Construction of pouch using “pantaloon” technic for pull-through of ileum following total colectomy

Valiente, Miguel A.; Rey, Hato; P, Rico; Bacon, Harry E.

doi:10.1016/0002-9610(55)90694-2

Cited by 84 publications

(20 citation statements)

References 2 publications

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“…After an ileoanal anastomosis, for example, fewer than half the patients obtained satisfactory function. 8 Two avenues of advance have now converged to allow a fresh approach to be made to this problem. The first is the work of Kock," who has shown that an ileal pouch is consistent with normal intestinal function.…”

Section: Introductionmentioning

confidence: 99%

Proctocolectomy without ileostomy for ulcerative colitis.

Parks¹,

Nicholls²

1978

BMJ

1,232

474

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85 axilla with thin polyethylene film held in place with cotton-wool balls and crepe bandage. After using this irksome regimen for six months one patient reported that control of sweating was achieved just as readily without occlusion. Accordingly we instructed our patients to apply the solution without an occlusive dressing, and subsequent experience showed that this element of Shelley and Hurley's method is unnecessary. The morning after application the axilla was washed thoroughly with soap and water. Nightly applications were continued for one week, after which the patient applied the solution only when necessary. ResultsAll the patients were followed up closely in the two departments, and after 12 months a questionnaire was sent to the Swindon group asking for their comments. Sixty-four patients were highly delighted with the treatment and had achieved complete control of axillary sweating by periodic use of the solution. We felt that the high rate of return of the questionnaire in Swindon (41 out of 42 returned in two weeks) also reflected their satisfaction. After the initial period of nightly treatment the interval between applications varied from two days to one year. Most patients, however, had to apply the solution once every seven to 21 days to maintain control. The only side effect mentioned was irritation of the axillary skin, which we presume is caused by the high acidity of the solution. Twenty-nine experienced some irritation, but 28 of these said that it was readily relieved by applying 1 hydrocortisone cream on the morning after treatment. Some of these patients also found that they could reduce the irritation by applying the solution more accurately to the area of excessive sweating. One patient, who had the least severe hyperhidrosis, had to stop treatment because of unbearable irritation. DiscussionThis trial was highly successful, and we think that 20", aluminium chloride hexahydrate in absolute alcohol should be considered to be the treatment of first choice in axillary hyperhidrosis. In particular, the troublesome occlusive dressing recommended by Shelley and Hurley7 was found to be unnecessary, which makes the treatment much more acceptable to the patient. Preparation of the solution has been described as laborious,1" but this has not been our experience. Our hospital pharmacists report that if the mixture of aluminium chloride hexahydrate crystals and absolute alcohol is left at room temperature and shaken occasionally a 20',( solution may be produced in three weeks. A local chemist has also made the solution without difficulty. Using absolute alcohol means paying excise duty, which increases the cost of the preparation. Thus we now use a lower-proof spirit (95-99-5%/,), and initial results indicate no diminution of effect.Irritation of the axilla was the only side effect reported and was almost always readily relieved by 1(( hydrocortisone cream. Most of the patients were so delighted with the control of their sweating that they would tolerate minor irritation for a few hours ever...

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Section: Introductionmentioning

confidence: 99%

Proctocolectomy without ileostomy for ulcerative colitis.

Parks¹,

Nicholls²

1978

BMJ

1,232

474

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“…Valiente and Bacon [44], who fashioned a triplicated ileal pouch from the terminal ileum in dogs and sutured it to the anal canal, became the first to demonstrate the advantage of such a procedure. It would be a long time until such an attempt was performed in humans, however.…”

Section: Restorative Proctocolectomymentioning

confidence: 98%

Proctocolectomy and Ileostomy to Pouch Surgery for Ulcerative Colitis

Hultén

1998

World j. surg.

