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 1,243 records · Page 69Linked to original sources
PubMed1996

Ileoanal anastomosis with pelvic pouch: short review.

Pelvic pouch surgery is still a rather new technique, but has been developed considerably over the years. The construction of J-shaped pouches and ileoanal anastomoses with a total stapling technique has meant considerable progress in the operative procedure compared to the method including mucosal proctectomy en bloc with excision of the rectum and colon, handsewn pouches, and handsewn ileoanal anastomoses. Omission of a deviating loop ileostomy saves the patient another operation, hospital stay and sick leave. Development of malignancy in an atrophic pouch mucosa cannot be ruled out. Careful surveillance of all patients at the operating clinic is therefore necessary.

Colitis, Ulcerative↗
PubMed1996

Small bowel volvulus following ileal pouch-anal anastomosis: CT demonstration.

We report a case of acquired small bowel volvulus as a cause of late obstruction after ileal J-pouch anal anastomosis. Computed tomography (CT) demonstrated signs of strangulated, adhesive obstruction with radial disposition of the loops around the mesenteric root and abnormal position of the superior mesenteric artery and vein on the right side of the aorta. These features were due to the surgical manipulation and tension of the mesentery and its vessels during ileoanal anastomosis.

Anal Canal↗
PubMed1992

Ileal pouch-anal anastomosis: state of the art.

IPAA surgery has evolved to assume a major role in the operative management of CUC and FAP. In experienced centres, the safety of performing this somewhat complex procedure, often in gravely ill patients, has been confirmed. A significant decrease in morbidity has accompanied increased experience and simplification of the operative techniques. Two major issues await resolution. The first has to do with the less than totally predictable functional results of IPAA surgery. While many patients do well, others, for no apparent reason, do poorly with excess frequency, urgency and incontinence. Whether operative modifications or preoperative testing can alter this outcome is at this time unclear. The second issue has to do with the potential long-term sequelae of IPAA surgery. Pouchitis and nutritional and metabolic consequences, including the potential for malignant transformation of ileal mucosa or of retained rectal mucosa, cannot be ignored. At present, these risks seem remote but only long-term follow-up will determine whether IPAA surgery deserves its current enthusiasm.

Adenomatous Polyposis Coli↗
PubMed1992

The surgical management of constipation.

The anal physiology laboratory plays a very important role in the selection of patients for surgical treatment for constipation. Any report which does not include reference to these methods of evaluation will not be helpful since there are several causes of constipation. The current recommended treatment for slow transit constipation is still total abdominal colectomy with ileorectal anastomosis. Treatment of pelvic floor outlet obstruction seems to be best accomplished using muscle/sensory retraining techniques since this is a functional disorder rather than an anatomical or physiological disorder. Combinations of colonic inertia, pelvic floor outlet obstruction and internal intussusception should be treated to correct the pelvic floor outlet obstruction initially, followed by correction of the colonic inertia. In this way failure will be avoided at the time of surgical treatment of the constipation.

Anal Canal↗
PubMedDate not supplied

Recurrent polyps in the ileo-anal pouch or rectum in familial adenomatous polyposis.

Most small bowel polyps in familial adenomatous polyposis (FAP) occur in the peri-ampullary region, and distal small bowel adenomas and carcinomas are comparatively less common. As standard therapy in FAP consists of proctocolectomy with ileal pouch anal anastomosis, or ileorectal anastomosis, it is essential to be aware of the potential for adenomatous polyp formation in the terminal ileum and rectum. Ileal adenomas are found in 9-20% of patients with FAP, and new polyps may develop after colectomy. Ileal lymphoid hyperplasia and polyps are 2-4 times more common than adenomas, may be indistinguishable from adenomas on examination (requiring biopsy for diagnosis), and tend to regress after colectomy. Adenomas may arise in pouches, usually after an interval of several years, and have been documented to occur in the terminal ileum up to 25 years after colectomy. At pouch construction, rectal mucosectomy may theoretically fail to remove all mucosa at risk. Small islets of rectal mucosa may remain after this technically difficult operation, and the late development of cancer, up to 20 years postoperation has been noted. A stapled anastomosis may arguably have a better physiological result, but a greater amount of residual rectal mucosa may increase late cancer risk. Annual endoscopic follow-up of pouches is recommended. All polyps or suspicious lesions should be biopsied, excised or destroyed, preserving a sample for histology. After ileorectal anastomosis, cancer risk in the rectal stump increases with chronological age, with risk ranging from 5-10% at age 50 years, to 14-29% at age 60 years. Surveillance of the rectal stump in FAP is recommended every 4-6 months. There may be a role for prostaglandin synthesis inhibitors in some patients.

Adenomatous Polyposis Coli↗
PubMed2006

Outcomes of a laparoscopic approach for total abdominal colectomy and proctocolectomy.

