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Restorative proctocolectomy

D Mege, F Colombo, M E Stellingwerf, A Germain, L Maggiori, D Foschi, C J Buskens, A de Buck van Overstraeten, G Sampietro, A D'Hoore, W Bemelman, Y Panis
Background and Aims: Although laparoscopic a1pproach is associated with the reduction of adhesions, no data are available about risk factors for small bowel obstruction (SBO) after laparoscopic ileal pouch-anal anastomosis (IPAA). The objective is to identify risk factors for SBO after laparoscopic IPAA for inflammatory bowel disease (IBD). Methods: All consecutive patients undergoing laparoscopic IPAA for IBD in 4 European expert centres were included and divided into Groups A (SBO during follow up) and B (no SBO)...
October 11, 2018: Journal of Crohn's & Colitis
Jonathan P Segal, Lawrence Penez, Soad Mohsen Elkady, Guy H T Worley, Simon D McLaughlin, Benjamin H Mullish, Mohammed N Quraishi, Nik S Ding, Tamara Glyn, Kesavan Kandiah, Mark A Samaan, Peter M Irving, Omar D Faiz, Susan K Clark, Ailsa L Hart
BACKGROUND: Restorative proctocolectomy with ileal pouch-anal anastomosis is considered the procedure of choice in patients with ulcerative colitis refractory to medical therapy. Subsequent inflammation of the pouch is a common complication and in some cases, pouchitis fails to respond to antibiotics, the mainstay of treatment. In such cases, corticosteroids, immunomodulatory or biologic treatments are options. However, our understanding of the efficacy of anti-tumour necrosis factor medications in both chronic pouchitis and Crohn's-like inflammation is based on studies that include relatively small numbers of patients...
September 29, 2018: Scandinavian Journal of Gastroenterology
Remil Simon, Keith Hollister, J Daniel Stanley, Shauna Lorenzo-Rivero
No abstract text is available yet for this article.
September 1, 2018: American Surgeon
Remil Simon, Keith Hollister, J Daniel Stanley, Shauna Lorenzo-Rivero
No abstract text is available yet for this article.
September 1, 2018: American Surgeon
Shannon P Sheedy, David J Bartlett, Amy L Lightner, Steven W Trenkner, David H Bruining, Jeff L Fidler, Wendaline M VanBuren, Christine O Menias, Joshua D Reber, Joel G Fletcher
Restorative total proctocolectomy with ileal pouch-anal anastomosis is the surgery of choice for patients with medically refractory ulcerative colitis, ulcerative colitis with high-grade dysplasia or multi-focal low-grade dysplasia, and for patients with familial adenomatous polyposis. The natural history of the surgery is favorable, and patients generally experience improved quality of life and acceptable long-term functional outcome. However, some patients experience significant long-term morbidity from early and/or late pouch-related complications...
September 27, 2018: Abdominal Radiology
Sharman P Tan Tanny, Minjung Yoo, John M Hutson, Jacob C Langer, Sebastian K King
BACKGROUND: Surgical management of adult ulcerative colitis (UC) is well-studied, but not readily applicable to children. Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA), performed as one-, two-, or three-stage procedure, is preferred in pediatric patients with adequate anal sphincter function. PURPOSE: METHODS: Systematic review of Cochrane Register of Controlled Trials, PubMed, and EMBASE databases was conducted (January 1987-December 2016), in accordance with PRISMA...
September 7, 2018: Journal of Pediatric Surgery
Jonathan P Segal, Cosimo Alex Leo, Jonathan D Hodgkinson, Emanuel Cavazzoni, Elissa Bradshaw, Phillip F C Lung, Rajpandian Ilangovan, Carolynne J Vaizey, Omar D Faiz, Ailsa L Hart, Susan K Clark
INTRODUCTION: Restorative proctocolectomy has gained acceptance in the surgical management of medically refractive ulcerative colitis and cancer prevention in familial adenomatous polyposis. Incontinence following restorative proctocolectomy occurs in up to 25% of patients overnight. The Renew® insert is an inert single use device which acts as an anal plug. The aim of this study was to assess the acceptability, effectiveness and safety of the Renew® insert in patients who have undergone restorative proctocolectomy...
