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 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim was to assess the value of reoperative surgery for pouch-related complications after ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis and familial adenomatous polyposis. Between January 1981 and August 1989, 114 of 982 IPAA patients (12%) seen at the Mayo Clinic had complications directly related to IPAA that required reoperation. Among the 114 patients, the complications prevented initial ileostomy closure in 33 patients (25%), occurred after ileostomy closure in 68 patients (60%), and delayed ileostomy closure in the remaining patients. The salvage procedures performed included anal dilatation under anesthesia for anastomotic strictures, placement of setons and/or fistulotomy for perianal fistulae, unroofing of anastomotic sinuses, simple drainage and antibiotics for perianal abscesses, abdominal exploration with drainage of intra-abdominal abscesses with or without establishment of ileostomy, and complete or partial reconstruction of the reservoir for patients with inadequate emptying. None of the reoperated patients died. Reoperation led to restoration of pouch function in two thirds of patients and, of these, 70% had an excellent clinical outcome. However approximately 20% of the 114 pouches required excision. Excision was common, especially among patients who had pelvic sepsis. Salvage procedures for pouch-specific complications can be done safely and will restore pouch function in two thirds of patients. Complications after reoperation, however, may ultimately lead to loss of the reservoir in one in five patients.
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PMID:Ileal pouch-anal anastomosis. Reoperation for pouch-related complications. 217 42

A 32-year-old woman with liver failure from end-stage cirrhosis and ulcerative colitis developed septicemia and severe ARDS. Subtotal colectomy and a successful liver transplantation resulted in complete resolution of the ARDS.
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PMID:Resolution of the adult respiratory distress syndrome following colectomy and liver transplantation. 220 14

Ileoanal anastomosis is usually performed with covering ileostomy. This is primarily done because of fear of pelvic sepsis. Temporary ileostomy may, however, be a source of significant complications. The first 21 patients in the authors clinic were operated upon using covering loop ileostomy in ileoanal operations. These patients had no anastomotic or pouch complications, but there were complications, especially with the closure of the ileostomy. Therefore, a trial of one-stage operations in ileoanal anastomosis was started. Ileoanal anastomosis without ileostomy was performed on 25 consecutive patients. All the patients were operated upon for ulcerative colitis. There was one patient with pelvic abscess who needed diverting ileostomy. Thus, the early failure rate in patients operated upon without ileostomy was 4 percent. There were many other complications among these patients, but no other relaparotomy was needed. The complication rate was not different in patients operated upon without ileostomy compared with the authors first 21 patients operated upon with ileostomy (60 and 52 percent, respectively). Patients with one-stage operation needed a significantly shorter mean hospital stay than patients with two-stage operation (13.6 days and 25.3 days, respectively; P less than 0.001). The use of corticosteroids appears not to be a contraindication for one-stage operation, because there were significantly more patients using corticosteroids in the one-stage group compared with the two-stage group (92 and 62 percent, respectively; P less than 0.05).
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PMID:Ileoanal anastomosis without covering ileostomy. 232 27

In 1974 total colectomy and ileoanal straight endorectal pull-through (ERPT) were first used at our institution for the definitive management of total colonic Hirschsprung's disease in infants and children. Early success with this operation encouraged us to use this procedure in children and adults with ulcerative colitis and familial polyposis in 1977. Since 1974 we have performed total colectomy and straight ileoanal ERPT on 100 consecutive patients with ulcerative colitis (79), familial polyposis (19), and total colonic Hirschsprung's disease (10). Patients who have undergone a colectomy and ERPT but have not had their temporary ileostomy closed have been excluded from this report. This group of patients represents the only large series of straight ERPTs available for comparison with the various reservoir modifications that have been reported. All operations were performed under the direction of the author. The mean age at surgery was 20.6 +/- 9.8 years, with a range of 1 to 48 years. Forty-six patients were younger than 18 years at the time of operation. All patients with ulcerative colitis and familial polyposis underwent a temporary loop ileostomy with total abdominal colectomy with ERPT; the 10 infants and children with Hirschsprung's disease underwent the total colectomy and ERPT without a back-up ileostomy. There were two deaths in this series, one from fulminate hepatic failure in the late postoperative period and the other from multiple bowel fistulas and sepsis in a teenager with Crohn's disease, in whom the initial diagnosis was ulcerative colitis. Follow-up has ranged from 3 months to 15 years. There were 13 cases of adhesive bowel obstruction, seven of which required an enterolysis. Pelvic sepsis occurred in three patients, two of whom required operative drainage. Two women developed rectovaginal fistulas, which healed with temporary diversion. Minor wound infections occurred in five patients. There were no anastomotic leaks, nor were any cases of pouchitis encountered. In five patients permanent conversion to a Brooke ileostomy was required. Mean stool frequency 3 years after surgery was 7.7 per 24 hours. Daytime continence was achieved in all patients. Occasional nocturnal soiling occurred in 11.1% of patients at 1 year and was absent by 3 years. Neither age nor diagnosis (ulcerative colitis versus familial polyposis) affected stool frequency.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:A personal experience with 100 consecutive total colectomies and straight ileoanal endorectal pull-throughs for benign disease of the colon and rectum in children and adults. 239 80

