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At least 1,603 records · Page 89Linked to original sources
PubMed2001

Long-time experience with the Kock ileal reservoir for continent urinary diversion.

OBJECTIVES: N.G. Kock performed the first continent cutaneous ileal reservoir for urinary diversion in 1975 at the Sahlgrenska University Hospital, Göteborg, Sweden. We have investigated the fate of the patients operated during the following 25 years at this hospital and analyzed their health-related quality of life (SF-36) as well as their psychological adjustment to a life with a continent urinary reservoir (OAS). MATERIAL AND METHODS: Between 1975 and 1999, 176 patients underwent continent urinary diversion using a Kock reservoir. At the end of 1999, 126 patients were known to be alive. Their reservoir function was estimated from their journals as well as from a questionnaire answered by the patients. RESULTS: Almost 90% of the survivors had a well-functioning reservoir at the time of follow-up. The need for reoperation has been high, mainly due to nipple problems. Kidney function is not influenced by the continent diversion per se. The health status of the patients is more influenced by the underlying disease than by their reservoirs. Patients with benign functional or inflammatory diseases experience comparatively more problems with their reservoirs. CONCLUSIONS: The functional end results as well as patient acceptance of continent urinary diversion with a Kock reservoir are excellent.

Adult↗
PubMed2001

Characteristics and evolution of extraintestinal manifestations associated with ulcerative colitis after proctocolectomy.

AIMS: Describe the characteristics of extraintestinal manifestations complicating ulcerative colitis present preoperatively and determine their evolution after surgery. METHODS: Between 1976 and 1986, 281 patients with ulcerative colitis exhibiting one or more extraintestinal manifestations (EIM) before either IPAA (n = 147), Brooke ileostomy (n = 71), Kock pouch (n = 48) or ileorectostomy (n = 15) were assessed retrospectively. The clinical evolution of each manifestation was classified as having disappeared, improved, remained unchanged or aggravated postoperatively. An efficacy index was designed to assess the ratio of the number of cases cured or improved over the number of cases unchanged or aggravated. The relationship between EIM and gender, age, duration of disease and the type of surgery was also ascertained. RESULTS: 433 EIM were observed in 281 patients. The most common were arthralgias of the large joints (n = 146), of the sacroiliac joint (n = 59) and the small joints (n = 51). In comparison to patients without EIM having received the same operation during the same period of time, EIM were seen more often in women, younger patients, than those with longer duration of disease and the ileoanal anastomosis group. 60% had only one EIM at a time. Based on the efficacy index, thromboembolic accidents and erythema nodosum were the most commonly cured or improved. Ocular manifestations and primary sclerosing cholangitis were unaffected. The other EIM responded favorably but variably with improvement in two thirds of patients. The presence of a rectal remnant (IRA) or ileal reservoir did not affect the evolution of the EIM. CONCLUSIONS: Thromboembolic complications which are life-threatening, erythema nodosum and arthralgia of the small and large joints which impair quality of life, benefited the most from proctocolectomy. Those conditions may be considered preoperatively when making the decision for surgery.

Adult↗
PubMed2000

Evaluation of J-pouch reconstruction after total gastrectomy: rho-double tract vs. J-pouch double tract.

OBJECTIVE: Various enteric reservoirs have been advocated to improve the quality of life after total gastrectomy. We evaluated the advantages of pouch reconstruction compared with traditional rho-double tract reconstruction. DESIGN: Prospective randomized study. SETTING: Second Department of Surgery, Hyogo College of Medicine, Japan. SUBJECTS: Forty patients who underwent total gastrectomy for cancer of the stomach were studied. INTERVENTION: Forty patients were randomly divided into two groups: 20 patients received rho-double tract reconstruction (RDT group), and 20 underwent J-pouch double tract reconstruction (PDT group) group. MAIN OUTCOME MEASURES: We compared the body weight, serum nutritional parameters, reflux score, scintigraphic esophageal reflux, food intake, and emptying time of the J-pouch or rho-limb between the two groups. RESULTS: No difference was noted between the two groups with regard to body weight, but food intake tended to be higher in the PDT group than in the RDT group. Total protein and albumin levels were higher in the PDT group than in the RDT group, while scintigraphic reflux was significantly less prominent in the PDT group. CONCLUSIONS: J-pouch reconstruction was superior with respect to protein metabolism, food intake and reduction of reflux esophagitis compared with the traditional RDT method. However, use of pouch reconstruction did not improve postoperative weight gain.

Female↗
PubMed2003

Surgical treatment of severe inflammatory bowel diseases.

