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At least 883 records · Page 49Linked to original sources
PubMed1992

Postoperative and long-term results of ileal pouch-anal anastomosis for ulcerative colitis and familial polyposis coli.

The immediate postoperative and long-term functional results of 51 ulcerative colitis patients and 21 familial polyposis patients who underwent ileal J-pouch-anal anastomosis were compared in this study. The incidence of postoperative complications requiring reoperation was not statistically different in both groups. The mean daily stool frequency was significantly higher in colitis patients. Pouchitis occurred in 44% of colitis patients but not in polyposis patients (P < 0.005). Symptoms of pouchitis included bloody diarrhea, urgency, abdominal pain, weight loss, fever, and arthritis. Six colitis patients required pouch excision because of intractable pouchitis. The overall pouch excision rate was 22% in ulcerative colitis patients and 5% in familial polyposis patients. Patient satisfaction was good in 46% of ulcerative colitis patients and 76% of polyposis patients (P < 0.05). Our data demonstrate that the long-term outcome of ileal pouch-anal anastomosis is more favorable in polyposis patients than in colitis patients. Pouchitis is a major long-term complication occurring exclusively in colitis patients.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

Colon J-pouch rectal reconstruction after total or subtotal proctectomy.

Multiple stools, urgency, and episodic frequency are common during the first 6 months after proctectomy and coloanal or low colorectal reconstruction. We used an 8-cm colon J-pouch in 23 patients and have confirmed that this approach obviates much of this early dysfunction.

Adenocarcinoma↗
PubMedDate not supplied

Evaluation of "gastric" emptying time in the J pouch compared with a standard esophagojejunal anastomosis.

Gastric emptying times and symptoms were recorded in 18 patients after total gastrectomy and either a 15-cm J-pouch (n = 10) or a standard esophagojejunal anastomosis (n = 8). A solid test meal labeled with 99mTc was used to compare the emptying times. The postoperative symptoms and nutritional status were also assessed. The J-pouch resulted in a prolonged period of food retention in the upper jejunum (p < 0.02) compared to that with a standard esophagojejunal anastomosis. The patients with a J-pouch had fewer episodes of postprandial pain (p < 0.03) or vomiting (< 0.04). They also had fewer dietary restrictions (p < 0.04) and better nutritional status.

Adult↗
PubMedDate not supplied

Complications associated with ileal pouch-anal anastomosis.

Seventy-three patients underwent total colectomy, rectal mucosectomy, creation of J or S ileal reservoir, and ileal pouch-anal anastomosis from 1982 to 1989. Mean follow-up was 38 months, with a minimum of 3 months in 15 patients being followed long-term at another institution. Forty-eight (66%) patients had histologically proven ulcerative colitis and 25 (34%) patients had familial polyposis. Thirty-eight J reservoirs and 35 S reservoirs were constructed. There were no perioperative deaths. The failure rate (loss of pouch) was 3%. Thirty-six complications in 34 (47%) patients were reported, 14 (19%) patients required surgery. Bowel obstruction was the most common postoperative complication (16%), followed by pouchitis (15%), and cuff infection (5%). Seventy-eight percent of the complications were associated with the J pouch. Average stool frequency at 1 year was 4 per 24-hour period. Other complications included postoperative pneumonia (1), peroneal nerve palsy (1), and temporary sexual dysfunction (1). Seven of 15 complications requiring surgical intervention occurred in the first 2 years of the study period, illustrating the learning curve associated with the procedure. Blood loss, transfusion requirements, and length of operation were not associated with higher complication rates. Use of the J pouch and experience of the individual surgeon affected morbidity.

Adenomatous Polyposis Coli↗
PubMed1994

Serum gastrin values in patients with familial adenomatous polyposis.

PURPOSE: An evaluation of the importance of gastrin in the colorectal carcinogenesis in patients with familial adenomatous polyposis was conducted. METHODS: Blood samples from 168 family members of 26 families were investigated for circulating gastrin. Blood was drawn from 65 affected patients, 66 clinically unaffected first-degree relatives, and 37 spouses. RESULTS: We did not find any difference in distribution of serum gastrin among these groups. CONCLUSION: Our results seem to exclude gastrin from being relevant in early carcinogenesis in patients with familial adenomatous polyposis.