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The development of continence-preserving and sphincter-preserving procedures for operation of ulcerative colitis has a long and interesting history. Reported clinical results on the continent ileostomy (Kock pouch) and the pelvic pouch procedure have often been enthusiastic; and when confronted with the options patients have mostly been in no doubt in selecting "the best operation." However, even if the continent ileostomy and subsequently restorative proctocolectomy were great innovations, it is by no means obvious that they should be recommended as the first choice for all patients. For patients old enough to join in a responsible discussion the pros and cons of the various operations available today must first be carefully described and a decision reached that reasonably meets the patient's wishes and that seems to the surgeon to be soundly based. When comparing the postoperative morbidity, long-term outcome, and quality of life assessment of the options, such a decision is in fact far from easy. Thus panproctocolectomy and ileostomy for ulcerative colitis can be considered a comparatively safe, predictable operation that can cure the patient and allow a short hospital stay, a quick recovery, and rehabilitation. It should also enable the patient to be free of hospital supervision after a year or so. Although there is a major change in body image and sexual disturbances may occur, the operation is in fact still the yardstick by which the other options should be compared. Despite the great attraction of rectum- and sphincter-preserving operations, there will always be patients for whom panproctocolectomy and a conventional end-ileostomy is the superior alternative. The ileal pouch operations are technically demanding and should probably best be restricted to specialist centers even in the future. Complications, if they arise, are often serious, and the hospital stay is often counted in weeks. The functional result may be good, but defects in continence are common and sexual dysfunction is a problem for many of these patients. The pouchitis syndrome is a great disappointment, and recent reports on subsequent epithelial dysplasia and even development of cancer are alarming. The long-term results are in this respect still uncertain. Careful patient selection, with full discussion with the patient and his or her family are essential before a decision on a continent ileostomy or a pelvic pouch is reached. Strong motivation toward avoidance of a conventional ileostomy is important. When compared with the imperfect functional results and the high morbidity associated with the pelvic pouch procedure, there is at present a great revival of interest for total colectomy with ileorectal anastomosis. It is still a useful operation and should be seriously considered particularly in the young. The functional results are comparatively good. Sexual function is well preserved. The use of the operation may enable the teenager to regain good health and finish education and family planning. Due to the cancer risk the need for subseq...

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“…As early as 1955, Valiente and Bacon [7] had noted that adding a reservoir to the old "anal ileostomy" was desirable to reduce stool frequency and in 1978 Parks and Nicholls [8] reported that four of five patients in whom a triplicated reservoir or S-pouch was constructed were continent. It was soon realized however that nearly half their patients required self-catheterization to evacuate the neorectum, a limitation soon to be blamed on the long efferent limb.…”

Section: Evolution and Refinementsmentioning

confidence: 98%

Techniques of ileoanal anastomosis: historical evolution, refinements, and current approaches

Radice

Dozois

1999

Techniques in Coloproctology

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Restorative proctocolectomy with ileal pouchanal anastomosis is the surgical option favoured by most in the definitive treatment of mucosal ulcerative colitis and familial adenomatous polyposis. Throughout this century, the operation has evolved from a concept to a very refined procedure which cures the underlying colorectal disease, restores bowel function and promises a quality of life superior to that of other surgical options. Each component of the operation whether it be the design of the reservoir or the necessity for a temporary ileostomy has been the subject of some degree of controversy, but the most debated aspect remains whether a transanal mucosectomy is detrimental and what type of ileoanal anastomosis is preferable, i.e. hand sewn to dentate line area or stapled at the level of proctectomy. This debate has arisen in part to simplify the operation, and in part to try to minimize complications and improve function, especially nighttime incontinence. The advantages and disadvantages of each current approach are reviewed and conclusions drawn from our own experience and that of others. Further research will be needed to improve continence and clarify the nature of pouchitis, which may in turn lead to the discovery of the cause of ulcerative colitis.

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Construction of pouch using “pantaloon” technic for pull-through of ileum following total colectomy

Cited by 84 publications

References 2 publications

Proctocolectomy without ileostomy for ulcerative colitis.

Proctocolectomy without ileostomy for ulcerative colitis.

Proctocolectomy and Ileostomy to Pouch Surgery for Ulcerative Colitis

Techniques of ileoanal anastomosis: historical evolution, refinements, and current approaches

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