September 15, 2018: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Freeha Khan, Xian-Hua Gao, Amandeep Singh, Jessica R Philpott, Bo Shen
Background: Our recent study showed the efficacy and safety of vedolizumab in the treatment of chronic antibiotic-refractory pouchitis. However, there are no published studies on its efficacy and safety in Crohn's disease (CD) of the pouch. The aim of this study was to assess the efficacy and safety of vedolizumab in those patients. Methods: This case series included all eligible patients with CD of the pouch from our prospectively maintained, IRB-approved Pouchitis Registry from 2015 to 2017...
August 2018: Gastroenterology Report
Kevin P Quinn, Amy L Lightner, William A Faubion, Laura E Raffals
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical procedure of choice for patients with medically refractory ulcerative colitis (UC) or indeterminate colitis, UC with colonic dysplasia or neoplasia, and familial adenomatous polyposis. In general, patients experience good function outcomes and quality of life with an IPAA. Although pouchitis is the most well-recognized and frequent complication after IPAA, a number of additional inflammatory, postsurgical, structural, neoplastic, and functional complications may occur, resulting in pouch dysfunction...
August 16, 2018: Inflammatory Bowel Diseases
S M Oke, J Segal, S K Clark, A L Hart, S M Gabe
Introduction Restorative proctocolectomy is a surgical treatment for patients with medically refractory ulcerative colitis and some cases of familial adenomatous polyposis. Intestinal failure, defined as an inability to maintain adequate hydration and micronutrient balances when on a conventionally accepted normal diet, is a rare complication of restorative proctocolectomy. We describe our experience of patients with restorative proctocolectomy who have developed intestinal failure requiring parenteral support...
August 16, 2018: Annals of the Royal College of Surgeons of England
Olga A Lavryk, Luca Stocchi, Tracy L Hull, Emre Gorgun, Sherief Shawki, Jeremy M Lipman, Stefan D Holubar, Conor P Delaney, Scott R Steele
THE AIM: The aim of this study was to analyze factors associated with quality of life (QoL) after ileal pouch anal anastomosis (IPAA). METHODS: Patients who underwent IPAA (1983-2015) and replied to QoL questionnaire were identified from an IRB-approved prospectively maintained IPAA-database. QoL was assessed using Cleveland Global Quality of Life (CGQL) questionnaire at 1, 3, 5, and 10 years postoperatively. Patient cohort was divided in two groups: overall QoL score ≤ 0...
August 10, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Petra Ganschow, Silke Trauth, Ulf Hinz, Anja Schaible, Markus W Büchler, Martina Kadmon
BACKGROUND: Restorative proctocolectomy with ileal pouch-anal reconstruction is the standard prophylactic surgical procedure for patients with familial adenomatous polyposis. However, several groups have reported the development of adenomas and even carcinomas within the ileal pouch. The predisposing factor was the time interval after pouch surgery in some studies, but it was the severity of the initial colonic disease and duodenal adenomatosis in others. OBJECTIVE: The aim of this study was to further clarify the prevalence of pouch adenomas, clinical risk factors, and a possible phenotype-genotype relation in a large population of patients with familial adenomatous polyposis, as well as to analyze pouch adenoma-free survival...
September 2018: Diseases of the Colon and Rectum
Guillaume Pineton de Chambrun, Barbara Tassy, Laura Kollen, Gaspard Dufour, Jean-Christophe Valats, Michael Bismuth, Natalie Funakoshi, Fabrizio Panaro, Pierre Blanc
Ulcerative proctitis is defined as a mucosal inflammation limited to the rectum. Ulcerative proctitis is responsible for distressing symptoms and alteration of patient quality of life. Effective treatment is important to prevent or delay proximal extension of the disease and to improve quality of life. Refractory ulcerative proctitis is defined as the failure of topical and oral 5-aminosalicylic acid and corticosteroids. Medical management of refractory ulcerative proctitis may be challenging as there is little evidence regarding drug efficacy in this clinical situation...
February 2018: Best Practice & Research. Clinical Gastroenterology
Francesco Colombo, Gianluca Pellino, Francesco Selvaggi, Fabio Corsi, Guido Sciaudone, Gianluca M Sampietro, Diego Foschi
BACKGROUND: Although the creation of a stoma reduces the risk of septic pouch complications following ileal pouch-anal anastomosis (IPAA), the stoma itself and its reversal can give rise to substantial morbidity during the two- or three-stage concept. Aim of study is to compare stoma-related complications in Ulcerative Colitis patients undergoing laparoscopic versus open IPAA. METHODS: We collected data on 250 IPAA patients from two Italian Centres between 2005 and 2015...
