Surgical options in the treatment of ulcerative colitis

Ryan, Daniel P.; Doody, Daniel P.

doi:10.1053/j.sempedsurg.2017.10.001

Cited by 17 publications

(8 citation statements)

References 76 publications

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“…The management of severe VEOIBD with IL10 gene mutations remains a challenge despite significant advances in medical and surgical therapies [15,23,24]. The burden of surgery and postoperative complications in children with IBD should be considered [25,26].…”

Section: Discussionmentioning

confidence: 99%

Complications of enterostomy and related risk factor analysis of very early onset inflammatory bowel disease with interleukin-10 signalling deficiency: a single-centre retrospective analysis

et al. 2020

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Background Interleukin-10 (IL10) signalling pathway deficiency results in severe very early onset inflammatory bowel disease (VEOIBD), and enterostomy is often inevitable. However, studies in these surgical populations are lacking. This study aims to determine the enterostomy characteristics, postoperative complications and related risk factors in enterostomy patients. Methods From March 1, 2015, to December 31, 2018, patients with IL10R-mutation who underwent enterostomy were recruited for analysis. We collected data on the patients’ clinical characteristics, enterostomy characteristics, postoperative complications and related risk factors. Results Twelve patients required emergency enterostomy, and 10 patients underwent elective enterostomy. Twelve patients experienced postoperative complications, including wound infection (27.3%), wound dehiscence (18.2%), reoperation (18.2%), etc. Compared with the pre-enterostomy values, there was a decrease in C-reactive protein (CRP) (P = 0.001), an increase in albumin (P = 0.001) and an improvement in the weight-for-age (P = 0.029) and body mass index (BMI) Z-scores (P = 0.004) after enterostomy. There was a significant difference between the pre-operation and postoperation medicine expenses (P = 0.002). Univariate binary logistic regression analysis revealed a statistically significant influence of CRP (OR: 1.43, 95% CI: 1.07–1.91, P = 0.016) and a tendency towards a significant influence of intestinal perforation, albumin level, BMI Z-score and weighted paediatric Crohn’s disease activity index (wPCDAI). Multivariate logistic regression analysis showed that CRP (OR: 1.40), wPCDAI (OR: 2.88) and perforation (OR: 1.72) showed a tendency to behave as independent risk factors for postoperative complications, but the results were not significant (all P > 0.05). Conclusions Surgery and enterostomy showed benefits for VEOIBD with IL-10 signalling deficiency. The timing of intervention, potential postoperative complications, economic burden and other related problems should be considered.

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Section: Discussionmentioning

confidence: 99%

Complications of enterostomy and related risk factor analysis of very early onset inflammatory bowel disease with interleukin-10 signalling deficiency: a single-centre retrospective analysis

et al. 2020

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“…Akut ağır koliti, yüksek doz steroid veya biyolojik ajan ile yakın zamanda tedavi edilmiş, ağır malnutrisyonu olan, undetermine koliti olan hastalarda 3 aşamalı prosedür (öncelikle subtotal kolektomi ve ileostomi, ikinci aşama total kolektomi ile poş ve ileoanal anastomoz, üçüncü aşama ileostominin kapatılması) önerilmektedir (1,9,10). İleostomisiz poş ve ileoanal anastomoz yapılan olgularda komplikasyon oranları, ileostomi açılan poş ve ileoanal anastomoz komplikasyonlarına göre farklı bulunmamıştır (1).…”

Section: Discussionunclassified

Ulseratif Kolitli Cocuklarda Kolektominin Etkileri

2019

GMJ

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Amaç: Ülseratif kolit (ÜK) tanısı ile izlenen çocuklarda kolektomi etkilerinin değerlendirilmesi amaçlanmıştır. Yöntem: Kolektomi öncesi ve sonrası klinik ve laboratuvar bulgular ve kolektomi ilişkili komplikasyonlar geriye dönük değerlendirilmiştir. Sonuçlar: Kolektomi yapılan 18 hastanın ortalama yaşları 8,02±5,66 olup; %66,6'sı erkektir. On altı hastada kolektomi endikasyonu medikal tedaviye yanıtsızlık, bir hastada displazi, bir hastada toksik megakolon ve kanamadır. Kolektomi öncesi; 13 hastaya, basamak yükseltici / kurtarıcı tedavi olarak siklosporin ve/veya infliksimab verilmiştir. On üç hastaya ileostomisiz ileoanal anastomoz, 2 hastaya ileostomisiz ileal poş ile ileoanal anastomoz, 2 hastaya ileostomi ve Hartmann poş ile subtotal kolektomi, 1 hastaya subtotal kolektomi yapılmıştır. Hastaların kolektomiden 1 yıl sonra bakılan ağırlık, boy, vücut kitle indeksi Z skorlarında kolektomi öncesine göre artış görülse de, istatistiksel olarak anlamlı fark bulunmamıştır. Kolektomiden 1 yıl sonra hemoglobin değeri artmış; lökosit, C-reaktif protein ve sedimentasyon değerleri düşmüştür. Kolektomi sonrası 2 hasta dışındaki tüm hastaların kullandığı immünsupresif ilaçlar kesilmiştir. En sık görülen kolektomi ilişkili komplikasyon dışkı kaçırma ve sık dışkılamadır. Tartışma: Ülseratif kolit tedavisinde en sık olarak medikal tedaviye yanıtsızlık endikasyonu ile yapılan kolektomi; inflamasyonu kontrol ederek, klinik ve laboratuvar bulguları düzeltmekte, çocukların büyüme ve gelişmesini sağlamaktadır. Önemli yan etkileri olan immünsupresif ilaçların kullanımını azaltmaktadır. Komplikasyonları, hastalığa göre kontrolü daha kolay problemlerdir.

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“…However, in a patient that does not respond to intravenous corticosteroids and at least one second-line agent, families may become more interested in the option of surgery. In patients with severe colitis who decide on surgery, we usually perform a colectomy and ileostomy, as a start to a "three-stage procedure" [51]. However, in some patients who desire a two-stage procedure, we may attempt to induce remission with a short-term agent such as a calcineurin inhibitor before proceeding to surgery [52].…”

Section: Surgical Considerationsmentioning

confidence: 99%

Management of Pediatric Patients Hospitalized with Ulcerative

Bousvaros¹

2021

Management of Inpatient Inflammatory Bowel Disease

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Surgical options in the treatment of ulcerative colitis

Cited by 17 publications

References 76 publications

Complications of enterostomy and related risk factor analysis of very early onset inflammatory bowel disease with interleukin-10 signalling deficiency: a single-centre retrospective analysis

Complications of enterostomy and related risk factor analysis of very early onset inflammatory bowel disease with interleukin-10 signalling deficiency: a single-centre retrospective analysis

Ulseratif Kolitli Cocuklarda Kolektominin Etkileri

Management of Pediatric Patients Hospitalized with Ulcerative

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