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At least 1,423 records · Page 79Linked to original sources
PubMed2002

Laparoscopic-assisted total colectomy with pouch reconstruction.

Whether in adults or children, benign diseases of the colon are ideally suited for laparoscopic-assisted resection. In children, the most frequent diseases leading to colectomy and pull-through include Hirschsprung's disease, ulcerative colitis, and familial polyposis. Laparoscopic proctocolectomy with J-pouch reconstruction is an ideal approach for children and adolescents who are generally stable but suffer from unremitting symptoms of ulcerative colitis. An early experience with this technique at the Children's Hospital in Alabama is described for children with ulcerative colitis.

Adolescent↗
PubMed2001

Hypokalemic nephropathy after pelvic pouch procedure and protective loop ileostomy.

Proctocolectomy with ileal pouch-anal anastomosis and temporary ileostomy has been established as a curative operation in severe ulcerative colitis during the last 2 decades. Electrolyte imbalances during the first postoperative weeks until ileostomy closure have been reported previously. Here we report about a 70-year-old male patient with a 38 year-history of severe ulcerative colitis who developed slowly progressive renal failure after proctocolectomy with ileal pouch-anal anastomosis and temporary ileostomy. He was referred to our centre with a serum creatinine of 818 micromol/L, hypokalemia of 2.83 mmol/L and metabolic alkalosis as a patient with suspected end-stage renal disease in order to perform shunt surgery and start chronic hemodialysis. However, hypokalemia and metabolic alkalosis are not typical for end-stage renal disease, and renal biopsy showed typical signs of hypokalemic nephropathy. Our patient almost completely recovered after ileostomy closure. This case clearly shows that temporary ileostomy in patients who underwent proctocolectomy, e. g. for ulcerative colitis, is associated with a risk of hypokalemic nephropathy. The appropriate and definite therapy is a surgical one, i. e. ileostomy closure. Monitoring metabolic changes after proctocolectomy and ileostomy, especially during the defunctionalized stage when temporary ileostomy is still present, is essential.

Adult↗
PubMed2001

[J-pouch. Selection of patients and how to avoid malfunctions].

J-pouch. Selection of patients and how to avoid malfunctions.Indications for a total proctocolectomy with ileal pouch-anal anastomosis are given in patients with a familial adenomatous polyposis (FAP) and in patients with an ulcerative colitis under certain circumstances: therapy-refractory ulcerative colitis, side effects from conservative treatment, malignant transformation and emergency situations, i. e. toxic megacolon or massive bleeding. The preparation follows along anatomic layers and includes in cases of malignant transformation a radical lymph node dissection of the dependent area. When mobilizing the rectum the branches of the hypogastric nerve have to be observed with caution. A total anorectal mucosectomy is discussed controversely. In many centers the transitional zone is preserved due to a better discrimination. The pouch and the pouch-anal anstomosis should be protected by a loop ileostomy.

Adenomatous Polyposis Coli↗
PubMed2001

[Jejunal reservoir for pouch. Anal reconstruction].

Jejunal reservoir for pouch. Anal reconstruction. For restaurative proctocolectomy the ileal J-pouch is a world-wide accepted procedure. In some cases the mesenteric vascular anatomy does not allow to bring the ileum down to the dentate line. In these patients a jejunal reservoir can be a good alternative. The different architecture of arteries and veins within the jejunal mesentery makes the bridging of a longer distance possible. Within a group of 38 restaurative proctocolectomies, jejunal pouch was performed in 2 cases. Failure of an ileal pouch was the reason in one patient. In the other, the ileal mesentery was too short to achieve a tension free ileal pouch-anal anastomosis. The functional result is good in both cases.

Adenomatous Polyposis Coli↗
PubMed2001

[Colon pouch as neorectum. Technique, indications and results].

