Outcome of 200 restorative proctocolectomy operations: The John Radcliffe Hospital experience

Romanos, John; Samarasekera, D. N.; Stebbing, Justin; Jewell, D P; Kettlewell, M. G. W.; Mortensen, N. J. McC.

doi:10.1046/j.1365-2168.1997.02684.x

Cited by 50 publications

(45 citation statements)

References 13 publications

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“…Pouch-related complications occur in 35% with pelvic sepsis in 9.5% despite 80% diverting ileostomies. Recent studies (since 1995) have not shown an improvement [17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35]. …”

Section: Discussionmentioning

confidence: 99%

Ileo-Neorectal Anastomosis: Medium- and Long-Term Follow-Up of 37 Patients

Laarhoven

Hueting²,

Schipper³

et al. 2004

Dig Surg

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Background: Ileo-neorectal anastomosis (INRA), an alternative restorative procedure, was developed to reduce the pouch-related complication rate with an (at least) equal functional result. Methods: For this surgical outcome, data of all INRA patients, including bowel function and complications, were prospectively recorded. The reservoir capacity was determined repeatedly by physiologic tests. The anal sphincter complex was assessed by manometry and ultrasound examination. Evaluation of the neorectal mucosa was performed by endoscopy. Results: An INRA procedure was carried out in 39/53 selected patients (47 ulcerative colitis and 6 familial adenomatous polyposis). Fourteen UC cases were converted to ileal pouch anal anastomosis or proctectomy only, because of impossibility to completely remove the rectal mucosa or short of length of the rectal stump. The median operation time for INRA was 323 min (range 240–518), with 1,400 ml blood loss (400–4,500). The reservoirs were permanently defunctioned in 2 patients – one because of reclassification into Crohn’s disease, and one with pouchitis refractory to medical treatment. In 18 out of 37 cases, web-like stenoses occurred at the mucosa-anal level, which were treated by single (9) or repeated (5) dilatation or surgical stenoplasty (2). No pouch-related complications like pelvic sepsis, fistula or sexual dysfunction occurred. Thirteen patients had episodes of ‘pouchitis’, successfully treated with antibiotics, and 7 other cases, with functioning reservoirs, also had proximal ‘non-specific’ (i.e. no histological criteria of Crohn’s disease found) small bowel inflammation. The median bowel frequency decreased from 15×/24 h initially to 7×/24 h at 2 years. Continence was perfect in 24/37 cases. Twelve out of 37 cases had occasional nocturnal soiling and passive nocturnal fecal incontinence was reported by 2/37 patients. The neorectal compliance volume recovered from 12.5 ml kPa after subtotal colectomy and 11 ml/kPa at 6 months after INRA to a neorectal compliance of 24 ml/kPa at 2 years’ follow-up (p < 0.002; Wilcoxon signed rank test). Conclusion: The INRA procedure shows a low complication rate and reasonable functional results, there was however a considerable conversion rate in these first 53 cases and a high incidence of reclassification to CD.

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Section: Discussionmentioning

confidence: 99%

Ileo-Neorectal Anastomosis: Medium- and Long-Term Follow-Up of 37 Patients

Laarhoven

Hueting²,

Schipper³

et al. 2004

Dig Surg

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“…Although several studies have reported on outcome after colectomy among people with inflammatory bowel disease, [25][26][27][28][29][30] they are mainly small, short term studies in specialist departments, which have reported a relatively good prognosis. We used routinely collected data to investigate mortality after colectomy for inflammatory bowel disease in large population based settings.…”

Section: Introductionmentioning

confidence: 99%

Mortality in patients with and without colectomy admitted to hospital for ulcerative colitis and Crohn's disease: record linkage studies

Roberts

Williams

Yeates

et al. 2007

BMJ

150

120

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Objective To compare mortality outcomes in the three years after elective colectomy, no colectomy, and emergency colectomy among people admitted to hospital for inflammatory bowel disease, to inform whether the threshold for elective colectomy in clinical practice is appropriate. Design Record linkage studies. Setting Oxford region and England (1998England ( -2003. Participants 23 464 people with hospital stay for more than three days for inflammatory bowel disease, including 5480 who had colectomy. Main outcome measures Case fatality, relative survival, and standardised mortality ratios. Results In the Oxford region, three year mortality was lower after elective colectomy than after either no colectomy or emergency colectomy, although this was not significant. For England, mortality three years after elective colectomy for ulcerative colitis (3.7%) and Crohn's disease (3.3%) was significantly lower than that after either admission without colectomy (13.6% and 10.1%; both P<0.001) or emergency colectomy (13.2% and 9.9%; P<0.001 for colitis and P<0.01 for Crohn's disease). Three or more months after elective colectomy, mortality was similar to that in the general population. Adjustment for comorbidity did not affect the findings. Conclusions In England, the clinical threshold for elective colectomy in people with inflammatory bowel disease may be too high. Further research is now required to establish the threshold criteria and optimal timing of elective surgery for people with poorly controlled inflammatory bowel disease.

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“…The cumulative incidence of pouchitis varies from 20 to 50%, depending on the definition and length of follow up. [3][4][5][6][7][8] When followed for more than 10 years, approximately half experience pouchitis at least once. 7 Antibiotic therapy is often effective, but 5-15% of patients with an IPAA created for ulcerative colitis experience ''refractory or frequently recurrent'' pouchitis.…”

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confidence: 99%

Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis

Mimura

Rizzello²,

Helwig³

et al. 2004

Gut

804

410

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Background: Ten to 15% of patients with pouchitis experience refractory or recurrent disease. The aim of this study was to evaluate the effectiveness of a single daily high dose probiotic preparation (VSL#3) in maintaining antibiotic induced remission, and quality of life (QOL), for one year in such patients. Methods: Patients with pouchitis at least twice in the previous year or requiring continuous antibiotics, associated with a pouchitis disease activity index (PDAI) >7 (0 = perfect; 18 = worst), in whom remission was induced by four weeks of combined metronidazole and ciprofloxacin, were randomised to receive VSL#3 6 g or placebo once daily for one year or until relapse. Symptomatic, endoscopic, and histological evaluations were made before, and two and 12 months after randomisation or at the time of relapse. Remission was defined as a clinical PDAI (2 and endoscopic PDAI (1. Relapse was defined as an increased clinical PDAI score >2 and increased endoscopic PDAI score >3. QOL was assessed using the inflammatory bowel disease questionnaire (IBDQ). Results: Thirty six patients were randomised: 20 to VSL#3 and 16 to placebo. Remission was maintained at one year in 17 patients (85%) on VSL#3 and in one patient (6%) on placebo (p,0.0001). The IBDQ score remained high in the VSL#3 group (p = 0.3) but deteriorated in the placebo group (p = 0.0005). Conclusion: The once daily high dose probiotic VSL#3 is effective in maintaining antibiotic introduced remission for at least a year in patients with recurrent or refractory pouchitis. This is associated with a high level of quality of life.

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Outcome of 200 restorative proctocolectomy operations: The John Radcliffe Hospital experience

Abstract: Continuous improvements in operative technique have simplified the procedure, and functional results, although variable, have generally been acceptable.

Cited by 50 publications

References 13 publications

Ileo-Neorectal Anastomosis: Medium- and Long-Term Follow-Up of 37 Patients

Ileo-Neorectal Anastomosis: Medium- and Long-Term Follow-Up of 37 Patients

Mortality in patients with and without colectomy admitted to hospital for ulcerative colitis and Crohn's disease: record linkage studies

Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis

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