out to 26 cases of ulcerative colitis for the past 13 years. Subtotal colectomy with colorectal anastomosis were performed to 11 cases. Three cases of colorectal carcinomas associated with ulcerative colitis were experienced. One of the resected specimen was investigated using stereomicroscopy after alcian blue staining to formalin fixed one. As a result of this research, we have convinced that colorectal anastomosis should be favorable surgical potion to the cases of chronic ulcerative colitis because postoperative anal function and quality of life are excellent in our series, in addition, carcinomas in the remnant intestine can be probably easily found out at the early stage by annual colonoscopic examinations with dye staining.

Adolescent↗
PubMed1995

Ileoanal anastomosis and ileoanal canal anastomosis in Japan: comparative retrospective study.

A questionnaire survey of ten institutions in Japan revealed that restorative proctocolectomy accounted for 81.8% of the surgical procedures performed in patients with UC in the last 5 years (1989-1993); ileoanal anastomosis (IAA) and ileo-anal canal anastomosis (IACA) were performed in 63% and 33% of these patients, respectively. Comparison of the two series showed that IACA was technically simpler and yielded better continence, but that it entailed a potential risk of recurrence of the disease in the remaining anal canal mucosa. Although IACA seems to be a useful surgical option for UC, until the long-term outcome of the procedure can be elucidated. It may be better regarded as a very low variation of IRA rather than as an improved technical version of IAA.

Adult↗
PubMed1995

Total colectomy and ileorectal anastomosis in ulcerative colitis.

In an attempt to determine the best indications for the classically adopted ileo-rectal anastomosis (IRA) and the new techniques of restorative proctocolectomy, namely, ileal J-pouch-anal anastomosis (IAA) ilea J-pouch-anal canal anastomosis (IACA), we retrospectively studied 72 surgically treated patients with ulcerative colitis (UC) followed in our surgical department in the period between 1963 and 1994. Compared to these new techniques, IRA had a lower incidence of postoperative fecal incontinence, and was one-stepped in the majority of the patients. No significant difference regarding postoperative bowel function, operation time, volume of bleeding, hospital stay, and the need for postoperative prednisolone was observed. We concluded that IRA is a good procedure that is indicated for patients receiving high-dose prednisolone, for those who need a quick return to social activity, and for those with poor anal function. IACA is a good indication for those patients with good anal function assessed preoperatively, who agree to receive a multi-step operation. For those patients with cancer or dysplasia, IAA should be the operation of first choice.

Anal Canal↗
PubMed1996

[Results of ileoanal reservoir surgery].

We report our surgical, late complications and functional outcome of 157 consecutive restorative proctocolectomies with an ileoanal J pouch at the Department of Surgery L, Arhus City Hospital. Nine patients had familial adenomatous polyposis, while 148 patients were operated for ulcerative colitis. All patients had a protecting ileostomy. There was no mortality. Surgical complications after J pouch: Six patients were reoperated, five due to intra-abdominal bleeding, one for ileus. There was only one pelvic abscess, and it was drained percutaneously. There were no fistulae, no anastomotic leakage and no early pouch removal. Surgical complications after ileostomy closure: Eight patients were reoperated; two due to wound infections, five for ileus and one due to a wound rupture. Late Complications: Four pouches were removed, due to incontinence, difficult evacuation, chronic pouchitis or Crohn's disease. There were three late pouchovaginal fistulae more than one year after surgery. Five patients had surgery for ileus, one for an intra-abdominal abscess, one for a perianal fistula and eight for incisional hernia. Functional outcome: One year after pouch surgery more than 90% of patients were satisfied with the operation, 2.2% had regretted and 3.6% were in doubt. The functional result was satisfactory in the majority of the patients, but 21.1% had one or more night evacuations and 13.9% had variable degrees of incontinence.

Adenomatous Polyposis Coli↗
PubMed1996

Is complete laparoscopic colectomy superior to laparoscopic assisted colectomy?