BACKGROUND: The role of laparoscopy for total abdominal colectomy (TAC) and total proctocolectomy (TPC) has been controversial given its technical difficulty, high conversion rate, and complication rate. Recent studies have documented its efficacy for experienced laparoscopic surgeons. The outcomes of a prospective series of patients undergoing TAC and TPC are presented. METHODS: A consecutive series of patients undergoing TAC or TPC were identified from prospectively collected data during 2002 to 2005. The database reflects a single colon and rectal surgical specialty practice. Patient characteristics, surgical parameters, and patient outcomes were documented. RESULTS: From a total of 51 patients, 19 underwent TAC and 32 underwent TPC. There were 26 women and 35 men. The mean patient age was 40 years (range, 17-74 y). The mean body mass index was 25 (range, 19-38). Twelve patients underwent surgery for colonic inertia, 2 for familial adenomatous polyposis, and 37 for chronic ulcerative colitis. Of the ulcerative colitis patients, 8 patients had toxic colitis, 4 had dysplasia, and 25 had medically refractory disease. The overall mean surgical time was 163 minutes (range, 85-227 min): the mean surgical time for TAC was 131 minutes (range, 85-189 min) and for TPC was 197 minutes (range, 131-227 min). The overall mean blood loss was 200 mL (range, 75-500 mL). The mean length of stay was 4.8 days (range, 2-16 d). Open conversion was required in 5 patients: 3 with toxic colitis (38%), and 2 during elective colectomy (4.8%). Ten complications occurred (19.7%) with no mortality. CONCLUSIONS: A laparoscopic approach to TAC and TPC is efficacious and safe. It is a viable alternative to open surgery for surgeons experienced with the laparoscopic approach to colectomy. Patients with toxic colitis may undergo a laparoscopic approach but will have a higher open conversion rate.

Adolescent↗
PubMed2006

Evaluating learning and knowledge retention after a continuing medical education course on total mesorectal excision for surgeons.

The purpose of this study was to determine whether knowledge gained (as determined by a formal course test) by surgeons in a continuing education course on total mesorectal excision and rectal cancer management is retained 1 year later. A formal course test had been previously developed and validated. The test evaluated course content including pelvic anatomy, surgical techniques, imaging, pathology, adjuvant therapies, and cancer and functional outcomes. Validation was determined by the absence of change in pre- and posttest scores of the "expert" course instructors (n = 8, P = .6) and by a linear correlation in test scores with increasing level of general-surgery resident training (n = 16, P = .001). Significant learning by the 58 surgeons taking the course had been shown by improvement in test scores from before the course (mean score 19) to after the course (mean score 25.3, P = .001, out of a possible 33 total mark). At 1 year after the course, those course participants (n = 44, 76%) who had provided postcourse contact information were asked to complete the course test again. Responses were received from 18 surgeons (41% of those surveyed, 31% of the original course participants). The mean score on the test after 1 year was 23.8. Compared with the immediate posttest scores, there was no significant knowledge loss over the year (P = .09). We conclude that knowledge acquired during a continuing education course for surgeons on total mesorectal excision and rectal-cancer management is retained 1 year later.

Clinical Competence↗
PubMedDate not supplied

[Laparoscopic ileal pouch-anal anastomosis].

Total coloproctectomy with ileal pouch-anal anastomosis is the operation of choice for both ulcerative colitis and familial adenomatous polyposis. In experienced teams, it is now possible to do this operation through a laparoscopic approach. Laparoscopy allows to perform the same operation than during open surgery, but with reduction of the surgical trauma, especially for the abdominal wound.

Anal Canal↗
PubMed2006

Hirschsprung's disease in a young adult: report of a case and review of the literature.

Hirschsprung's disease (HD) in adults is rare and often undiagnosed or misdiagnosed. We report a case of HD in a 26-year-old woman who had a history of chronic constipation that required laxatives and enemas since early childhood. She developed severe intestinal obstruction and presented to the emergency department with significant abdominal distension. A computed tomographic scan confirmed significant fecal loading of the entire colon and rectum. An anal manometry revealed lack of normal rectoanal inhibitory reflex. A rectal biopsy showed hypoganglionic anorectum, suspicious for HD. Because of the severe fecal retention that was refractory to conservative management, total proctocolectomy with ileal pouch-anal anastomosis was performed. The entire colon showed massive dilatation and marked wall thickening. Histologic examination showed absence of ganglion cells in submucosal (Meissner's) and myenteric (Auerbach's) plexuses in the distal rectum. A diagnosis of adult HD was made. Her postoperative course was uneventful with complete resolution of the symptoms. Hirschsprung's disease should be considered in adults who have long-standing and refractory constipation.

Adult↗
PubMed2006

Do patient preferences influence decisions on treatment for patients with steroid-refractory ulcerative colitis?