Since 1978, J. Utsunomiya has performed total colectomy, mucosal proctectomy and ileoanal anastomosis (IAA) in 105 patients and analysed their results in 97 patients consisting of 61 of familial polyposis (FP) and 36 of ulcerative colitis (UC) those who have been observed for two months to 10 years after operation. The operative procedures were classified in the three modalities. I. the "end to end-long cuff", II. "J-pouch-long cuff" and III. "J-pouch-short cuff" procedure. The success rate has been improved to 93.0% in the procedure III. compare with 74.1% in the II and 61.5% in the I. This improvement was achieved by preservation of reservoir continence, reduction of pelvic sepsis and less damaging of the internal sphincter during operation. Through a series of evolutional modification, the surgical technique has been established to the present method which is constructed with the four principal components: direct anastomosis of J-ileal pouch to the anus, short rectal cuff mucosectomy, anoabdominal approach at prone jack-knife position and routine use of defunctioning ileostomy. With this technique, both FP and UC patients enjoyed excellent or good function in 90% of the cases. Sex of the patient did not influence the functional result, but older patients showed poorer results compared with the younger patients. This procedure can provide a function comparable with ileorectal anastomosis with a technical difficulty similar to that of the abdominal pouch. All patients with FP or UC who require colectomy are candidates for IAA unless they are 60 years or older. For UC a three stage surgical procedure of IAA proceeded by open rectal excluding colectomy could improve the result.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:J-pouch: change of a method over years. 247 71

Univariate and multivariate analysis has been used to assess the influence of 14 variables on the results of 65 consecutive ileoanal pouch procedures over 5 years. There were 9 failures requiring intubation, ileosomy or pouch excision. There was a significant association between failure and pelvic sepsis (p less than 0.05; n = 8), endoanal mucosectomy (p less than 0.05; n = 7), preservation of a long rectal cuff (p less than 0.05; n = 5) and lack of experience with the operation (p less than 0.05; n = 8). Of 49 patients with preoperative evidence of ulcerative colitis, 3 are now known to have Crohn's disease. The only factor having a significant adverse influence on complications was endoanal mucosectomy (p less than 0.01). Functional outcome was significantly impaired in patients who developed pelvic sepsis (p less than 0.001), a post-operative fistula (p less than 0.05) and who had an endoanal mucosectomy (p less than 0.05). Success with ileo-anal pouch reconstruction increases with experience. Avoidance of sepsis is associated with a lower failure rate, improved functional results and reduced hospital stay. Preliminary colectomy is also advised to exclude Crohn's disease if the diagnosis is in question.
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PMID:Multivariate analysis of factors influencing the results of restorative proctocolectomy. 247 72