Much debate has centered around what constitutes a true laparoscopic colon resection. Purists argue that intracorporeal division of the mesentery and anastomosis confer a benefit over a "laparoscopic assisted" procedure. The aim of this study was to further examine this issue. Data were prospectively collected on 102 consecutive laparoscopic colon resections. Five procedures were converted to open cases and were excluded from analysis. Procedures were divided into two groups. Group 1 (n = 34) consisted of complete laparoscopic procedures (no abdominal incision was made): abdominoperineal resection (3), Hartmann's reversal (3), end colostomy (7), low anterior resection (5), proctectomy (1), sigmoid colectomy (15). Group 2 (n = 63) consisted of laparoscopic "assisted" procedures (i.e., an incision was made to facilitate anastomosis, division of the mesentery, and/or specimen retrieval): Ileocolic resection (6), restorative proctocolectomy (26), right colectomy (19), subtotal colectomy/end ileostomy (5), subtotal colectomy/ileorectal anastomosis (7). Length of hospitalization and duration of postoperative ileus were compared. A subset analysis of right colectomy (intracorporeal mobilization and extracorporeal division of the mesentery and anastomosis) versus sigmoid colectomy (intracorporeal mobilization, division of the mesentery and anastomosis) was also performed. There were no statistically significant differences in length of hospital stay (Group 1, 7.47 +/- 2.75 days; Group 2, 7.78 +/- 5.55 days) or duration of postoperative ileus (Group 1, 3.24 +/- 1.56 days; Group 2, 3.68 +/- 1.58 days). Similarly, in the sigmoid colectomy versus right colectomy subset analysis, there were no statistically significant differences in length of hospital stay (sigmoid colectomy, 7.92 +/- 2.90 days; right colectomy, 6.40 +/- 1.50 days) or duration of postoperative ileus (sigmoid colectomy, 3.36 +/- 1.39 days; right colectomy, 3.18 +/- 1.07 days). Our data demonstrate that intracorporeal division of the mesentery and anastomosis confer no advantage over the laparoscopic assisted procedures. Data were prospectively collected on 102 consecutive laparoscopic colon resections. There were no statistically significant differences in length of hospital stay or duration of postoperative ileus regardless of whether intracorporeal or extracorporeal mesenteric division and anastomosis were undertaken. These data demonstrate that a completely laparoscopic procedure does not appear to offer any advantage as compared to a laparoscopic assisted one.

Abdomen↗
PubMedDate not supplied

Image analysis in multisample biopsy after ileal pouch-anal anastomosis.

Pouchitis in ileal anal anastomosis represents an important clinical complication after restorative proctocolectomy. Acute and chronic inflammation of the reservoir is a frequent event sometimes associated with villous atrophy and colonic metaplasia. After ileal pouch anastomosis, twenty-one patients affected by ulcerative colitis were studied. An image analyzer CAS 200 (Becton Dickinson) was utilized to evaluate the DNA intranuclear content in every biopsy. In two cases abnormal DNA distribution was observed, and in one case a poliploid pattern was seen. Abnormal DNA distribution was also present in colonic metaplasia. Therefore, image analysis for the detection of DNA aneuploidy may be of additional value together with histologic parameters in follow up, in order to exclude transformation of the ileal mucosa in neoplastic epithelia.

Adolescent↗
PubMed1996

Stapled anastomoses in colorectal surgery: a prospective study.

OBJECTIVE: To evaluate the safety and efficacy of stapled anastomosis in left sided colorectal reconstructions. DESIGN: Prospective study. SETTING: District hospital, UK. SUBJECTS: 218 Consecutive patients who underwent elective colorectal reconstructions with stapled anastomoses between July 1980 and July 1994. INTERVENTIONS: 154 Anterior resections of the rectum using single or double stapled anastomoses, 37 rejoining after Hartmann's operations, and 28 restorative proctocolectomies with formation of J pouch ileoanal anastomoses. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: There were 5/154 clinical anastomotic leaks after anterior resection of the rectum and 1/28 after stapled J pouch ileoanal anastomoses. There were no leaks after rejoining of Hartmann's. The overall clinical leak rate was therefore 3%. 11/154 tumours recurred locally after anterior resection of the rectum (7%) during a mean follow up of 18 months, and 8 (73%) developed within 2 years of operation. All but one recurrence developed after single stapled anastomosis. Dukes' staging remains the most reliable prognostic indicator of the local recurrence of the tumour. There were five postoperative deaths after anterior resection but none after Hartmann's procedure or J pouch ileoanal anastomosis, giving an overall postoperative mortality of 2.3%. CONCLUSION: The use of stapling instruments in left sided colorectal anastomosis is safe and technically easy, with a low clinical anastomotic leak rate and an acceptable rate of local recurrence after anterior resection of the rectum.

Anastomosis, Surgical↗
PubMed1997

The role of Seprafilm bioresorbable membrane in adhesion prevention.

OBJECTIVE: To evaluate, the safety and efficacy of Seprafilm, a novel bioresorbable membrane of chemically modified hyaluronic acid and carboxymethylcellulose, in preventing and reducing postoperative adhesion formation. DESIGN: Randomized, controlled, blinded, prospective multicenter study. SETTING: Major academic surgical centers. SUBJECTS: 183 (treatment, n = 91; control, n = 92) patients with ulcerative colitis or familial polyposis. INTERVENTIONS: Restorative proctocolectomy and ileal J-pouch anastomosis with diverting ileostomy followed by second-stage laparoscopy for ileostomy closure and direct visual assessment of the peritoneal cavity. Before abdominal closure in treated patients, Seprafilm, averaging 406.9 cm2 per patient, was applied without suturing between the midline incision and underlying tissues and organs. MAIN OUTCOME MEASURES: Determination of the incidence, extent (mean percentage of midline incision associated with adhesions), severity (grade 1, least severe; grade 2, moderately severe; grade 3, very severe), and distribution of adhesions. RESULTS: In 175 (treatment, n = 90) evaluable patients, Seprafilm significantly reduced the incidence (49% and 94%, respectively, p < 0.0001), extent (23% and 63%, respectively, p < 0.0001), and severity (15% versus 58% grade 3 severity, respectively, p < 0.0001) of postoperative adhesions. Seprafilm decreased the rate of adhesion formation by nearly 50%. More than half (51%) of Seprafilm recipients were adhesion-free, versus only 6% of untreated patients. Thus treated patients were eight times more likely to be free of adhesions than untreated controls. The incidence of incisional adhesions associated with the omentum, small bowel, left sidewall, bladder, ileostomy, and stomach was significantly reduced in the Seprafilm patients. Effects on vital signs and laboratory parameters were comparable in the two groups and were attributable to the operative procedure, concomitant therapy, or comorbid disease. All reported adverse events were associated with the surgical procedure and/or comorbid disease and did not differ significantly between the two groups (p > 0.05). CONCLUSION: Seprafilm is safe and significantly reduces the incidence, extent, and severity of postoperative adhesions to the midline incision compared with no treatment, the current standard of surgical care.