Colon pouch as neorectum. Technique, indications and results.The possibilities to preserve the intestinal continuity after surgery for rectal cancer have remarkably improved. After straight coloanal anastomosis the problem of a high stool frequency together with urgency was frequently to observe. The introduction of the colonic J-Pouch improved the functional outcome of rectal cancer-surgery very much. In a review of the literature the stool-frequency after one year was 0.5-4 bowel movements per day compared to 0.5-10 per day after straight coloanal anastomosis. Urgency was as well reduced. The parameter of urgency can be best expressed by measuring the urgency volume in balloon-volumetry. Here the volume for J-Pouch was 75 ml compared to 50 ml in straight coloanal anastomosis. At the beginning of colonic J-pouch-surgery evacuation disorders were more frequent observable. Clinical and experimental studies could demonstrate that a big pouch-size caused this problem. Since a pouch-length of 6 cm is used evacuation disorders are very rare. The improved perfusion of the side-to-end anastomosis in pouch-anastomosis reduces the rate of anastomotic leakage's (pouch 1.9 % vs. coloanal anastomosis 15.2 %). In published retrospective studies the oncological outcome is completely comparable to straight coloanal anastomosis. In the case of technical impossibility of J-pouch formation the ileocecal interponant is a possible alternative. This procedure has the same functional outcome.

Anal Canal↗
PubMed2001

[Pouch reconstruction after resection of the rectum].

Pouch reconstruction after resection of the rectum. Functional results after low anterior resection of the rectum and straight end-to-end coloanal anastomosis are often poor. Patients are frequently troubled by the so called "anterior resection syndrome" which comprises faecal incontinence, urge, frequency and fragmentation. To investigate the potential functional benefit of a coloanal pouch reconstruction we conducted a prospective study. Some 55 patients [29 men; median age 66,4 (30-85)] underwent low anterior resection of the rectum followed by coloanal J-pouch reconstruction. Pouch size was 5-7 cm, a temporary stoma was fashioned in 32 patients. Indications for the operation were: 1. rectal cancer: n = 51, 2. recurrent adenoma n = 2, 3. recto-vaginal fistula n = 1 and 4. severe non-specific proctitis n = 1. We observed 5 anastomotic leakages of which two patients required reoperation. A pelvic abscess was encountered in three patients as well as one pelvic haematoma. Micturition was impaired in five patients. To date 47 patients have completed 12 months follow-up after reversal of the ileostomy. Patients were seen at three-monthly intervals. Mean stool frequency/day was 3.9 after 3 and 2.6 after 12 months. After 3 months 38 patients (69 %) reported complete continence which increased to 83 % at 1 year. 18 Patients (33 %) complained of urge defaecation initially, which decreased to 14.5 % after 1 year. Fragmentation was observed in 40 % at 3 and and 22 % at 12 months, respectively. In conclusion, our initial experience with colonic J-pouch reconstruction shows good functional results.

Adult↗
PubMed2001

[The transverse coloplasty pouch. Review of experimental data and clinical application].

The transverse coloplasty pouch. Review of experimental data and clinical application. The transverse coloplasty pouch is a novel technique for sphincter preserving colonic reconstruction after total mesorectal excision. The method was developed in an animal model and resulted in favorable early functional results. Our results in patients with rectal cancer demonstrate that the technique is technically easy and safe. The transverse coloplasty pouch provides a neorectal reservoir of adequate volume and a favorable early functional outcome. It leads to a reduction in stool frequency compared with a straight anastomosis and the outcome is comparable to other colon reservoirs.

Anal Canal↗
PubMed2001

[Defecation properties after coloanal reconstruction in the pig model].

