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Results for “Proctocolectomy, Restorative”

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At least 685 records · Page 38Linked to original sources
PubMed1991

Contaminated fistula following J-pouch ileoanal reservoir. Treatment with a collagen sponge containing gentamicin and metronidazole. Case report.

In a 55-year-old woman, a 1 x 5 cm fistula developed in the ileoanal anastomosis after restorative proctocolectomy with J-pouch ileoanal reservoir and temporary ileostomy for intractable ulcerative colitis. The fistula extended between the pouch and the sacral bone. Lasting closure was achieved by intrafistular placement of a collagen sponge containing gentamicin and soaked in metronidazole solution and pouch drainage through a transanal Foley catheter.

Anal Canal↗
PubMed1990

Functioning neorectum.

Seventeen patients (15 males, 2 females) underwent restorative proctocolectomy during the 4 year period 1983-87. Twelve patients had familial adenomatous polyposis. Two of these had superimposed malignancy--one each in the cecum and transverse colon. Five patients had ulcerative colitis. Ten pouch procedures were of the J type, six of the S type and one of W configuration. There was one death (mortality 6%). Mean stool frequency was 4.2 per day at one year after surgery and all patients were totally continent at this time. The ileal pouch-anal anastomosis provided a functioning neorectum with low stool frequency and complete continence. The J pouch was found to be functionally superior though the numbers were too small to allow statistical comparison.

Adenomatous Polyposis Coli↗
PubMed1990

Conversion of malfunctioning J pouch to Kock's pouch. Case report.

A patient with ulcerative colitis previously treated with restorative proctocolectomy and ileal J-pouch anal anastomosis had recurrent pelvic abscess and poor functional results for 3 years postoperatively. To improve the quality of life, the J pouch was converted to a Kock's pouch. The successful result implies that Kock's continent ileostomy is a good replacement for failed pelvic pouch.

Abscess↗
PubMed1990

Complications, surgical revision and quality of life with conventional and continent ileostomy.

Continent ileostomy remains an alternative to restorative proctocolectomy in selected cases. Results with continent ileostomy in 55 patients are reported--in 82% after conversion from conventional ileostomy. Three years postoperatively 93% were continent and 7% partially continent, and after 5 years 95% were continent. Complications requiring laparotomy arose in ten patients (18%) during the immediate postoperative period (30% among the first 27 patients, 7% of the subsequent 28). The incidence of late complications requiring laparotomy was 16% in the first year, 10% in the next 2 years and 5% after the third year. Slipping of the nipple occurred in 9% of the patients in the first postoperative year. No reservoir has been removed. The quality of life improved after colectomy with conventional ileostomy, but most patients experienced a dramatic further improvement after construction of the continent ileostomy. The improvement in ultimate quality of life was not influenced by revision for malfunction of continent ileostomy.

Adolescent↗
PubMed1984

The sphincteric and sensory components of preserved continence after ileoanal reservoir.

Sphincteric and sensory components of anal continence were investigated before and after restorative proctocolectomy and three loop ileal reservoir. Bowel habit, appearance of small intestinal mucosa, resting tone, squeeze pressure, anal canal length, pouch capacity and ileal sensation were investigated in 50 patients. The physiologic, endoscopic and histologic patterns were related to the occurrence of functional disturbances. The pressures in the anal canal as measured by manometry were found to be within the range of normality. The length of the sphincter was 3.4 +/- 0.6 centimeters; the maximal capacity of the reservoir was 450 +/- 204 milliliters of air. An ileorectoanal inhibitory reflex was recorded postoperatively in 52 per cent of the patients and normal postoperative continence was observed in 86 per cent of the patients, with no instances of gross incontinence. According to the results of the present study, the anatomic rearrangement that occurs after this surgical procedure preserved a satisfactory continence due to the integrity of the anal sphincters; minor leakage rarely occurred and was mainly related to a long inflamed distal portion of the ileum requiring self catheterization after operations for colitis. The best results were obtained in patients with polyposis who neither had staged procedures nor preoperative steroids.

Adolescent↗
PubMed1996

Inflammatory bowel disease.