BACKGROUND & AIMS: Patients with steroid-refractory ulcerative colitis face a difficult treatment decision between colectomy and therapy with infliximab or cyclosporine. The aim of this study was to understand how individual patient preferences for the various treatment outcomes influence the optimal treatment decision for a given patient. METHODS: A Markov model was used to simulate treatment with total colectomy with an ileo pouch-anal anastomosis (TC/IPAA), cyclosporine (CSA), infliximab (INFLX), and infliximab followed by cyclosporine for treatment failures (INFLX-->CSA). Utility weights for treatment outcomes were elicited from 48 patients using both time trade-off and visual rating scale methods. Preference sets were applied to the model to identify the therapy that maximized quality-adjusted life years (QALYs) for each patient. Sensitivity analyses were performed to assess model robustness. RESULTS: Optimal treatment was highly variable among patients (INFLX-->CSA = 42%, 20/48; TC/IPAA = 37%, 18/48; CSA = 21%, 10/48; INFLX = 0%, 0/48). However, when average preference weights from our sample were applied to the model, medical treatments were superior to TC (CSA = .26 QALYs gained vs TC/IPAA; INFLX-->CSA = .25 QALYs gained vs TC/IPAA). CONCLUSIONS: Patient preferences have a clear impact on the optimal treatment for steroid-refractory ulcerative colitis. Although averaged preferences support the use of medical interventions, a third of individual patients may benefit most from proceeding directly to colectomy. Failure to fully assess individual preferences may result in suboptimal treatment for these patients.

Adult↗
PubMed2005

Indeterminate colitis: a pathologist's view.

Indeterminate colitis is only a partial diagnosis, which is provisional until sufficient information becomes available for a more precise diagnosis of either ulcerative colitis or Crohn's disease. As originally defined, i.e. based only on the pathological features in the colon resected for fulminant colitis, a few patients eventually developed Crohn's disease. If the term is used only after all available clinical and investigative evidence is considered, 'indeterminate colitis' behaves clinically like ulcerative colitis. This has important implications for pouch surgery.

Colitis↗
PubMed2006

Collagenous pouchitis.

Collagenous colitis is characterised by watery diarrhoea, normal colonic mucosa on endoscopy, diffuse colitis with surface epithelial injury, and a distinctive thickening of the subepithelial collagen table on histology. Some patients can develop medically refractory collagenous colitis, in which case they may require surgical intervention. This is the first report of collagenous pouchitis in a collagenous colitis patient with proctocolectomy and ileal pouch-anal anastomosis. A patient with medically refractory collagenous colitis who underwent a total proctocolectomy and ileal pouch-anal anastomosis was sequentially evaluated with an endoscopy and histology of the colon, distal small intestine, and ileal pouch. A 58-year-old female had a 10-year history of collagenous colitis before having a total proctocolectomy and ileal pouch-anal anastomosis for medically refractory disease. The histologic features of collagenous colitis were present in all colon and rectum biopsy or resection specimens, but were absent in the distal ileum specimen. The post-operative course was complicated by persistent increase of stool frequency, abdominal cramps, and incontinence. A pouch endoscopy was performed 3 years after ileal pouch-anal anastomosis which showed the histologic features of collagenous colitis in the ileal pouch, collagenous pouchitis, while the pre-pouch neo-terminal ileum had no pathologic changes. After antibiotic therapy, the histologic changes of collagenous pouchitis resolved. This is the first reported case of collagenous pouchitis. Since the abnormal collagen table and its associated features were only present in the pouch and absent in the neo-terminal ileum, and the patient had histologic improvement after antibiotic therapy, it would suggest that faecal stasis and bacterial load may play a role in the pathogenesis.

Anal Canal↗
PubMed2004

Functional outcome after intersphincteric resection of the rectum with coloanal anastomosis in low rectal cancer.

OBJECTIVES: Anterior rectal resection with partial removal of the internal sphincter is an option for low rectal cancer. The objective of this study was to evaluate the functional outcome after this intersphincteric rectal resection. METHODS: Anal continence was evaluated by anorectal manometry and a standardized questionnaire (Wexner Score) in 33 patients 28+/-15 weeks and 100+/-45 weeks, respectively, after intersphincteric resection. Nineteen of the 33 patients were reconstructed with a straight anastomosis; 12 received a colonic J-pouch. RESULTS: Post-operatively, 25.8% of the patients were incontinent to solid stool and 54.8% were incontinent to liquid stool at least once a week. Mean and maximum resting tone (24+/-10 and 40+/-13 mmHg), maximum tolerable volume (77+/-28 ml) and rectal compliance (1.4+/-1.2 ml/mmHg) were reduced in anorectal manometry. Squeeze pressures remained unchanged. Only the maximum tolerable volume correlated significantly with the continence score (r=-0.45, p<0.05). The Wexner score and maximum tolerable volume were significantly better after colonic J-pouch reconstruction than after straight anastomosis (9.9+/-4.5 vs 13.4+/-4.0, p<0.05, 65+/-20 ml vs 100+/-27 ml, p<0.01). CONCLUSION: Intersphincteric resection of the rectum leads to impaired post-operative continence. The functional outcome is improved with a colonic J-pouch.