UNLABELLED: Defecation properties after coloanal reconstruction in the pig model. OBJECTIVE: Functional aspects after low anterior resection are of major interest. While patients with straight coloanal anastomoses may suffer from disabling stool frequency and incontinence, evacuation difficulties can be a problem in coloanal pouch anastomoses. The aim of the study was to investigate functional results by establishing a standardized defecation protocol after low anterior resection of the rectum in the pig model. METHOD: 24 adult Göttinger mini pigs were studied. They were randomly assigned to three groups: 8 animals served as control animals (group 1), the remaining 16 underwent low anterior resection with small colon-J-pouch (4-5 cm) reconstruction (n = 8) and large pouch design of 8-9 cm length (n = 8). The animals were investigated after 12 weeks postoperatively. Defecation properties we studied using a Ceruletide-induced defecography (0.3 microgram kgKG) with a 100 ml barium sulfate bolus, placed just above the anastomosis. RESULTS: Evacuation was significantly impaired in the large pouch (45 min.). However, the small pouches evacuated completely after 14 min. which was comparable to the unoperated controls (17.3 min.). CONCLUSION: Ceruletide-induced defecation reveals reproducible results in pigs. Evacualtion properties are highly depending upon the coloanal reconstruction. A small colon-J-pouch design reveals nearly physiologic results 3 months after surgery.

Anal Canal↗
PubMed2002

[Vulnerability of ileocoecal interposition pouch and colonic J-pouch to postoperative adjuvant radiotherapy].

AIM: The interposition of an ileocoecal segment has been introduced as an alternative procedure to impair the functional outcome following total mesorectal excision (TME). Up to now, there is no information concerning the effect of postoperative radiotherapy on the functional outcome of this method. PATIENTS AND METHODS: We compared functional outcome, anorectal physiology, and radiation therapy-related morbidity of 18 patients treated with TME und ileocoecal interposition (ICI) of which ten had postoperative radiotherapy, with 15 patients who had TME and colonic J-pouch (CJP) reconstruction of which 7 were subjected to radiotherapy. RESULTS: Patients with no radiotherapy revealed a satisfying functional result with a similar median frequency of defecation of 4.25 (2-5) and 3 (2-6) and an incontinence-score of 2.8 (0-6) and 1.0 (0-2) after ICI and CJP, respectively. Median stool frequency (7 (2-11) (ICI) and 5 (2.5-11) (CJP)) and incontinence score (6 (0-12) (ICI) and 7 (6-12) (CJP)) were markedly increased in both groups after radiotherapy. Besides a reduced anal resting pressure, a lower compliance and a smaller volume of the neorectum were observed in the irradiated patients. A radiogenic injury which required surgery was seen in 4/10 patients after ICI. In three of these four patients the interposed ileocoecal segment was mainly affected. None of the patients treated with a CJP suffered a similar complication. DISCUSSION: These data indicate that postoperative radiotherapy severely impairs the functional outcome after TME independent of the type of surgery used for reconstruction, and causes a significant morbidity after ICI. CONCLUSION: Postoperative radiotherapy following TME should be indicated cautiously, and ICI should not be used if postoperative radiotherapy is intended.

Adult↗
PubMed2002

[Total mesorectal excison and colonic-J-pouch-anal anastomosis in the therapy of low rectal carcinoma--results in 116 patients].

BACKGROUND: Total mesorectal excision with coloanal anastomosis has been accepted as standard therapy of low rectal carcinoma. Interposition of colonic J-pouch improved the functional results and was associated with better postoperative quality of life. In this study our own results are evaluated. METHODS: Between 1. 7. 1999 and 30. 6. 2001 116 patients underwent total mesorectal excision with coloanal anastomosis and colonic J-pouch interposition. Thirty-eight patients (32.9 %) with uT3-carcinoma received preoperative adjuvant short-time irradiation with 5 x 5 Gy and seven patients (6.0 %) with local non resectable cancer conventional radiochemotherapy with 50.4 Gy. A protective stoma was constructed in 56 patients (48.3 %). Six patients (5.2 %) received secondary stoma due to anastomotic complications. RESULTS: A clinically relevant insufficiency of the anastomosis occurred in eight patients (6.9 %). Three patients needed a secondary laparotomy for local peritonitis. Fecal diversion was constructed secondarily in four patients due to pouchvaginal fistula and in one patient for ischiorectal abscess one year after the first operation. Six patients revealed small fistulas in the radiological examination without clinical consequences. Five patients with primary fecal diversion showed pouchvaginal fistulas. The over-all anastomotic complication rate was 16.4 %. The follow-up demonstrated already in the first year after surgery good functional results with satisfying anorectal continence. Only nine patients complained of intermittent incontinence for solid stool. No patient needed a definitive stoma due to anastomotic complications. One patient developed a small anastomotic tumor recurrence one year after surgery. He could be cured by abdomino-perineal excision. CONCLUSIONS: Our results confirm the importance of total mesorectal excision as standard therapy for low rectal carcinoma. Good functional results can be obtained already in the early postoperative period by colonic J-pouch interposition.