Patients with extensive ulcerative and Crohn's colitis represent a group at high risk for developing colorectal cancer. Two clear independent risk factors for developing colorectal cancer in patients with chronic colitis include duration and extent of disease. Cancers in chronic colitis do not develop from a colonoscopically recognizable adenomatous polyp similar to that in sporadic colon cancer, but instead arises from flat dysplastic epithelium that is typically not colonoscopically distinguishable from adjacent nondysplastic epithelium. All patients with extensive disease require active management of their increased cancer risk. Active management of cancer risk in chronic long-term colitis should not be presumed to be equivalent to colonoscopic surveillance. There is little data with which to reassure a patient regarding the efficacy of colonoscopic surveillance. A reasonable alternative to colonoscopic surveillance in patients with ulcerative colitis is the restorative proctocolectomy (ileoanal pull-through), which maintains continence and avoids a stoma and appliance. If colonoscopic surveillance is undertaken, a clear understanding of what the definition of a positive surveillance test, ie, when surgical action is taken, is pivotal to the success of the surveillance program. There are now ample data confirming that the finding of any unequivocal dysplasia (low- or high-grade) is associated with a high risk of coexistent or future colorectal cancer. Dysplasia confirmed by a second pathologist (preferably an experienced gastrointestinal pathologist) should prompt a recommendation for colectomy. Future cancer surveillance in chronic colitis will almost certainly involve some applied molecular genetic test.

Adult↗
PubMed1998

Laparoscopic-assisted bowel resections in inflammatory bowel disease: state of the art.

The objectives of this paper are to review the rational, the present results and future of laparoscopic-assisted bowel surgery in patients with inflammatory bowel disease (IBD). Only a few centres in the world report on laparoscopic bowel resection in IBD that include stoma surgery, ileocolic resection, left, right and (sub)total colectomy for Crohn's disease, and subtotal or restorative total proctocolectomy (ileal pouch anal procedures). The combined series report conversion rates between 2.5% and 22.2%. Ileocolic resection, stoma creation, stricturoplasty and segmental small bowel resection are associated with an acceptable length of surgery, but laparoscopic(-assisted) total colectomy or restorative proctocolectomy still demand up to 4-6 hours of operative time. The few randomised studies addressing laparoscopic-assisted (segmental) bowel surgery versus conventional surgery demonstrated significantly less pain, a quicker return to self-care and a shorter hospital stay. The results of the series reporting on laparoscopic-assisted (ileo)colectomy in IBD are similar to those from these randomised studies. Laparoscopic-assisted subtotal colectomy and restorative proctocolectomy have no benefit compared with conventional surgery other than superior cosmesis. Morbidity of laparoscopic (ileo)colectomy in IBD is low, that of laparoscopic-assisted subtotal colectomy and restorative proctocolectomy remains to be seen. The various laparoscopic bowel resections done in IBD are all feasible. The first series describing laparoscopic surgery for IBD indicate that laparoscopic-assisted segmental (ileo)colectomy is safe and is the preferred approach provided it is done in a centre specialised in the treatment of IBD and by skilled laparoscopic surgeons beyond the learning curve. Until now, laparoscopic-assisted subtotal colectomy and restorative proctocolectomy do not have the same short-term benefits as seen in other laparoscopic colorectal procedures. Patients with inflammatory bowel disease (IBD) have a high life-time risk of having abdominal surgery and reoperations. The proposed advantages of laparoscopic surgery in this group of young patients might be higher than in patients with other colorectal diseases. Minimal physiologic insult in patients who already are under significant physiologic stress, less adhesion formation and superior cosmesis are important benefits over time. In a time where patient's demands will increase, the future of laparoscopic colonic surgery in IBD looks assured.

Anastomosis, Surgical↗
PubMedDate not supplied

[Surgical alternatives in the treatment of chronic unspecific ulcerative colitis].