Adult↗
PubMed2005

Anorectal reconstruction by electrostimulated graciloplasty as part of abdominoperineal resection.

AIMS: To report the outcomes of anorectal reconstruction by electrostimulated graciloplasty as part of abdominoperineal resection, on data prospectively collected over 10 years. PATIENTS AND METHODS: Twenty-three abdominoperineal resections were associated to coloperineal pull through, double graciloplasty and loop abdominal stoma. Fifteen patients also received an implantable pulse generator, either for unsatisfactory result after external-source intermittent electrostimulation and biofeedback (five cases) or during graciloplasty (10 cases). Follow-up was to a maximum of 10 years. Functional outcome was followed up in sixteen patients who underwent stoma takedown. RESULTS: Mean actuarial survival at 5 years was 72.3%. Satisfactory results (score < or =8) occurred in 75% of patients (three without and 13 with stimulator) in the early stages, decreasing to 57% at 1 year and gradually increasing up to 100% at 5 years and over. CONCLUSIONS: Total anorectal reconstruction yields a good functional outcome over time. Thus, despite, and because of, a high complication rate and a great drain on resources, it should be considered a suitable procedure only for selected, strongly motivated patients.

Aged↗
PubMed2005

Comparative study of epithelial gene expression in the small intestine among total proctocolectomized, dietary sodium-depleted, and aldosterone-infused rats.

We previously demonstrated enhanced plasma aldosterone, ileal activation of epithelial sodium channel (ENaC), and induction of 11 beta-hydroxysteroid dehydrogenase type 2 after total proctocolectomies in rats. However, factors other than circulating aldosterone may cause molecular induction associated with sodium transport. Sprague-Dawley rats were treated with sodium-deficient diets or subcutaneous aldosterone infusion for 4 weeks. Rats also underwent total proctocolectomies as positive control. We extracted epithelial RNA from the distal small intestine and compared mRNA expression of the alpha, beta, and gamma subunits of ENaC, prostasin, sodium glucose transporter 1 (SGLT1), and the alpha1 and beta1 subunits of Na(+)/K(+)-ATPase among control, total proctocolectomized, dietary sodium-depleted, and aldosterone-infused rats by quantitative reverse transcription-polymerase chain reaction or Northern blotting. A significant increase in aldosterone was noted in sodium-depleted and aldosterone-infused rats. The induction of three subunits of ENaC and prostasin mRNA was observed in proctocolectomized, aldosterone-infused rats but not in dietary sodium-depleted rats. The levels of the alpha1 and beta1 subunits of Na(+)/K(+)-ATPase were similar among the experimental groups. SGLT1 mRNA was induced only in proctocolectomized rats. The molecular induction of ENaC, prostasin, and SGLT1 is unique for total proctocolectomized rats. Aldosterone infusion can induce several essential molecules for sodium absorption, as seen in total proctocolectomy.

Animals↗
PubMed2006

An approach to analyze mechanisms of intestinal adaptation following total proctocolectomy.

We hypothesized that epithelial cells of the remnant small intestine display "colonic" phenotype after total proctocolectomy. The aims of the present study were to identify preferentially expressed molecules in the colon or in the small intestine and to evaluate mRNA levels of those in the ileal pouch. Differential gene expression was investigated between the small intestine and the colon by using cDNA microarray and was confirmed by Northern blotting. Expression of three colonic mRNAs (3-hydroxy-3-methylglutaryl-coenzyme A synthase 2, deleted malignant brain tumors 1, carcinoembryonic antigen-related cell adhesion molecule 1) and one "small intestinal" (microsomal triglyceride transfer protein) mRNA were compared between the control and the ileal pouch mucosae by quantitative reverse transcriptase-polymerase chain reaction. Seventy-four clones were differentially expressed with more than a threefold difference. Differential expression was confirmed in all mRNAs examined, including 3-hydroxy-3-methylglutaryl-coenzyme A synthase 2 and microsomal triglyceride transfer protein. The mucosal expression of carcinoembryonic antigen-related cell adhesion molecule 1 mRNA in the ileal pouch was enhanced in humans. The remnant ileum develops some, but not all, colonic phenotype after total proctocolectomy. Comparative study of epithelial gene expression between the small intestine and the colon enables us to analyze mechanisms of intestinal adaptation after total proctocolectomy.

Adaptation, Physiological↗