Radiological study of changes in the pelvis in women following proctocolectomy

Asztély, M; Palmblad, Suzanne; Wikland, M.; Hultén, L.

doi:10.1007/bf00300204

Cited by 40 publications

(24 citation statements)

References 17 publications

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“…A second study of tubal patency after proctocolectomy and end ileostomy in 12 patients with UC and 9 with Crohn's disease demonstrated that 11 of 21 patients (52 percent) had complete unilateral or bilateral obstruction of the fallopian tubes. 16 In addition, the fallopian tubes were adherent to the pelvic floor in 20 of 21 (95 percent) patients. These studies suggest that pelvic dissection is the likely cause of adhesions and altered pelvic anatomy, because similar rates of fallopian tube obstruction were observed regardless of pelvic pouch or end ileostomy formation.…”

Section: Discussionmentioning

confidence: 98%

Female Infertility After Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Johnson¹,

Richard²,

Ravid³

et al. 2004

Diseases of the Colon &Amp; Rectum

160

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Section: Discussionmentioning

confidence: 98%

Female Infertility After Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Johnson¹,

Richard²,

Ravid³

et al. 2004

Diseases of the Colon &Amp; Rectum

160

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“…19 Eighty-five of 428 women younger than 40 in this study conceived after IPAA, but the intent to conceive was not prospectively assessed in this study. Proctocolectomy and restoration of well-being has been associated with improved sexual function.…”

Section: Discussionmentioning

confidence: 99%

Functional Outcomes After Ileal Pouch-Anal Anastomosis for Chronic Ulcerative Colitis

Farouk¹,

Pembérton²,

Wolff³

et al. 2000

Annals of Surgery

267

187

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ObjectiveTo assess long-term outcomes after ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis (CUC) with specific emphasis on patient sex, childbirth, and age. Summary Background DataChildbirth and the process of aging affect pelvic floor and anal sphincter function independently. Early function after IPAA is good for most patients. Nonetheless, there are concerns about the impact of the aging process as well as pregnancy on long-term functional outcomes after IPAA. MethodsFunctional outcomes using a standardized questionnaire were prospectively assessed for each patient on an annual basis. ResultsOf the 1,454 patients who underwent IPAA for CUC between 1981 and 1994, 1,386 were part of this study. Median age was 32 years. Median length of follow-up was 8 years. Pelvic sepsis was the primary cause of pouch failure irrespective of sex or age. Functional outcomes were comparable between men and women. Eighty-five women who became pregnant after IPAA had pouch function, which was comparable with women who did not have a child. Daytime and nocturnal incontinence affected older patients more frequently than younger ones. Incontinence became more common the longer the follow-up in older patients, but this was not found in younger patients. Poor anal function led to pouch excision in only 3 of 204 older patients. ConclusionsIncontinence rates were significantly higher in older patients after IPAA for CUC compared with younger patients. However, this did not contribute to a greater risk of pouch failure in these older patients. Patient sex and uncomplicated childbirth did not affect long-term functional outcomes.Early reports of function after ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis (CUC) have indicated favorable outcomes, with an excellent quality of life for more than 90% of patients.1-3 Areas of concern remain, however, regarding long-term functional outcome after vaginal delivery and the natural aging process, which may affect pelvic floor function regardless of sex. 4,5 Chronic ulcerative colitis has a bimodal distribution of incidence based on age, with a peak at 25 years and a second peak at 60 years.6 A selected group of older patients choose, in the absence of contraindications, to undergo IPAA. Short-term follow-up has shown that such patients may have comparable or only marginally worse functional outcomes compared with younger patients. 7-9Our aim was to assess long-term outcomes after IPAA for CUC with specific reference to the impact of age, aging, and childbirth to determine how these factors affect the incidence of pouch failure. METHODSBetween January 1981 and December 1994, 762 men and 692 women were identified from the Mayo Ileal Pouch Registry as having undergone proctocolectomy, endoanal mucosal resection, and hand-sewn ileal J pouch-anal anastomosis for CUC. Ethical permission to review patient records was obtained from the Institutional Review Board.

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“…In fact, two previous studies carried out after coloproctectomy and IPAA or terminal ileostomy with hysterosalpingograms found complete unilateral or bilateral obstruction of the Fallopian tubes in 52% of patients [232,240].…”

Section: Fertilitymentioning

confidence: 94%

“…To date, the reasons for this difference between FAP and UC are still not known and will need further investigation. Notwithstanding this difference, it has been postulated that this adverse effect of IPAA on fertility, for both FAP and UC, could to some extent be a result of surgical technique and postoperative pelvic adhesions [159,225,232,[235][236][237][238][239][240]. It seem plausible that it is the extent of dissection and the location right down to the pelvic floor of the IPAA surgery that causes such a severe reduction in fertility by partial or complete occlusion of the Fallopian tubes, altering the normal tubo-ovarian relationship necessary for ovum capture and transport [159,225,[235][236][237][238].…”

Section: Fertilitymentioning

confidence: 97%

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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Radiological study of changes in the pelvis in women following proctocolectomy

Cited by 40 publications

References 17 publications

Female Infertility After Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Female Infertility After Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Functional Outcomes After Ileal Pouch-Anal Anastomosis for Chronic Ulcerative Colitis

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

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