BACKGROUND: Newer techniques for surgical treatment of chronic ulcerative colitis have been developed. PURPOSE: This review article analyzes the current surgical alternatives, attempting to define their role in the overall management of patients with chronic ulcerative colitis. RESULTS: Non-restorative total proctocolectomy with permanent ileostomy remains as the gold-standard operation for chronic ulcerative colitis. Restorative total proctocolectomy, with or without excision of the anal transitional zone, is becoming one of the most widely used procedures for this disease. It avoids a permanent ileostomy, and permits good functional results in the majority of patients. Subtotal proctocolectomy, with a Hartmann Pouch may be an adequate procedure in patients operated upon on emergency basis, to permit an ileo-anal pouch in a subsequent operation. Colectomy with ileo-rectal anastomosis, and creation of a continent ileostomy are procedures that should be limited to selected candidates. CONCLUSIONS: Currently, total proctocolectomy with ileo-anal pouch seems to be the operation of choice in the majority of patients, but the preoperative general status is important to define the best surgical alternative for each patient.

Anastomosis, Surgical↗
PubMed1998

Pouchitis: pathophysiology and treatment.

Pouchitis is a potential complication after proctocolectomy and restorative ileoanal anastomosis. It is more frequent in UC than in familial polyposis. Little is known about the etiopathology of pouchitis. Risk factors include the presence of extraintestinal manifestations, primary sclerosing cholangitis, cessation of smoking, and previous course of disease. A host of pathophysiological pathways have been identified as potential mechanisms of pouchitis, which include inflammatory mediators, adhesion molecules, oxygen radical species, p-ANCA, and short-chain fatty acids. The microflora in the pouch may also be an important factor in causing inflammation. The risk of developing cancer in cases of pouchitis has not been established as clearly as in those of UC. Particular attention should be paid to patients who have remaining anorectal mucosa after pouch construction. Experience in the treatment of chronic relapsing and chronic refractory pouchitis is limited. The continuation of conventional anti-inflammatory treatment is successful only in a small percentage of patients. New biological response-modifying therapies which target novel immunoregulatory molecules in IBD will also have impact on the systemic and topical treatment of pouchitis.

Colitis, Ulcerative↗
PubMed1998

[The use of laser spectroscopy of the blood plasma for selecting rectal cancer patients with a colostomy for the performance of a restorative operation].

The blood plasma changes were studied up in 37 patients, to whom Hartmann [correction of Gartman] operation was conducted for cancer of recti, using the laser correlational spectroscopy (LCS) method. In 22 patients the LCS data did not differ of such in healthy persons. In these patients the reconstructive operation on colon was conducted. In 12 patients the LCS data were characteristic for cancer of recti. Of them in 5 the progress of the disease was noted while laparotomy conduction and in 6--one year after the colonic continuity restoration.

Colostomy↗
PubMedDate not supplied

[Emergency surgical treatment of ulcerative rectocolitis and Crohn's disease of the colon].

We examine the indications and the operative options for proceeding to emergency surgery in patients with inflammatory bowel disease. Emergency surgery is absolutely mandatory in case of generalized peritonitis due to bowel perforation. Other life-treating complications are acute disease not responding to medical treatment, toxic megacolon, bowel obstruction and massive hemorrhage. Early medical treatment of these conditions often prevents most severe clinical expressions and improves the prognosis. However surgery should be performed immediately if there is no improvement within 5 days of medical management in case of acute colitis, within 24-48 hours in case of toxic megacolon, within 48-72 hours in patients with intestinal obstruction or severe bleeding, or if the patient deteriorates during this period. In such circumstances, subtotal colectomy with ileostomy and mucous fistula of distal sigmoid colon is the best procedure. That is because it is relatively easy to perform and consents a simpler restorative operation than other procedures preserving the rectum. Moreover it leads to lower morbidity and mortality than the total proctocolectomy that should be reserved to patients with severe rectal disease or sphincter lesion. The most important factors influencing outcome of complicated or severe inflammatory bowel disease are the choice of the appropriate timing for surgery and the procedure performed.

Colectomy↗
PubMed1999

Fertility after ileal pouch-anal anastomosis in women with ulcerative colitis.