Surgical treatment of severe inflammatory bowel diseases is required in failed medical treatment, in emergencies and for complications. Indications for surgery and operative techniques have changed significantly over the last few years. There is a clear tendency towards earlier and less invasive surgical interventions performed in specialized and experienced centers. Improved quality of life of patients with Crohn's disease or ulcerative colitis after surgical therapy supports an earlier consideration of the surgical treatment option. A close cooperation with the involved gastroenterologist is mandatory in this context.

Colitis, Ulcerative↗
PubMed2003

Ileocecal valve-preserving ileostomy after total proctocolectomy--a novel technique for ileostomy.

BACKGROUND: Although ileoanal anastomosis has become popular for ulcerative colitis, in an emergency situation patients must undergo ileostomy. AIM: A novel ileocecal valve-preserving ileostomy procedure was devised to reduce high output liquid loss. METHOD: After total colectomy, the ascending colon was clamped and the terminal ileum and ileocecal valve were isolated from the cecum by dissection. The ileum was then brought out through a conventional ileostomy opening in the abdominal wall. RESULTS: Two patients with ulcerative colitis underwent ileostomy in this fashion. The stool became solid within 1 week after the start of solid food and their body weight increased by more than 10% 1 year after surgery. CONCLUSION: This novel procedure may result in an improvement in the quality of life of patients who undergo total proctocolectomy.

Adult↗
PubMedDate not supplied

Does botulinum type-A toxin affect motor activity after proctocolectomy and ileal pouch-anal anastomosis? An experimental study in dogs.

AIM OF THE STUDY: The use of anticholinergic drugs has provided a useful therapeutic approach to reduce stool frequency in patients with proctocolectomy and ileal pouch-anal anastomosis (IPAA). Botulinum type-A (BTA) toxin has been shown to specifically block acetylcholine release in the intestinal wall. Therefore this study investigated the effect of BTA on small intestinal and J-pouch motility after IPAA. MATERIAL AND METHODS: Proctocolectomy and IPAA were performed in 4 dogs. The motility of the small intestine and the ileal pouch was recorded by serosal electrodes and strain gauge transducers. The intestinal transit time was determined radiologically and pouch compliance was determined manometrically. Multiple measurements were performed before and after endoscopic injection of BTA into the pouch wall. RESULTS: This treatment did not significantly influence stool frequency, intestinal transit time or pouch compliance. Intrinsic pouch motility was characterized by irregular contractions, the amplitudes and frequencies of which remained unchanged after BTA administration. With the exception of lower contraction amplitudes directly proximal to the pouch, there were no significant differences in the characteristics of the migrating myoelectric complex or in the fed pattern of the small intestine and ileal pouch. CONCLUSIONS: BTA does not significantly affect ileal pouch motility. The beneficial effects of anticholinergic drugs therefore seem to be due to their multifactorial mode of action and not to the inhibition of cholinergic neurons in the pouch.

Anal Canal↗
PubMed2006

Postoperative joint symptoms: a risk factor for pouchitis in ulcerative colitis patients.

BACKGROUND: The prevalence and significance of joint symptoms appearing in patients with ulcerative colitis (UC) following a colectomy are unclear. AIM: We investigated the relationship between joint symptoms during steroid tapering following an ileal pouch-anal anastomosis (IPAA) and the cumulative risk for developing pouchitis. PATIENTS AND METHODS: The medical records of 571 patients who underwent an IPAA with a mucosectomy were retrospectively reviewed to evaluate their joint symptoms. A diagnosis of pouchitis was obtained using the Pouchitis Disease Activity Index (PDAI) and the cumulative risk of pouchitis was estimated using a Kaplan-Meier life table analysis. RESULTS: Joint symptoms during steroid tapering were reported by 126 (22.0%) of the UC patients and each of those had involvement of the small joints of the hand. The main symptoms were pain and stiffness, especially in the morning. The cumulative risk for developing pouchitis after 10 years was found to be 20% in patients who experienced joint symptoms during steroid tapering and 10% in those without those symptoms (p = 0.001). CONCLUSION: The presence of joint symptoms during steroid tapering is a significant risk factor for the development of pouchitis in patients who have undergone an IPAA for UC.

Adolescent↗
PubMed1991

What happens to the rectal muscular cuff? An experimental study in dogs.

The anatomy and histology of the rectal muscular cuff was studied in 15 dogs with an ileal pouch-anal anastomosis. Eight channel, three-dimensional anal manometry showed normal maximal squeeze pressure (128 +/- 20 mm Hg) compared to a control group (135 +/- 4 mm Hg). The rectal muscular cuff showed complete absence of the cuff in three cases. In 12 dogs, the rectal cuff was retracted to a length of less than 1 cm, the muscle fibers were degenerated and fibrotic. The results in the canine model and the clinical results of patients with an ileal pouch-anal anastomosis with a cuff demonstrated that a rectal muscular cuff is not essential to maintain continence after ileal pouch-anal anastomosis.

