A selective approach to restorative proctocolectomy without ileostomy: a single centre experience

Lovegrove, Richard E.; Symeonides, Panayiotis; Tekkis, Paris; Goodfellow, Peter; Shorthouse, A. J.

doi:10.1111/j.1463-1318.2008.01506.x

Cited by 22 publications

(16 citation statements)

References 29 publications

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“…[218][219][220][221][222][223] although they report similar anastomotic leak rates and pelvic sepsis-related complications for both diverted and nondiverted groups, in all of these studies, the use of protective ileostomy was left to the discretion of the surgeon-a potential source of bias. [218][219][220][221][222][223] although they report similar anastomotic leak rates and pelvic sepsis-related complications for both diverted and nondiverted groups, in all of these studies, the use of protective ileostomy was left to the discretion of the surgeon-a potential source of bias.…”

Section: In Carefully Selected Patients a 1-stage Ipaa Can Be Considmentioning

confidence: 99%

“…in general, those patients undergoing 1-stage procedures have been younger, healthier, less obese, without anemia or hypoalbuminemia, and on either no immunosuppressive medications or lower dosages. 223,228,229 although it is clear that the use of a protective ileostomy does not alter the incidence of anastomotic leak, the milder pelvic sepsis related to fecal diversion may have a favorable impact on subsequent pouch function or retention. a few studies have strongly encouraged the abandonment of this practice owing to higher anastomotic leak rates, more life-threatening septic complications, and the need for subsequent emergent operation.…”

Section: In Carefully Selected Patients a 1-stage Ipaa Can Be Considmentioning

confidence: 99%

See 1 more Smart Citation

Practice Parameters for the Surgical Treatment of Ulcerative Colitis

Ross

Steele

Varma

et al. 2014

Diseases of the Colon &Amp; Rectum

159

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Section: In Carefully Selected Patients a 1-stage Ipaa Can Be Considmentioning

confidence: 99%

Section: In Carefully Selected Patients a 1-stage Ipaa Can Be Considmentioning

confidence: 99%

Practice Parameters for the Surgical Treatment of Ulcerative Colitis

Ross

Steele

Varma

et al. 2014

Diseases of the Colon &Amp; Rectum

159

View full text Add to dashboard Cite

“…Their mean age was 45 years . The mean length of hospital stay was 11 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) days. Twenty two (63%) were treated due to FAP, 12 (34%) for colon tumor or polyp with concomitant rectum cancer and 1 (3%) for severe dysplasia in ulcerative colitis.…”

Section: Resultsmentioning

confidence: 99%

“…They both increasingly improve within the first two years. In large series, the average number of daytime defecations is reported as 6 and nocturnal defecations as 1 (16,17). While our cases had 5 defecations per day on average, 4 cases were identified to have 1 nocturnal defecation.…”

Section: Discussionmentioning

confidence: 99%

Review of our ileal pouch experience in the light of literature

Çakır

Doğan

Küçükkartallar

et al. 2015

UCD

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Objective: Retrospective proctocolectomy is a distinguished, sphincter saving treatment used for the treatment of ulcerative colitis and FAP disease. We aimed to evaluate ileal pouch interventions performed at our clinic and their results in the light of literature. Material and Methods:Medical records of 35 restorative proctocolectomy and J pouch ileo-anal anastomosis surgeries performed at Necmettin Erbakan University, Meram School of Medicine between the years 2006-2013 were retrospectively examined. The patients were assessed according to their age, gender, length of hospital stay, diagnosis, follow-up duration and pouch-related complications. All patients were contacted by phone and they were scheduled for controls at the outpatient clinic.Results: Nineteen patients were male (54%) and 16 were female (46%). Their mean age was 45 years (21-74). The mean length of hospital stay was 11 (5-20) days. Twenty two (63%) patients were operated on due to FAP, 12 (34%) due to synchronous rectum cancer and colon tumor or polyp, and one (3%) due to ulcerative colitis. All patients received J pouch and protective ileostomy. After the closure of ileostomy, two cases were identified to have J pouch fistulas. The patients were followed up for 6 months to 7 years. They were contacted by phone and they were questioned about their active complaints, number of defecations, urinary and sexual dysfunctions. It was identified that they had 5 (3-8) defecations per day on average and that 4 (11%) cases had one nocturnal defecation. No pouchitis was identified in the follow-up endoscopic examinations. Conclusion:Restorative proctocolectomy and ileo-anal anastomosis technique is a surgical procedure that can be performed with low rates of morbidity and mortality, including the elderly.

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“…In patients who have an IPAA for FAP, the frequency is much lower. In a review of almost 800 patients with IPAA for FAP, a presumptive diagnosis of pouchitis was made in 5.5%, although not every case was confirmed endoscopically [9,10].…”

Section: Incidence Of Pouchitismentioning

confidence: 98%

Surgical Prophylaxis of Pouchitis in Ulcerative Colitis

et al. 2010

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Ileal pouch-anal anastomosis (IPAA) is now the procedure of choice for most patients requiring proctocolectomy for ulcerative colitis. The J-shaped pouch, usually 15-20 cm in length, is easiest to construct and has functional outcomes identical to those of the more complex designs. IPAA is a complex procedure, and complications occur frequently. Despite the significant improvements this surgical advance has made on the quality of life in these patients, inflammation of the surgically created ileal pouch or pouchitis remains a major late postoperative complication that can often overshadow the benefits of this otherwise curative operation. Several inflammatory and noninflammatory complications can occur after IPAA. Pouchitis is the most common, occurring in ≈50% of patients. Whereas acute pouchitis can be treated rapidly and successfully in the majority of patients, refractory and chronic pouchitis remain therapeutic challenges to patients and physicians. The problem is believed to be caused by stasis of feces in the pouch with overgrowth of aerobic and anaerobic organisms. The size of the pouch has a significant influence on the incidence of pouchitis: a smaller pouch usually empties better than a larger pouch and so may be less susceptible to pouchitis.

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A selective approach to restorative proctocolectomy without ileostomy: a single centre experience

Abstract: Selective omission of a covering ileostomy in most cases can produce good results following RPC with no increase in the risk of septic complications or pouch failure, and a decreased risk of anastomotic stricture, with maintenance of good function in the majority.

Cited by 22 publications

References 29 publications

Practice Parameters for the Surgical Treatment of Ulcerative Colitis

Practice Parameters for the Surgical Treatment of Ulcerative Colitis

Review of our ileal pouch experience in the light of literature

Surgical Prophylaxis of Pouchitis in Ulcerative Colitis

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