Adenomatous Polyposis Coli↗
PubMed1994

Histologic and microbiologic features of biopsy samples from patients with normal and inflamed pouches.

PURPOSE: This study was undertaken to assess the electron microscopic and microbiologic findings in tissue biopsy samples from patients with pouchitis and to compare them with findings in patients with normal pouches, conventional ileostomies, and normal ileum. METHODS: Tissue samples were obtained from 78 patients: 23 patients with normal pouches endoscopically and histologically (Group 1), 12 patients with endoscopic and histologic evidence of inflammation (pouchitis) (Group 2), 14 patients who had either endoscopic or histologic evidence of inflammation but not both (Group 3), 20 patients with conventional ileostomies (Group 4), and 9 patients without ileostomies from whom biopsy samples of normal ileum were obtained (Group 5). RESULTS: The mean total aerobic facultative counts in the biopsy samples from the pouchitis patients were significantly higher when compared with biopsy samples from Groups 4 and 5 (P < 0.05). There were no significant differences in the mean anaerobic counts among the five groups. Positive cultures were obtained in 90 percent of patients with pouches compared with 69 percent of patients with conventional ileostomies or normal ileum (P < 0.05). Intramural bacteria were observed on electron microscopy in biopsy specimens of 47 percent patients with pouches compared with 14 percent of patients with conventional ileostomies or normal ileum (P < 0.05). However, the proportion of patients with positive cultures or intramural bacteria was not increased in the pouchitis group compared with the normal pouch group. CONCLUSION: These data suggest that intramural aerobic facultative bacterial counts are elevated in patients with pouchitis and may play a role in the pathogenesis of pouchitis.

Adult↗
PubMed1993

Attempts to aid the adaptation of pelvic pouch before temporary ileostomy closure.

Most patients experience a high stool frequency immediately following the closure of the temporary ileostomy after total colectomy and ileoanal pouch reconstruction. Adaptation occurs within the ensuing weeks to reach a plateau in about three months. Increasing volumes of liquid nutrients were injected, twice daily for two months, into the pelvic pouch through a mucous ileal fistula proximal to the pouch before closing the temporary ileostomy. With this method the number of evacuations per 24 hours was significantly reduced during the first few weeks following the reestablishment of intestinal continuity, compared with a control group (average, 8.5 vs. 18.2, respectively). Patients also had better continence and less urgency to defecate. We suggest this technique in patients undergoing pelvic ileal reconstruction with temporary ileostomy.

Adaptation, Physiological↗
PubMed1993

Crohn's disease as a contraindication to Kock pouch (continent ileostomy).

Crohn's disease is often described as a contraindication to the construction of a Kock pouch (KP), but a consensus opinion is less definite. One hundred consecutive patients with a KP were reviewed after a minimum follow-up time of 2 1/2 years. The 95 patients with inflammatory bowel disease were analyzed for serious complications. All eight patients in whom the diagnosis of Crohn's disease or inflammatory disease of indeterminate type was made suffered serious complications requiring resections of the pouch or continuing treatment. By contrast, of the 87 cases with ulcerative colitis, only 17 (20 percent) had complications, six of which were readily and simply corrected. Our findings suggest that Crohn's disease should continue to be regarded as a firm contraindication to the KP procedure. It should be actively sought out preoperatively, and it should be treated aggressively if it is discovered after surgery. If such a patient requires further surgery, the KP should be removed.

Adolescent↗
PubMed1994

Results of ileal J-pouch-anal anastomosis in familial adenomatous polyposis complicated by rectal carcinoma.

PURPOSE: Rectal cancer frequently occurs in patients with familial adenomatous polyposis (FAP) and, in some cases, proctocolectomy and ileal pouch-anal anastomosis (IPAA) can be proposed as an alternative to end ileostomy. This study aimed to assess the results of IPAA for familial adenomatous polyposis complicated by rectal carcinoma. PATIENTS AND METHODS: Postoperative morbidity and bowel function following IPAA were assessed in six patients who had a mesorectal excision for rectal cancer. The functional results were compared with those obtained after IPAA in 134 FAP patients without bowel cancer. RESULTS: Carcinomas were located at a mean of 11 cm from the dentate line. There were no postoperative complications. One patient with synchronous hepatic metastases died 6 months after operation and the 5 others were alive without recurrence after a mean follow-up of 29 months. Mean frequency of defecation was 6.5/day (vs. 4.2/day in patients without carcinoma), 86 percent of patients had nocturnal defecation (vs. 50 percent), day and night continence were normal in 66 percent and 33 percent of patients, respectively, compared with 90 percent and 85 percent for IPAA without cancer. Pouch excision was required in one patient for unsatisfactory functional result. CONCLUSION: IPAA can be safely performed for cancer of the upper rectum complicating FAP, but a poor functional outcome related to mesorectal excision has to be expected.

