Perimuscular excision of the rectum for Crohn's disease and ulcerative colitis. A Conservation technique

Lee, E. C. G.; Dowling, Barbara

doi:10.1002/bjs.1800590108

Cited by 67 publications

(22 citation statements)

References 11 publications

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“…This stapling technique has permitted relatively effortless and faster pouch construction and anastomosis [23,34,[46][47][48], because of which it is preferred by the overwhelming majority of surgeons [39,49].…”

Section: Endoanal Mucosectomy Vs Double-stapled Anastomosismentioning

confidence: 99%

Restorative proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis revisited

et al. 2006

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Since restorative proctocolectomy (RPC) with ileal-pouch anal anastomosis (IPAA) removes the entire diseased mucosa, it has become firmly established as the standard operative procedure of choice for familial adenomatous polyposis (FAP). Many technical controversies still persist, such as mesenteric lengthening techniques, close rectal wall proctectomy, endoanal mucosectomy vs. double stapled anastomosis, loop ileostomy omission and a laparoscopic approach. Despite the complexity of the operation, IPAA is safe (mortality: 0.5-1%), it carries an acceptable risk of non-life-threatening complications (10-25%), and it achieves good long-term functional outcome with excellent patient satisfaction (over 95%). In contrast to the high incidence in patients operated for ulcerative colitis (UC) (15-20%), the occurrence of pouchitis after IPAA seems to be rare in FAP patients (0-11%). Even after IPAA, FAP patients are still at risk of developing adenomas (and occasional adenocarcinomas), either in the anal canal (10-31%) or in the ileal pouch itself (8-62%), thus requiring lifelong endoscopic monitoring. IPAA operation does not jeopardise pregnancy and childbirth, but it does impair female fecundity and has a low risk of impairment of erection and ejaculation in young males. The latter can almost completely be avoided by a careful "close rectal wall" proctectomy technique. Some argue that low risk patients (e.g. <5 rectal polyps) can be identified where ileorectal anastomosis (IRA) might be reasonable. We feel that the risk of rectal cancer after IRA means that IPAA should be recommended for the vast majority of FAP patients. We accept that in some very selected cases, based on clinical and genetics data (and perhaps influenced by patient choice regarding female fecundity), a stepwise surgical strategy with a primary IPA followed at a later age by a secondary proctectomy with IPAA could be proposed.

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Section: Endoanal Mucosectomy Vs Double-stapled Anastomosismentioning

confidence: 99%

Restorative proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis revisited

et al. 2006

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“…There is no reason to go along with the TME principle. CRD is a well-known ‘old’ technique but used to be too laborious to gain support [12]. It leaves the mesorectum in situ.…”

Section: Discussionmentioning

confidence: 99%

“…toxic mega colon) procedures. During pouch formation, the rectum was dissected according to the CRD technique [12]. The dissection was conducted circular to the mesorectum, in the nonanatomic perimuscular plane, thereby preserving the mesorectum fat layer just outside the rectum.…”

Section: Methodsmentioning

confidence: 99%

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Ileal Pouch Anal Anastomosis with Close Rectal Dissection Using Automated Vessel Sealers for Ulcerative Colitis: A Promising Alternative

et al. 2011

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Background: Despite decennia of experience, ileal pouch anal anastomosis for ulcerative colitis is still associated with high complication rates. The development of automatic vessel sealers has resulted in the revival of a promising surgical alternative to the conventional procedure: close rectal dissection. By preserving the mesorectal layer it is hypothesized that nerve-related and other postoperative complications can be reduced. Methods: All patients with ulcerative colitis with indication for restorative proctocolectomy at our institution during the pilot study underwent the close rectal pouch procedure with temporary diverting ileostomy. Standardized clinical history, anorectal physiology measurements, and endoscopic and histological examination were carried out before and after surgery. Results: The procedure was technically successful in all 10 patients, with a median age of 41 years and a median postoperative follow-up period of 16 months. There were no cases of pelvic sepsis and bladder or sexual dysfunction. The median daytime defecation frequency was 6.0. Endoscopic and histological examination showed no abnormalities. The anorectal physiology supported the good functional results. Conclusion: The preliminary results of the close rectal pouch procedure are promising, with good functional results and a low complication rate after 1 year.

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“…Before 1950, most surgeons treated benign dis ease with the same technique as for carcinoma [9]. In recent series, a modified technique [10,11] has been used to avoid unnecessarily wide dissection, thus pre venting damage to the autonomic erectile and ejacula tory nerves.The incidence of sexual dysfunction after radical sur gery for bladder or prostate cancer used to be more than 90%. Even with simple prostatectomy for benign dis ease, Finkle and Prian [ 12] reported an impotence rate of 29% after perineal prostatectomy and 16% after supra pubic prostatectomy.…”

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confidence: 99%

Impotence after Radical Pelvic Surgery: Physiology and Management

Lue

1991

Urol Int

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Impotence has been a common problem after radical surgery of the colon, rectum, prostate, bladder, and seminal vesicle. However, a better understanding of the neuroanatomy of erection has resulted in its decline. When impotence does result, in cases where the extent of tumor involvement renders preservation of the neurovascular bundle impossible, the variety of treatments available is now improved: these include intracavernous injection of vasodilators, vacuum constriction devices, penile arterial and venous surgery, and penile prostheses. The improved understanding and management of impotence has greatly enhanced the quality of life of patients after radical pelvic surgery.

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Perimuscular excision of the rectum for Crohn's disease and ulcerative colitis. A Conservation technique

Cited by 67 publications

References 11 publications

Restorative proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis revisited

Restorative proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis revisited

Ileal Pouch Anal Anastomosis with Close Rectal Dissection Using Automated Vessel Sealers for Ulcerative Colitis: A Promising Alternative

Impotence after Radical Pelvic Surgery: Physiology and Management

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