July 24, 2018: American Journal of Surgery
Yuki Horio, Motoi Uchino, Toshihiro Bando, Teruhiro Chohno, Yoshio Takesue, Hiroki Ikeuchi
BACKGROUND/AIMS: Higher body mass index (BMI) is associated with an increased risk of postoperative complications, but only a few studies have clarified the effect of higher BMI on perioperative outcomes in ulcerative colitis (UC). The -purpose of this study was to evaluate the effect of higher BMI on patients undergoing surgery for UC. METHODS: UC patients who underwent surgery between April 2012 and August 2015 were included. Higher BMI was defined as a BMI ≥25 kg/m2...
July 25, 2018: Digestion
J Hardt, P Kienle
PURPOSE: Ileal pouch prolapse is a rare complication after j-pouch formation with an incidence of about 0.3%. However, if a pouch prolapse occurs, it can be a debilitating complication for the patient. Full-thickness pouch prolapse usually warrants surgical repair as reported by Sagar and Pemberton (Br J Surg 99(4):454-468, 2012) and Sherman et al. (Inflamm Bowel Dis 20(9):1678-1685, 2014). This report presents our first experience with laparoscopic ventral pouch pexy with acellular dermal matrix (ADM)...
July 21, 2018: International Journal of Colorectal Disease
Adam Nałęcz, Krzysztof Dębski, Marek Dobosz, Magdalena Krauze
Desmoid (desmoid tumor) is a cytologically benign fibrous tumor that originates from musculoskeletal structures of the entire body [1]. The term "desmoid", first introduced by Muller in 1838, derives from the Greek word desmos, which means tendinous [2]. The etiopathogenesis of desmoid is not fully understood, most reports of publications regarding its treatment are based on individual case reports. The prognosis is good, and healing is achieved mainly through surgical excision of the lesion. The aim of the paper is to present a case of a 33-year-old woman with diagnosed familial polyposis in the colon, who has been identified with mesenteric desmoid...
May 16, 2018: Polski Przeglad Chirurgiczny
Jörn Gröne, Eva-Maria Lorenz, Claudia Seifarth, Hendrik Seeliger, Martin E Kreis, Mario H Mueller
BACKGROUND: There is no general consensus regarding the ideal timing of surgery in patients with refractory ulcerative colitis (UC). Decision-making and timing of restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is influenced by treating physicians and patients themselves. The aim of this study was to determine whether or not patients would have preferred the operation to be performed earlier, at the same time, or at a later point of time and to determine the reasons for their preference...
July 12, 2018: International Journal of Colorectal Disease
Jonathan Athayde, Sarah C Davies, Claire E Parker, Leonardo Guizzetti, Christopher Ma, Reena Khanna, Brian G Feagan, Vipul Jairath
BACKGROUND: Approximately half of the patients with ulcerative colitis (UC) who undergo restorative proctocolectomy develop pouchitis within 10 years of surgery. Currently, there are no approved pouchitis treatments. It is important to quantify, and ultimately minimize, placebo rates to design and conduct efficient pouchitis trials. AIMS: To quantify the placebo rate observed in pouchitis randomized controlled trials (RCTs) in meta-analysis. METHODS: Embase, MEDLINE, and the Cochrane Library were searched from inception to November 3, 2017, for placebo-controlled RCTs enrolling adult UC patients with, or at risk for developing, pouchitis...
July 11, 2018: Digestive Diseases and Sciences
Erkin İsmail, Halil İbrahim Açar, Murat Nihat Arslan, İsmail Çoban, Ayhan Cömert, Ahmet Keşşaf Aşlar, Mehmet Ayhan Kuzu
BACKGROUND: The IPAA technique restores anal functionality in patients who have had the large intestine and rectum removed; however, 1 of the most important reasons for pouch failure is tension on the anastomosis. OBJECTIVE: The aim of this study was to compare technical procedures for mesenteric lengthening used for IPAA to reduce this tension. DESIGN: After randomization, 4 different techniques for mesenteric lengthening were performed and compared on fresh cadavers...
August 2018: Diseases of the Colon and Rectum
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