Adenomatous Polyposis Coli↗
PubMed1992

Functional results of coloanal anastomosis with reservoir.

Functional results in 33 patients who underwent a coloanal anastomosis with reservoir were prospectively evaluated three months after colostomy closure and later (16.2 +/- 5.7 months) and were compared with those of 36 healthy controls. We were unable to demonstrate any significant difference between patients and controls concerning frequency of stools, feeling of the need to defecate, continence of stools and flatus, differentiation between flatus and feces, urgency, and need to wear a protective pad. There was a statistically significant difference concerning the ability to evacuate, which was better in the control group (score = 1.03) than in the patients (score = 1.63) (P less than 0.001). These results suggest that coloanal anastomosis with reservoir provides nearly normal function except for the ability to evacuate.

Adult↗
PubMed1992

Consequences of delayed ileostomy closure after ileal pouch-anal anastomosis.

Temporary diverting loop ileostomy is a generally accepted component of the ileal pouch-anal anastomosis (IPAA) procedure. Ileostomy closure is usually performed within two to three months but may be delayed because of disruption of the ileonanal anastomosis, suspected leak from the ileal reservoir, concomitant medical problems, or patient convenience. Of 362 patients undergoing IPAA at The Cleveland Clinic Foundation for inflammatory bowel disease, 10 have had their ileostomy closures delayed for more than six months. Clinical and manometric parameters are examined in these patients and compared with those who had earlier closure. There appears to be no significant difference in the functional outcome of IPAA in these patients in terms of number of bowel movements and degree of continence. Reservoir compliance and maximum tolerated volumes are similar. We conclude that delaying ileostomy closure for more than six months after IPAA has no deleterious effect on pouch function.

Adult↗
PubMed1995

Colostomy tube: new device for a continent colostomy.

PURPOSE: This study describes a new device (the colostomy tubus) for potentially establishing continence in patients with a diverted bowel. METHODS: The device was used in an animal experiment on dogs. The period of wearing the device was from one day to an uninterrupted insertion period of eight months. The device was used on an end sigmoid colostomy (4 dogs) and on a specifically shaped pouch stoma (2 dogs), in which the results proved most favorable. RESULTS: There were no complications caused by the device itself. The colostomy tubus seems to be a safe method of creating a continent colostomy and causes no tissue lesions. It proved reliable to wear. CONCLUSION: The device seems reasonable for human use, and a trial is currently under way.

Animals↗
PubMed1994

Ileal pouch-anal anastomosis: is preoperative anal manometry predictive of postoperative functional outcome?

PURPOSE: The aim of this study was to determine the value of preoperative anal manometry in predicting post-operative continence. METHODS: Anal manometry was performed in 73 consecutive patients before ileal pouch-anal anastomosis (IPAA) surgery (m1), before loop ileostomy closure (m2), and at a follow-up of one (m3) and two (m4) years. Mean and maximum resting and squeezing pressures were documented at each occasion. One year after surgery, pressures were correlated (r) with an incontinence score. RESULTS: A significant (P < 0.05) decrease in mean resting pressures was observed after IPAA (m1 = 66 mmHg; m2 = 42.8 mmHg), followed by a significant (P < 0.05) improvement of mean resting pressure after loop ileostomy closure (m3 = 53.8 mmHg; m4 = 54.7 mmHg). Mean squeezing pressures did not change (P > 0.05) at any time during the study (m1 = 114 mmHg; m2 = 102.9 mmHg; m3 = 103.4 mmHg; m4 = 95.8 mmHg). There was no correlation between preoperative mean resting pressure and postoperative (mI) incontinence score. CONCLUSION: Anal manometry showed a characteristic trend in internal anal sphincter injury after IPAA followed by recovery after ileostomy closure. However, it failed to prove helpful in the prediction of clinical outcome. Thus, although this study supports the continued use of manometry in a research setting, it challenges the value of routine manometry in a clinical context.