Animals↗
PubMed1994

Morphology following proctocolectomy in dogs: effect of introduction of a 'neocolon' using an interposed jejunal segment.

Intestinal mucosal morphology was studied in dogs given a new reconstruction procedure following proctocolectomy in which a jejunal segment was interposed between the terminal ileum and the anus to function as a 'neocolon'. Chronic inflammatory cell infiltration, villous atrophy, and fibrosis of the lamina propria were sought in three different intestinal sites and assigned a severity score. Twenty-four weeks after proctocolectomy, villous atrophy and fibrosis of the lamina propria were noted both in the interposed jejunum (neocolon) (p < 0.05, p < 0.01, respectively) and the terminal ileum (p < 0.05, p < 0.05, respectively). Similar changes were also observed in the proximal jejunum, but a significant difference compared to the preoperative time was not seen. Fibrosis of the lamina propria in the interposed jejunum tended to be more advanced than that in the other two sites. A statistical difference in severity was obtained between the interposed jejunum and the proximal jejunum (p < 0.05). Chronic inflammatory cell infiltration was similar in all sites examined. No obvious evidence of acute inflammation was found at any site examined. These data suggest that chronic morphologic changes inevitably occur at any site in the remaining intestine after proctocolectomy and that an interposed jejunal segment is most severely affected. The new interposition procedure may be effective in reducing the morphologic changes in the terminal ileum because of its proximal displacement.

Animals↗
PubMedDate not supplied

Pharmacotherapy of inflammatory bowel disease.

The standard treatments for inflammatory bowel disease have been aminosalicylates and corticosteroids, administered both systemically and topically. They are frequently extremely effective, especially at higher doses. Unfortunately steroid side effects are too frequent and agents with low systemic bioavailability (budesonide, beclamethasone and tixocortol) are being investigated. Azathioprine, although a useful adjunct to steroids, has occasional and unpredictable severe side effects. Cyclosporin is an important new therapy in severe refractory disease. Several new phospholipid mediator inhibitors, mepacrine, zileuton, and ridogrel, may be useful in moderate colitis. Other topical treatments, butyrate, acetarsol and bismuth subsalicylate, can be beneficial in refractory distal disease. Quadruple antimycobacterials, antioxidants and antimicrobials warrant further study, while newer immunosuppressives such as methotrexate, FK 506 and monoclonal antibodies against helper T lymphocytes show some early promise.

Colitis, Ulcerative↗
PubMedDate not supplied

Ileo-anal pouch function and dysfunction.

Ileal pouch-anal anastomosis (IPAA) has become well established as the ideal surgical option for the majority of patients with chronic ulcerative colitis. Improvements and simplifications in operative technique over recent years mean that such patients need no longer live with the fear of a permanent ileostomy with its associated physical, sexual and sometimes psychological problems. Most patients who have undergone IPAA achieve a good quality of life. There are, however, a number of questions with regard to the ileal pouch that remain unanswered. The purpose of this review is to summarize the advantages and disadvantages of the various designs of pouch which have been described, to discuss the function of the normal pouch and manifestations of dysfunctional pouches.

Colitis, Ulcerative↗
PubMed1993

Adenocarcinoma in an ileal conduit: recurrence of bladder adenocarcinoma.

Recurrent adenocarcinoma developed in an ileal conduit in a 75-year-old man who had undergone cystectomy and ileal conduit diversion for adenocarcinoma of the bladder 16 months before. The excised tumor was histologically identical to the original bladder tumor, and the mucosa of the ileal conduit was not involved by the tumor. Multiple lung metastases preceded the development of the recurrent tumor. The recurrent adenocarcinoma in the ileal conduit seemed to be a manifestation of a generalized spread of the tumor.

Adenocarcinoma, Mucinous↗
PubMed1993

Evaluation of upper urinary tract dynamics by diuresis renography in patients receiving urinary reservoir operation. Comparison of full and empty reservoir.

Upper urinary tract dynamics was evaluated using diuresis renography during full and empty reservoir in 14 patients (11 men, 3 women, 13-70 years old) with intestinal urinary reservoir or intestinal bladder augmentation. Types of operation were Mainz pouch urinary diversion 5, Mainz neobladder to urethra, 5, Kock pouch urinary diversion 2, and Mainz bladder augmentation 2. Diuresis renography was performed using 99mTc-DTPA and furosemide during full and empty reservoir, and several parameters (Tmax, T75, T50, GFR) in addition to the patterns of renogram were evaluated. In the normal control, none of the parameters of the diuresis renogram with full bladder differed from those with empty bladder. In 5 of 14 patients, abnormal waves on cystometry (CMG) were found, and in 4 of these 5 patients, the patterns of diuresis renogram of full reservoir were worse than those of empty reservoir. However, the patterns of diuresis renogram of full reservoir were not different from those of empty reservoir in 9 patients without abnormal waves on CMG. In conclusion, renal injury may easily occur in patients with intestinal reservoir and abnormal waves on CMG.