Absorption↗
PubMed1997

[Surgery for familial polyposis of the colon. A functional follow-up].

Functional assessment of pelvic pouch procedures for FAP is not different from that of UC and consists of clinical, manometric and radiologic investigations. Ileo-rectal anastomosis and pelvic pouch operation are equally effective for the disease, but function is still questionable after restorative proctocolectomy. Based on a personal series of 43 patients, relevant technical aspects influencing functional results are discussed and guidelines for a correct follow-up of these patients are presented.

Adenomatous Polyposis Coli↗
PubMed1998

Reconstructive surgery for pelvic pouches.

Restorative proctocolectomy with ileo-pouch-anal anastomosis has become the elective surgical procedure of choice for most of our patients with ulcerative colitis and for selected patients with familial adenomatous polyposis. This report reviews the results of the outcome of patients who have undergone a more radical reconstructive approach for salvage of the pelvic pouch where multiple local procedures have failed. A group of 24 patients were reviewed (19 females, 5 males). The indication for surgery was ulcerative colitis in 22 patients; 10 of the 24 patients were referred from other centers. The 24 patients underwent a mean of 2.9 local salvage procedures per patient. Of the 19 females within the group, 12 had an anastomotic vaginal fistula. The 24 patients were divided into two groups. The first group consisted of 14 patients whose initial pouch was used once again for revisionary surgery. Group 2 comprised 10 patients whose initial pouch was removed and a redo pouch was constructed. Of the 24 patients, only 2 have had their pouches removed. More than 75% of the patients have had a successful outcome using a reconstructive approach. Four patients still have an ileostomy; of these four, two are awaiting closure of their loop ileostomy. Of 18 patients who were evaluable, 13 were considered to have normal daytime continence, and 17 of 18 were sexually functional. Of the 18 evaluable patients, 15 were satisfied with the outcome. Radical reconstructive surgery can be performed where local procedures to effect pouch salvage have failed, and it should be considered as a first-line management where factors dictate that local procedures might fail. The commitment of the surgeon and the patient to achieving a successful outcome is essential. Severe pouch-specific complications can be managed successfully by surgeons who have a specific interest in pelvic pouch surgery and have considerable experience dealing with complications that arise.

Adolescent↗
PubMed1998

Closure of transverse loop colostomy and loop ileostomy.

The aim of a defunctioning stoma is to protect patients from the consequences of faecal leakage and pelvic sepsis, should it occur. A retrospective audit of 77 patients who had undergone closure of a loop stoma between 1988 and 1996 was performed. Sixty patients had either transverse loop colostomy (52) or loop ileostomy (8) to defunction distal colorectal/anal anastomoses or pathology, and 17 patients had a loop ileostomy to defunction an ileoanal pouch. Those who had restorative proctocolectomy experienced a much higher (24%) complication rate than the loop colostomy group (5%), despite similar perioperative care and surgery performed by surgeons of equivalent seniority. The complication rate of ileostomy closure in pouch patients is similar to other published series. As a result of these findings, a selective approach to the use of loop ileostomy to protect pouches has been introduced. The absence of wound infections in our series would suggest that primary closure of the stomal wound without drainage can be achieved.

Adult↗
PubMed1998

Arterial thrombosis: a complication of loop ileostomy.

Restorative proctocolectomy has become the surgical treatment of choice in ulcerative colitis. Most commonly, this is performed as a staged procedure which includes formation of a defunctioning loop ileostomy. High output loop ileostomies are associated with both local and systemic complications. We describe two patients with loop ileostomies who developed acute arterial thrombosis, a complication not previously described, thus further emphasizing the importance of careful management and early reversal of high output ileostomies.

Aged↗
PubMed1998

[Heidelberg polyposis register. Experiences with ileoanal pouch in familial adenomatous polyposis coli (FAP): the ileoanal anastomosis problem zone].

Restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) is the therapy of choice for the prophylactic treatment of FAP. Despite maximal radicality, we frequently observed remaining rectal mucosa and in some cases even adenomas at the pouch-anal anastomosis. Therefore, we changed our postoperative care by adding a yearly proctoscopy to regular pouchoscopies.

Adenomatous Polyposis Coli↗