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PubMed1996

Defecographic assessment after colonic J pouch-anal anastomosis.

Colonic J pouch anal anastomosis is widely employed after rectal resection. In the 36 patients who participated in our retrospective study, although postoperative continence was retained/maintained in each individual, a survey questionnaire indicated some difficulties in neoanorectal function. Therefore, defecography was performed in 20 of these patients. Patients experiencing soiling were found to have an increased ano-pouch angle and pelvic floor descent. Loss of sensation and incomplete evacuation were also associated with an abnormally large pelvic floor descent. However, stool frequency, urgency, and the need for medication showed no correlation with any of the defecography parameters. These findings thus suggested that the puborectal muscle and the levator ani muscle played an important role in postoperative function. Defecography was also found to provide a dynamic assessment of the postoperative state of colonanal reconstruction.

Aged↗
PubMed1995

Terminal motor latency in the pudendal nerves after colectomy with mucosal proctectomy and ileal J pouch-anal anastomosis for ulcerative colitis.

Pudendal nerve terminal motor latencies (PNTML) were measured in eight patients with ulcerative colitis who underwent colectomy with mucosal proctectomy and ileal J pouch-anal anastomosis, using a new digitally directed transrectal stimulation and recording technique, and the results were compared with data obtained from 15 control subjects. The conduction delay of PNTML in the patients with some degree of fecal incontinence was the longest, followed by those without any incontinence, and then the control subjects. These findings support the hypothesis that fecal incontinence after this procedure may be partially caused by damage to the pudendal nerve.

Adolescent↗
PubMed1995

The use of an ileostomy connector to diminish the frequency of defecation prior to ileostomy closure in patients with a pelvic pouch.

A new method for allowing stool passage into the pelvic pouch before ileostomy closure to verify the defecation state and diminish stool frequency is reported herein. This was accomplished by fitting an ileostomy connector connecting the proximal and distal openings of the diverting loop stoma. The ileostomy connector was initially in place for 6 h a day, the length of time being gradually increased until it was able to be left in for 24 h a day over a 3-month period. The calculated daily frequency of stools decreased from 24 to 6 or 7 times, and the mean daily frequency immediately after ileostomy closure was 6.5 times. Physiological study also showed an improvement, with squeeze pressure increasing from 35 cmH2O to 116 cmH2O and the maximum tolerated volume increasing from 35 ml before, to 90 ml 3 months following the use of an ileostomy connector. Thus, we conclude that an ileostomy connector may be useful to predict postoperative functional outcome and its complications, and to diminish the frequency of defecation before ileostomy closure in patients with a covering loop stoma.

Adult↗
PubMed1996

Comparison of the functional results of ileorectostomy and ileal pouch-anal anastomosis following total colectomy.

To evaluate the functional results of continence reconstruction techniques following total colectomy, an analysis of long-term follow-up, quality of life parameters, and recurrence of basal disease was conducted on 17 patients who underwent ileal pouch-anal anastomosis, and 16 who underwent ileorectostomy. Satisfactory results were achieved in 29 of the 33 patients, partial results were achieved in 3, and only 1 remained totally incontinent. While this outcome was independent of the reconstruction technique, a lower mean daily frequency of defecation, better day-night distribution, faster definitive recovery from surgery, a higher degree of rehabilitation, and a lower frequency of unplanned outpatient visits, hospitalizations, and minor complications were achieved after ileorectostomy than after pouch-anal anastomosis. Furthermore, better results were observed in patients who had undergone surgery for familial polyposis or complicated diffuse colonic diverticulosis, compared to those who had undergone surgery for inflammatory bowel diseases (IBD). During the postcolectomy stage, tumor recurrence was found in 5 of 7 patients with familial polyposis and histologically confirmed malignancy, compared to only 1 of 6 patients with negative histological results. Extracolonic manifestations developed in two patients with ulcerative colitis, and a small bowel obstruction occurred in one with Crohn's disease. These findings emphasize the importance of carefully selecting patients for each type of continence reconstruction method after total colectomy according to their individual requirements.

Adult↗
PubMed1995

Sacral nerve terminal motor latency after ileal J pouch-anal anastomosis for ulcerative colitis.

Using a new transcutaneous magnetic stimulation technique, sacral nerve terminal motor latencies (SNTML) were measured after ileal J pouch-anal anastomosis in eight patients with ulcerative colitis, and the results were compared with those obtained from 15 normal subjects. The conduction delay of the SNTML in patients with soiling was significantly longer than that of the continent group as well as that of normal subjects (P < 0.01). There were no significant differences in the conduction delay between the continent group and the control subjects. These findings therefore support the hypothesis that such soiling, which is sometimes seen after ileal J pouch-anal anastomosis, is partly due to damage to the sacral nerves.