Adolescent↗
PubMed1996

Absorption of vitamin B12 administered to continent ileal reservoirs for urinary diversion.

Urinary diversion through intestinal segments is a widely used method after radical cystectomy. During the last few years, new methods of bladder substitution, continent ileal neobladders, were developed. We used the method described by Hautmann et al. in 1986. 70 cm of ileum is used to form a reservoir. The ureters are implanted into the reservoir, which is then anastomosed to the urethral stump. A known problem when intestine is used for urinary diversion is the absorption of urinary solutes leading to metabolic disturbances. Therefore, the absorption of vitamin B12, instilled into the neobladders of 20 patients, was measured and related to the postoperative interval. The results show a high absorption rate 2 weeks postoperatively that is reduced quickly and significantly (p < 0.001) within the first 10 months (from more than 30 to below 5%). One year to 23 months after the operation, some neobladders absorbed no vitamin B12 at all, whereas others still absorbed significantly but only small quantities. These results may probably be attributed to the loss of villous structure as well as atrophy of the epithelial surface.

Absorption↗
PubMed1995

The Camey-Le Duc antireflux technique for the Koch pouch: evaluation of the upper urinary tract.

Between November 1989 and June 1993, 41 patients (78 renal units) underwent Camey-Le Duc technique for prevention of reflux of a Kock pouch. In 30 patients the ileal reservoir was connected to the skin for cutaneous urinary diversion, and in 11 it was connected to the urethra for lower urinary reconstruction. The mean postoperative follow-up period was 23 months, with a range of 6-47 months. Postoperative excretory urography (IVP) was performed at least once a year to evaluate the upper urinary tract configuration, and ascending cystography was performed to evaluate the reflux. No urinary tract dilatation was observed in 73 renal units (93.6%), while slight dilatation was noted in 3 (3.8%), moderate dilatation in 1 (1.3%), and marked dilatation in 1 (1.3%). Reflux was not found in any patient. Of 23 renal units in 12 patients in whom the last IVP examination was performed 6 months postoperatively, dilatation was noted in 4 (17.4%). In contrast, of 55 renal units in 29 patients in whom the last IVP examination was performed 12 months or more after the Kock pouch operation, dilatation was noted in only 1 (1.8%). We conclude that the Camey-Le Duc antireflux technique is effective in terms of simplicity and reliability.

Adult↗
PubMedDate not supplied

Short-chain fatty acids, lactate, and ammonia in ileorectal and ileal pouch contents: a model of cecal fermentation.

Fecal concentrations of total short-chain fatty acids were normal in 16 patients with ileorectal anastomoses (mean +/- SEM, 99.7 +/- 10.3 mmol/L) and 28 patients with ileal pouch-anal anastomoses (138.8 +/- 8.5 mmol/L) and did not differ from those in 14 healthy noncolectomized controls (130.7 +/- 12.6 mmol/L). Acetate:propionate:butyrate:isobutyrate+valerate+isovalerate ratios were similar in the ileorectum (71:12:12:5%) and in the colorectum (66:14:13:7%) of healthy noncolectomized controls, whereas the concentration of acetate was increased at the expense of the polypeptide-derived isobutyrate, valerate, and isovalerate in the ileal pouch (77:12:11:1%). Ammonia was accordingly significantly diminished in ileal pouch contents (28.8 +/- 3.2 mmol/L vs 45.2 +/- 4.1 mmol/L in controls) in contrast to concentrations in ileorectal contents (36.2 +/- 5.3 mmol/L). Concentrations of lactate were normal and low. Twenty-four-hour productions of total short-chain fatty acids in 16.6% fecal homogenates from both groups of patients were normal. Addition of saccharides (eg, glucose, starch, pectin, ispaghula husk) increased the production of acetate, propionate, and butyrate and decreased the production of ammonia and isobutyrate, valerate, and isovalerate, which was increased in homogenates with albumin added. This pattern of substrate fermentation was similar in homogenates from ileal pouch, ileorectum, and control colorectum. In conclusion, the concentrations of short-chain fatty acids, lactate, and ammonia indicate that ileorectal fermentation resembles normal colorectal fermentation in noncolectomized healthy individuals, whereas the fermentation in ileal pouch contents seems to be more carbohydrate predominated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