The aim of this study was to assess gastrointestinal function and quality of life, including occupational, social, and sexual function, in 75 patients who underwent pelvic pouch construction between November 1984 and May 1988 at our institution. Complications occurred in 45 percent of patients after pouch construction and in 17 percent after ileostomy closure. One patient died from sepsis caused by an anastomotic leak after ileostomy closure. The most common complication was a pouch-anal anastomotic stricture (22 percent), and the complication with the greatest potential morbidity was pouch-anal dehiscence (8 percent), which was highly predictive of pouch failure. Functional results were assessed by questionnaire during the 3-month period after ileostomy closure in all 58 patients who successfully attained intestinal continuity. A second assessment was performed at 15 +/- 11 months after ileostomy closure in 52 patients whose continuity had been restored for longer than 3 months. In an overall assessment, 94 percent of all patients with restored intestinal continuity (73 percent of entire patient group) rated the pouch as being superior to a permanent ileostomy and 92 percent (71 percent of entire group) would go through another pouch procedure. These results support the continued recommendation of this procedure as an acceptable alternative to proctocolectomy and permanent ileostomy in patients with ulcerative colitis or familial polyposis.
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PMID:Function and quality of life results after ileal pouch surgery for chronic ulcerative colitis and familial polyposis. 254 Jun 65

The aim of this study was to compare the immediate postoperative results and the long-term outcome of ileal pouch-anal anastomosis in 94 patients with familial adenomatous polyposis to those in 758 patients with ulcerative colitis. Two colitis patients died after operation (0.3%), but no polyposis patients died. Overall operative complications appeared in 26% and 29% of polyposis and colitis patients, respectively (NS). Reoperation for intestinal obstruction did not differ between the two groups, but sepsis requiring reoperation was more common in colitis patients (6%) than in polyposis patients (0%, p less than 0.04). At follow-up (mean, 3 years), polyposis patients had fewer daytime stools (4.5 stools per day), less nighttime fecal spotting (26%), and less pouchitis (7%) than colitis patients (5.8 stools per day; spotting, 40%; pouchitis, 22%; p less than 0.002). The conclusion was that polyposis patients tolerated the operation better and had less long-term disability than did colitis patients. The data suggest that postoperative sepsis, daytime stooling frequency, nocturnal incontinence, and pouchitis may be, at least in part, disease related and not surgeon or operation related.
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PMID:Ileal pouch-anal anastomosis: comparison of results in familial adenomatous polyposis and chronic ulcerative colitis. 216 96

Ulcerative colitis requiring surgical removal of the colon can be approached via four surgical options: previously (until 1975) by a Brooke ileostomy or ileorectostomy, and more recently by a Kock's continent reservoir ileostomy and ileal pouch-anal anastomosis. This review assesses the current surgical alternatives with particular emphasis on ileal-pouch anastomosis. Ileal pouch-anal anastomosis is described in detail, since this is the preferred method at the Mayo Clinic in patients in whom proctocolectomy is recommended. 390 patients operated on for chronic ulcerative colitis by this method were followed up for at least 6 months postoperatively. Ninety-four percent of the patients were ultimately satisfied with their results despite a few postoperative complications. Twenty-four patients had their ileal pouch-anal anastomosis taken down and either a Brooke ileostomy or a continent ileostomy established because of pelvic sepsis or subsequent appearance of Crohn's disease or poor functional results. In some cases a Kock pouch was fashioned. When all is said and done, ileal pouch-anal anastomosis is the only procedure that promises to meet the criteria for an ideal operation. If appropriately timed and done by experienced surgeons, the beneficial effect of such a curative, yet continence-preserving procedure could be profound.
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PMID:Surgical treatment of chronic ulcerative colitis. 268 Aug 60

Conservative proctocolectomy was performed for ulcerative colitis in 19 patients, Crohn's disease in three and familial adenomatous polyposis in one. Healing was uncomplicated in only three patients (13 per cent). Eleven developed an anal discharge and nine an infected pelvic haematoma despite peranal drainage. Fourteen patients developed pelvic sepsis and, despite surgical curettage in 11, none healed. Six of these patients have had the anal sphincter divided, with healing in only one, and the anal canal has been excised in two. Eleven patients have ultimately healed at a median time of 28 months and eight have persistent sepsis after a median period of 45 months. Two patients with sepsis have had a successful ileoanal anastomosis. Conservative proctocolectomy cannot be recommended as a definitive operation for ulcerative colitis even though it may permit a subsequent restorative procedure.
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PMID:Conservative proctocolectomy: a dubious option in ulcerative colitis. 276 16


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