Restorative proctocolectomy without temporary ileostomy

Everett, W. G.

doi:10.1002/bjs.1800770608

Cited by 39 publications

(22 citation statements)

References 5 publications

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“…Since then, several other studies have reported that septic complications and functional results were the same after one-or twostage procedures [14,25,63,95,98,103,110,113,119,[122][123][124][125][126]. Moreover, there are also fewer episodes of intestinal obstruction, fewer instances of re-exploration and fewer total days in the hospital [95,97,102,106,109,113,119].…”

Section: Loop Ileostomy Omissionmentioning

confidence: 93%

“…The construction of an ileostomy may also increase the risk of small bowel obstruction up to 15-21% [44,106,109,113,[119][120][121]. Moreover, patients treated with IPAA as a two-stage procedure have to undergo another operation for reversal of the ileostomy, entailing an additional risk of perioperative complications, such as anastomotic leak from the ileostomy closure site in 2.5-7.5%, considerable time off work for the patient, and markedly higher overall costs for surgical therapy [25,44,74,108,110,113,119,121,122].…”

Section: Loop Ileostomy Omissionmentioning

confidence: 98%

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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: Loop Ileostomy Omissionmentioning

confidence: 93%

Section: Loop Ileostomy Omissionmentioning

confidence: 98%

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

et al. 2006

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“…Now some centers prefer to omit the ileostomy routinely, whereas others only do so in selected patients who meet strict criteria. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] This study was designed to determine postoperative complications, functional outcome, and quality of life in IPAA patients selected for omission of ileostomy in our large 20-year series, compare results with those in patients with diverting ileostomy, and further shed some light on this controversial issue.…”

mentioning

confidence: 99%

The Outcome After Restorative Proctocolectomy With or Without Defunctioning Ileostomy

Remzi

Fazio

Görgün

et al. 2006

Diseases of the Colon &Amp; Rectum

149

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For carefully selected patients undergoing restorative proctocolectomy with ileal pouch-anal anastomosis, omission of diverting ileostomy is a safe procedure that does not lead to an increase in septic complications or mortality. Quality of life and functional results are similar to those who undergo ileal pouch-anal anastomosis with diversion, provided that certain selection factors are considered.

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“…After the initial studies by Matikainen et al 19 and Everett and Pollard, 20 RPCs without a covering ileostomy are now performed routinely. [21][22][23][24][25][26] Moreover, specific complications have been reported after creating an ileostomy, 27 which could, in part, balance the risk of pelvic sepsis that may be more frequent if no covering stoma is constructed.…”

Section: Discussionmentioning

confidence: 99%

The Effect on Morbidity of Mesentery Lengthening Techniques and the Use of a Covering Stoma After Ileoanal Pouch Surgery

Araki

Parc

Lefèvre

et al. 2006

Diseases of the Colon &Amp; Rectum

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Restorative proctocolectomy without temporary ileostomy

Cited by 39 publications

References 5 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

The Outcome After Restorative Proctocolectomy With or Without Defunctioning Ileostomy

The Effect on Morbidity of Mesentery Lengthening Techniques and the Use of a Covering Stoma After Ileoanal Pouch Surgery

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