Adolescent↗
PubMed1992

The application of a thread holding ring for ileoanal and coloanal anastomosis.

A thread holding ring, originally developed for valve replacement surgery and now commercially available, was successfully employed when performing ileoanal or coloanal anastomosis in 34 patients. The use of this instrument for ileoanal or coloanal anastomosis shortened the operation time and resulted in a decreased rate of complications related to the anastomosis.

Anastomosis, Surgical↗
PubMed1995

Water and electrolyte balance after ileal J pouch-anal anastomosis in ulcerative colitis and familial adenomatous polyposis.

The water and electrolyte balance was studied in 31 patients with ulcerative colitis (UC) and 22 with familial adenomatous polyposis (FAP) who underwent staged surgery involving colectomy and ileal J pouch-anal anastomosis (IAA), preoperatively, after terminal ileostomy, after high ileostomy, and after ileostomy closure. Serum electrolytes did not differ between each surgical stage. After terminal or high ileostomy, daily urine volume and urinary sodium loss was significantly lower, and daily fecal weight and fecal sodium loss was significantly higher than preoperatively. After ileostomy closure, urinary and fecal sodium loss became closer to preoperative value. Daily urinary potassium loss was significantly higher and fecal loss was lower after terminal and high ileostomy than preoperatively and did not show a significant change after ileostomy closure. The urinary sodium to potassium ratio after ileostomy closure was lower than preoperatively, but was higher than that after terminal and high ileostomy. Plasma aldosterone and renin levels were only significantly increased after high ileostomy. These findings indicate that high or terminal ileostomy caused chronic dehydration, which was compensated for by activation of the renin-aldosterone axis, while the water and electrolyte balance became closer to normal after ileostomy closure following ileoanal anastomosis.

Adenomatous Polyposis Coli↗
PubMed1991

Pouch dynamics--a simple test of ileo-anal pouch evacuation.

A simple technique for quantifying ileo-anal pouch evacuation has been used to compare patients with good pouch function and fully spontaneous defaecation (n = 10) to patients with a symptomatic disorder of pouch evacuation (n = 10), usually due to a pouch-anal stricture (n = 7). Pouch emptying was significantly less efficient in those with disordered evacuation (median 54% evacuated) than in those with good function (median 98% evacuated, p = 0.02) and significantly slower (median 22.4 sec vs 5.2 sec to evacuate 75% of instilled barium, p less than 0.02) even when of comparable efficiency. Testing of four further patients with high stool frequency but neither stenosis nor symptomatic difficulty with evacuation excluded a significant disorder of evacuation in three but identified inefficient emptying in the fourth. This test may prove useful in the investigation of patients with poor pouch function of uncertain origin.

Adult↗
PubMed1991

Lactulose hydrogen and [14C]xylose breath tests in patients with ileoanal anastomosis.

To study the intestinal bacterial flora and mouth to pouch transit time after ileoanal anastomosis, lactulose hydrogen and [14C]xylose breath tests were performed on 19 patients with ileoanal anastomosis and J-pouch and 8 patients with conventional ileostomy. Evaluated by the [14C]xylose breath test, patients with ileoanal anastomosis and ileal pouch showed no difference in the bacterial flora of the proximal small bowel when compared with ileostomy patients. The lactulose hydrogen breath test showed a significant rise in breath hydrogen, indicating bacterial overgrowth, in 68% of patients with ileoanal anastomosis but in none with conventional ileostomy (p less than 0.01). It was concluded that this peak in breath hydrogen was produced by the bacteria in the pouch. Thus the lactulose hydrogen breath test can be used to measure mouth to pouch transit time in 2/3 of patients with ileoanal anastomosis. Mouth to pouch transit time was 63 +/- 9 min and it correlated inversely with stool frequency (p less than 0.05).

Adult↗
PubMed1996

Ileal pouch-anal anastomosis: pregnancy, delivery and pouch function.

OBJECTIVE: To evaluate the pregnancies, deliveries and functional results of patients who have undergone and ileal pouch-anal anastomosis. DESIGN: A retrospective survey by questionnaire. SETTING: The study was conducted at a university hospital. SUBJECTS: Twelve women who had undergone an ileal pouch-anal anastomosis at the Inflammatory Bowel Disease Centre, Mount Sinai Hospital and who had subsequently become pregnant, were identified from the hospital records. A follow up questionnaire was completed by all subjects. RESULTS: Twelve patients had 16 deliveries. There were 10 vaginal deliveries and 6 caesarian sections. There were no pouch-related complication during the 16 pregnancies and there were two postpartum complications. CONCLUSIONS: Pregnancy is safe in women with an ileal pouch-anal anastomosis. Functional results are altered minimally. Vaginal delivery is safe and obstetric reasons should determine whether a caesarian section is performed.