BACKGROUND: Women with ulcerative colitis are believed to have normal fertility but colectomy and ileal pouch-anal anastomosis (IPAA) may impair fertility. The aim was to compare fertility in patients with ulcerative colitis before and after IPAA with that in the national population. METHODS: Some 258 consecutive women who had undergone IPAA for ulcerative colitis were identified. Data were collected by questionnaire and from medical records. The observed number of births was compared with the number expected by indirect standardization by age and calendar year. Fertility from the age of 15 years to colectomy, from the onset of ulcerative colitis to colectomy, and from the 12 months after stoma closure to the time of data collection was investigated. RESULTS: A total of 237 women (92 per cent) responded. From the age of 15 years to colectomy there were 251 deliveries compared with an expected number of 286 (P < 0. 05). The number of births from the onset of ulcerative colitis to colectomy was 120, compared with an expected 131 (P > 0.3). From the 12 months after ileostomy closure until data collection there were 34 deliveries, compared with an expected 69 (P < 0.001). CONCLUSION: There is a considerable reduction in postoperative fertility after restorative surgery for ulcerative colitis.

Adult↗
PubMed2004

Anal canal pressure after ileal pouch-anal anastomosis with strengthened internal anal sphincter.

INTRODUCTION: The aim of sphincter-saving operative techniques and creation of intestinal reservoirs is to improve the quality of life for patients with restorative prococolectomy. METHODS: In this study, 48 consecutive patients (19 males and 29 females of ages between 19 and 55 years; mean age, 35.52 years) with ulcerative colitis and familial adenomatous polyposis underwent ileal pouch-anal anastomosis after proctocolectomy in 1986 to 2002. In 26 patients (54.17 percent of the cases), 10 males and 16 females, ileal pouch-anal anastomosis was performed after a modified surgical technique for strengthening the internal anal sphincter by creation of a smooth muscle cuff through plication of a mucosectomized segment of residual rectum. Basal resting anal canal pressure and pressure after voluntary contraction were recorded preoperatively, one month after surgery, and every six months for two years. RESULTS: One month after the operation manometric results showed significantly higher values of resting pressure in patient with a plicated rectal segment than values measured preoperatively (P < 0.001). This effect was absent after the standard ileal pouch-anal anastomosis. With the rectal plication technique, basal pressure increased from a preoperative value of 69 +/- 6 mmHg up to 80 +/- 6 mmHg at the end of the second postoperative year (P < 0.001). CONCLUSIONS: We concluded that ileal pouch-anal anastomosis with rectal plication perhaps improved sphincter function. The operative technique did not affect anal squeeze pressure. Patients quality of life was improved for those undergoing the modified ileal pouch-anal anastomosis.

Adenomatous Polyposis Coli↗
PubMed2000

Functional outcome after restorative panproctocolectomy for ulcerative colitis decreases an otherwise enhanced quality of life.

BACKGROUND: Restorative panproctocolectomy is a favoured operation for ulcerative colitis, but altered bowel habit may adversely affect overall quality of life. METHODS: Specific and generic quality of life questionnaires and an instrument to award money for continuing disability based on government guidelines were sent to 103 patients who had curative surgery for ulcerative colitis between 1995 and 1997. Seventy-one patients returned completed questionnaires: 30 with an ileostomy (representing incontinence and abnormal body image), 11 with a Koch pouch (representing continence and abnormal body image) and 30 with a pelvic pouch (representing continence and normal body image). RESULTS: Patients valued the disability of having an ileostomy similar to that for a Koch pouch or a pelvic pouch: pound 40 000, pound 30 000 and pound 40 000 respectively (P = 0. 97). There was no sex difference. Body image measured with a visual analogue scale (least = 1, worst = 10) was worst with the ileostomy and Koch pouch (8 each) and best with a pelvic pouch (5) (P = 0.06). However, pelvic pouches scored significantly worse than an ileostomy with regard to altered bowel emptying (pelvic pouch, 8; Koch pouch, 7; ileostomy, 5) (P = 0.01). CONCLUSION: Poor function after pelvic pouch surgery offsets any advantage in body image over an ileostomy. Thus, overall quality of life and perceived monetary damage were the same for the two operations. Improved pelvic pouch function is likely to be reflected in better quality of life after restorative panproctocolectomy.

Adult↗