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Restorative proctocolectomy

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
Venkata Subhash Gorrepati, Sanjay Yadav, August Stuart, Walter Koltun, Evangelos Messaris, Emmanuelle D Williams, Matthew D Coates
PURPOSE: Anxiety and depression (A&D) are more common in inflammatory bowel disease (IBD) and in IBD patients who undergo proctocolectomy with ileal pouch-anal anastomosis (IPAA). Our aim was to test the hypothesis that chronic inflammatory conditions in IPAA are associated with increased incidence of A&D. METHODS: Retrospective cohort study at a single tertiary care referral center using a consented IBD and colon cancer natural history registry. Demographic and clinical factors, including surgical and psychiatric history, were abstracted...
June 29, 2018: International Journal of Colorectal Disease
Theodore Delmonico, Andrew H Stephen, Daithi S Heffernan
BACKGROUND: Necrotizing soft tissue infection (NSTI) is a rapidly progressive infection characterized by tissue necrosis, septic shock, and is associated with a high risk of death. Key aspects of successful treatment include early recognition and emergent surgical source control. Necrotizing soft tissue infection may occur from a range of etiologies but may also occur rarely from gastrointestinal routes. We report a case of severe lumbar NSTI arising from an ileal pouch fistula in a patient with inflammatory bowel disease...
July 2018: Surgical Infections
Hannah Buettner, Maria X Kiely, Mengdi Yao, James Yoo, Lilian Chen
Total proctocolectomy with ileal pouch-anal anastomosis can restore gastrointestinal continuity in patients requiring colectomy for ulcerative colitis, however, it can be associated with high morbidity. Reoperation for pouch-related complications is technically challenging and often leads to deterioration of pouch function or need for permanent stoma. We report a case of acute on chronic small bowel obstruction secondary to a 360-degree twist in the small bowel introduced during creation of the ileal-anal pouch...
June 2018: Journal of Surgical Case Reports
Gianluca M Sampietro, Francesco Colombo, Alice Frontali, Caterina M Baldi, Stefania Carmagnola, Andrea Cassinotti, Alessandra Dell'Era, Alessandro Massari, Paola Molteni, Dario Dilillo, Paolo Fociani, Massimo Tonolini, Giovanni Maconi, Paolo Fiorina, Fabio Corsi, Roberto Bianco, Manuela Nebuloni, Gianvincenzo Zuccotti, Sandro Ardizzone, Diego Foschi
BACKGROUND: Laparoscopic ileo-pouch-anal anastomosis (IPAA) has been reported as having low morbidity and several advantages. AIMS: To evaluate safety, efficacy and long-term results of laparoscopic IPAA, performed in elective or emergency settings, in consecutive unselected IBD patients. METHODS: All the patients received totally laparoscopic 2-stage (proctocolectomy and IPAA - stoma closure) or 3-stage (colectomy - proctectomy and IPAA - stoma closure) procedure according to their presentation...
May 21, 2018: Digestive and Liver Disease
Aleksandra Glapa, Krystian Waraczewski, Jan Krzysztof Nowak, Jacek Paszkowski, Maciej Borejsza-Wysocki, Patrycja Krzyzanowska-Jankowska, Tomasz Banasiewicz, Jaroslaw Walkowiak
No abstract text is available yet for this article.
May 28, 2018: Inflammatory Bowel Diseases
Venkata Subhash Gorrepati, Negar Rassaei, Kofi Clarke
After ileal pouch anal anastomosis, one of the frequently encountered complications is polyposis of the pouch. We describe a case of proximal neoterminal ileal polyposis associated with deep ulceration suggestive of Crohn's disease and review the available literature. A 36-year-old male presented with resistant pouchitis 11 years after surgery for ulcerative colitis. With all-negative initial workup, pouchoscopy showed multiple deep ulcers in the proximal ileum with some polyps. Biopsy of polyps showed inflammatory polyps with negative immunohistological staining for IgG pouchitis...
January 2018: Case Reports in Gastroenterology
Paolo Giuffrida, Alessandro Vanoli, Elena Biletta, Catherine Klersy, Gaetano Bergamaschi, Gianluca M Sampietro, Sandro Ardizzone, Ombretta Luinetti, Michele Martino, Marco Vincenzo Lenti, Nicola Aronico, Marco Curti, Rachele Manca, Paolo Fociani, Marta Truffi, Fabio Corsi, Gino Roberto Corazza, Antonio Di Sabatino
BACKGROUND: Inflammatory bowel disease (IBD) is associated with neuroendocrine cell hyperplasia. AIMS: We investigated neuroendocrine cells in J-pouches of patients with ulcerative colitis undergoing restorative proctocolectomy and ileal pouch-anal anastomosis. METHODS: Sections from pouch biopsies of 17 patients and ileal biopsies of 17 active IBD patients and 16 controls were processed by immunohistochemistry for chromogranin A (CgA) and serotonin...
April 28, 2018: Digestive and Liver Disease
Marica Grasso, Alessandro Cimmino, Nicola Sangiuliano, Antonello Niglio
INTRODUCTION: Nowadays, after wide left colectomy, it is necessary to choose one of the following procedures: a definitive transverse colostomy, an ileo-rectal anastomosis or a right colo-rectal anastomosis (Deloyers procedure). PRESENTATION OF CASE: We performed our new procedure on a 63 years-old man. After an extensive left proctocolectomy, the intestinal continuity between the transverse colon and rectum was obtained by transposition and rotation of the right colon into the pelvis...
2018: International Journal of Surgery Case Reports
I Helavirta, M Hyöty, P Oksanen, H Huhtala, J Haapamäki, P Aitola
BACKGROUND AND AIMS: Patients undergoing restorative proctocolectomy have often suffered from active ulcerative colitis which should be remembered when assessing quality of life after operation. The aim of this study was to explore health-related quality of life after restorative proctocolectomy in those with poor or good pouch function and to compare that to patients with active or inactive ulcerative colitis and to the general population. MATERIAL AND METHODS: Altogether, 282 restorative proctocolectomy patients were investigated...
May 1, 2018: Scandinavian Journal of Surgery: SJS
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