Anal Canal↗
PubMed1996

Simple radiographic evaluation of ileoanal pouch volume.

PURPOSE: Total colectomy and mucosal protectomy with ileal reservoir and anal pull-through is used in the treatment of ulcerative colitis or familial polyposis, with one complication being frequent bowel movements. A simple radiographic test to predict frequency of bowel movements and measure spasticity was evaluated. METHODS: Fourteen patients underwent evaluation after ileal reservoir and anal pull-through J-pouch construction. Barium sulfate suspension was instilled into the pouch via the anus in the standing position until reflux flowed into the small intestine proximal to the pouch and patients felt the urge to defecate. Total volume infused (VOLtot), volume to reflux (VOLrflx), and volume voided (VOLvoid) were measured. RESULTS: VOLvoid and the "voiding efficiency" (VOLvoid/VOLtot) correlated significantly with stool frequency (R=-0.744, P<0.002 and R=-0.754, P<0.002, respectively). Time from operation was correlated with VOLvoid and stool frequency (R=-0.723, P<0.003 and RO.573, P<0.032, respectively). CONCLUSIONS: The addition of quantitative measurements to this radiographic test gives useful information about pouch performance. Furthermore, the data imply that spasticity, as measured by voiding quantum and efficiency, rather than actual pouch volume is a major determinant of bowel movement frequency.

Adult↗
PubMed1995

Paradoxical puborectalis contraction in patients after pelvic pouch construction.

UNLABELLED: Normal defecation is associated with relaxation of sphincters during the evacuation process. However, obstructive defecation is sometimes seen clinically manifested by abnormal contraction of the puborectalis during defecation rather than relaxing. This condition has not previously been described after pelvic pouch construction. PURPOSE: This study was done to evaluate patients for defecation difficulties caused by paradoxical puborectalis contraction after pelvic pouch procedures. METHODS: Prospectively, patients with defecation difficulties were questioned. They then underwent electromyography if they met particular criteria. Biofeedback was offered to all patients demonstrating paradox on electromyography. Follow-up was by clinic visits and interviews. RESULTS: After pelvic pouch construction, 13 patients were found to have paradoxical puborectalis contraction. Twelve of 13 patients elected to have biofeedback therapy. Eleven of these 12 were available for follow-up an average of eight (1-15) months after biofeedback. Nine improved, and two had no change in their defecation difficulty. Of the initial 13, 10 had an event, either pouchitis or abdominal trauma, directly before their defecation problems. CONCLUSION: Paradoxical puborectalis contraction can occur in patients after pelvic pouch surgery. It should be suspected in patients with defecation difficulties in the absence of an anatomic abnormality. Biofeedback is effective treatment.

Biofeedback, Psychology↗
PubMed1994

Recovery of anal sphincter function after the ileoanal reservoir procedure in patients over the age of fifty.

PURPOSE: This study was undertaken to postoperatively assess the progression of anal sphincter function and clinical outcome in patients > or = 50 years old (Group I) compared with those < 50 years old (Group II). METHODS: Clinical data were assessed after ileostomy closure by a questionnaire. These data were compiled to obtain an incontinence score, which ranged from 0 (perfect continence) to 20 (total incontinence). Anorectal manometry was performed preoperatively (MN1) and postoperatively, before (MN2) and after (MN3) ileostomy closure. Wilcoxon and paired t-test were used to compare the clinical and functional results, respectively. RESULTS: Group I consisted of 22 patients (mean age, 56 years) and Group II, 50 patients (mean age, 32 years). No differences were found relative to either preoperative pressures or clinical outcome. However, both the mean and high resting pressures were significantly lower in Group I at the MN2 examination. CONCLUSION: The effect on anal sphincters of ileoanal reservoir in patients over the age of 50 years is similar to that noted in younger patients. Transient impairment of internal anal sphincter function observed after ileoanal reservoir is more severe in older patients (P = 0.01). However, as in younger patients, it does completely recover after ileostomy closure.

Adenomatous Polyposis Coli↗