Adolescent↗
PubMed1992

The failing pelvic pouch conversion to continent ileostomy.

Excision of a failing pelvic pouch is often a great disappointment for the patient. It is also an unfortunate decision considering that a significant length of terminal ileum is sacrificed. Transformation of the pouch to a continent ileostomy is an alternative. Five patients with a malfunctioning pelvic pouch have had their pouch converted to a continent ileostomy. The operative technique is described.

Adult↗
PubMed1992

Sodium and potassium excretion before and after conversion from conventional to reservoir ileostomy.

Sodium and potassium in the ileostomy output and urine were determined in 28 patients with ulcerative colitis on a free diet and in eight patients on a defined constant diet, before and after conversion from a conventional ileostomy (CI) to a continent reservoir ileostomy (RI). Feces and urine were collected both in the hospital and at home. Patients with CI on free diet had a median intestinal loss of 62 mmol sodium and those with RI 74 mmol/24 h collected in the hospital (p < 0.05). The figures for at home was 79 and 81 mmol/24 respectively, and were larger than in the hospital (p < 0.01). Sodium loss in the urine (U-Na) and the intake of sodium did not change significantly after conversion. Patients with a low U-Na before conversion also had a low U-Na after, in a few almost nil, implying a need for increased intake of sodium. Patients with a CI and low urinary output of sodium should be carefully studied with respect to their sodium balance before accepting them for conversion to RI. The ileostomy output of potassium increased after conversion (4.3 vs. 6.8 mmol/24 h; p < 0.01) in the hospital (5.3 vs 7.1 mmol/24 h; p < 0.01) at home. Patients on a defined constant diet before and after conversion did not show any significant differences in absorption of sodium, potassium, magnesium or calcium after conversion, but did show a reduced dry weight of the ileostomy output, indicating an increased degradation of intestinal contents in RI patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Morphology, mucin histochemistry and crypt cell kinetics of ileal mucosa in an experimental model.

An animal model was used to investigate the morphology, mucin hisotchemistry and crypt cell kinetics of ileal pouch mucosa. Forty-eight Sprague Dawley rats underwent control laparotomy with ileal transection and reanastomosis, leocolic transposition of a 3 cm segment of ileum or colectomy and ileal pouch rectal anastomosis. Animals were sacrificed 20 weeks later. Partial villous atrophy and chronic inflammation were found in both transposed and pouch ileum. Although mucin histochemistry showed patchy colonic type changes, overall there was preservation of a small bowel pattern in both transposed and pouch ileum. Crypt cell mitosis, measured by bromodeoxyuridine labelling index, was reduced in ileal pouch mucosa. These data indicate that predominantly villous atrophy, rather than colonic metaplasia occurs in ileal pouch mucosa and suggest that there is a low propensity for dysplastic change in such mucosa.

Animals↗
PubMed1994

Direct and quantitative vitamin B12 absorption measurement in patients with disorders in the distal part of the bowel. Comparison of stool spot test [SST] with whole body counting in patients with ileal pelvic reservoir, ileostomy or Crohn's disease.

Direct and quantitative vitamin B12 absorption studies were performed in 25 patients with disorders in the distal small intestine using whole body counting as the gold standard. Simultaneously, vitamin B12 absorption was also determined by the more simple stool spot test (SST) which incorporates 51CrCl3 as a nonabsorbable marker. The SST provided a reliable direct and quantitative measure of vitamin B12 absorption in patients with previous ileal resections due to Crohn's disease (CD) (n = 7) as compared with whole body counting. In ulcerative colitis (UC) patients with either an ileal pelvic reservoir (n = 10) or a conventional ileostomy (n = 8), markedly shorter bowel transit times and absence of colon may have hindered sufficient mixture of the tracer and marker isotopes which could explain the false absorption values according to the SST in single patients. Therefore, an intact colon and a near-normal bowel transit time seem to be essential for performance of the SST. Whole body counting showed, as expected, that all CD patients except one had decreased vitamin B12 absorption (median 23%; range 3-39%) (normally > 35%). In UC patients with ileostomy, only one had a markedly decreased vitamin B12 absorption, two borderline normal values, while the rest had normal values (median 54%, range 15-76%). All UC patients with ileal pelvic reservoir had normal vitamin B12 absorption values (median 40.5%, range 36-87%). We conclude that vitamin B12 substitution therapy is probably required in patients with CD with ileal resection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