Aged↗
PubMed2003

[Functional results and quality of life after proctocolectomy and ileal J-pouch-anal anastomosis for ulcerative colitis].

BACKGROUND: Ileal pouch-anal anastomosis is the surgical standard in the therapy of ulcerative colitis. It was the aim of the present study to evaluate functional long-term results and correlate them with quality of life. PATIENTS AND METHODS: 37 patients with a follow-up of more than 5 years were included. Functional results and quality of life were assessed by standardised questionnaires (modified Kelly-Hohlschneider-Score, EORTC QLQ-C30). RESULTS: 24 of 37 patients could be evaluated. Median follow-up was 8 (5-13) years. Postoperative stool- frequency was 5.5 +/- 1.7/d. When compared with the preoperative situation, patients suffered less from urgency. Stool-frequency and -consistency, soiling and sensibility remained unchanged. 83 % of patients had a subjective increase of life quality with the ileoanal pouch. The quality of life index was almost normal with 83 (28-100) %. Patients with postoperative complications had a significant decrease of life quality when compared to patients with uneventful course. There was no statistically significant correlation of life quality with age, gender or stool continence. CONCLUSIONS: Ileal pouch-anal anastomosis leads to a long-term increase of stool frequency with partially impaired stool continence. Patients with uneventful course have a significantly better life quality.

Adolescent↗
PubMed2005

[Surgical strategies for the prevention of gastrointestinal tumours].

Over many decades the surgical treatment of gastrointestinal tumours was limited to cases of manifest malignancy and was performed with curative or palliative intent. Molecular diagnostics have now led to an optimised characterisation of different sporadic and hereditary tumour entities. Furthermore, a number of diseases which are an obligatory precancerosis or which carry a very high risk of cancer in their long courses have now been identified. Parallel to these developments, a dramatic reduction of morbidity has been achieved in major abdominal surgery due to more subtle and blood-sparing surgical techniques and mortality has been reduced to a minimum even in the most major procedures. This combination nowadays safely allows preventive or preventive extended surgical measures in cases where interventional therapy cannot be adequately employed.

Adenomatous Polyposis Coli↗
PubMed1992

[The ileoanal reservoirs as a rectal replacement. The late complications and long-term functional results].

Late complications and functional results in 44 consecutive patients (17 women, 27 men; mean age 36 years) were collected prospectively after continence-preserving proctocolectomy for ulcerative colitis. In all patients a J-pouch was placed by direct end-to-side machine-stapled anastomosis without rectal cuff. 5 years postoperatively 12 of 13 (92%) were totally continent during the day, 11 of 13 (85%) at night. Stool frequency at that time was 6.3 +/- 2 per 24 hours; 4 patients (31%) had on average one motion during the night. Lasting sexual dysfunction occurred in three men. Fistulae, as a result of previously undiagnosed Crohn's disease, developed postoperatively in three patients: between pouch and vagina in one, between pouch and bladder in another. The pouch had to be removed in both instances. In the third patient an enterocutaneous fistula was closed. If strict indications are followed, the clinical and functional results of a pelvic ileoanal reservoir meet the daily demands of life at both a professional and social level.

Adenomatous Polyposis Coli↗