| 1. |
- Bengtsson, Jonas, 1961, et al.
(författare)
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Can a failed ileal pouch anal anastomosis be left in situ?
- 2007
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Ingår i: Colorectal disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 9:6, s. 503-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Failure after ileal pouch-anal anastomosis (IPAA) is reported with a frequency of 10-20%. The failed IPAA can be excised or defunctioned. Indications for excision and further management of an indefinitely diverted pouch are poorly described. The aim of the present investigation was to investigate pouch-related problems and the histopathological pattern of the pouch mucosa in this group of patients. METHOD: In a cohort of 620 patients having IPAA with a median follow-up of 14 years, 56 patients with failure were identified. The patients with defunctioned pouches were assessed with regard to pouch-related problems and endoscopy with biopsies was performed. Biopsies were stained with haematoxylin-eosin, PAS for neutral mucins and Alcian blue/high iron diamine for sialomucins/sulphomucins. Morphological changes were grouped into three types modified according to Veress and assessed for dysplasia. RESULTS: Twenty-two patients with an indefinitely diverted pouch were found. The follow-up time after surgery for failure was 10 years. Thirteen patients completed the follow-up. Except for two patients with pelvic/perineal pain, there were no clinical problems. The majority of patients displayed mild to moderate macroscopic signs of inflammation. Morphologically, findings ranged from a preserved mucosal pattern to intense inflammatory reaction. No case of dysplasia or carcinoma was found. CONCLUSION: Most patients with an indefinitely diverted pouch had no complaints regarding the pouch. There was no case of dysplasia. Indefinite diversion may be preferable to pouch excision, especially given the associated morbidity.
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| 2. |
- Berndtsson, Ina, 1953, et al.
(författare)
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Health-related quality of life and pouch function in continent ileostomy patients: a 30-year perspective.
- 2004
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Ingår i: Diseases of the colon and rectum. - : Ovid Technologies (Wolters Kluwer Health). - 0012-3706. ; 47:12, s. 2131-7
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The principal aim of this study was to assess long-term pouch durability and health-related quality of life in an original series of patients operated on with a continent ileostomy. PATIENTS: Data from 68 of 88 patients who had a continent ileostomy performed at Sahlgrenska University Hospital between 1967 and 1974 were analyzed. Median age at follow-up was 60 (range, 40-89) years and median follow-up was 31 (range, 29-36) years. METHODS: Patients were sent a questionnaire on pouch function along with the Short Form-36 Health Survey 2.0. A random age-matched and gender-matched sample was drawn from the Swedish national Short Form-36 Health Survey norm database to compare with the patient group. RESULTS: The majority of the patients reported good physical condition and satisfactory pouch function. Patients evacuated the pouch a median of four times every 24 hours. Twelve patients (18 percent) had leakages. Forty-four patients (65 percent) had had at least one postoperative revision to restore continence. Generally minor peristomal skin irritation occurred in seven patients (10 percent). Patients with concurrent complaints (mostly age related) reported poorer health-related quality of life. Nevertheless, 78 percent of the patients rated their overall health as good, very good, or excellent. The patients' Short Form-36 Health Survey scores were comparable to reference values. CONCLUSIONS: Although revisional operations may be needed to restore continence, continent ileostomy has a good durability. Pouch function was satisfactory and patients' satisfaction was high. Health-related quality of life levels were similar to those of the general population.
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| 3. |
- Berndtsson, I, et al.
(författare)
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Sexuality in patients with ulcerative colitis before and after restorative proctocolectomy: a prospective study.
- 2004
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Ingår i: Scandinavian journal of gastroenterology. - 0036-5521. ; 39:4, s. 374-9
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to assess sexuality in patients with ulcerative colitis (UC), before and one year after an ileal-pouch anal anastomosis (IPAA).Group I comprised 14 medically treated patients (7 M) and Group II comprised 29 patients (18 M), operated with colectomy and ileostomy, with preservation of the rectum. Patients were interviewed about desire, excitement and general sexual satisfaction before and one year after the IPAA operation.Most of the patients had restarted sexual activity < or = 3 months after surgery. Sexual desire and desire for intercourse had not changed from before the IPAA operation. In Group I, one woman suffered from dyspareunia both before and after the IPAA. In Group II, three women had dyspareunia before the IPAA and four after surgery. Erection and ejaculation were normal in all men before the IPAA operation. After IPAA, one man in Group I and two men in Group II had loss of ejaculation. In Group 1, 10 out of 14 patients were satisfied with their sexual life both before and after the IPAA. In Group II the corresponding figures were 15 out of 28 before and 22 after IPAA surgery.A third of the patients stated that they were dissatisfied with their sexual life before IPAA. Although a few patients experienced sexual imperfections such as loss of ejaculation and dyspareunia, the majority of patients in both groups considered that the overall general satisfaction with their sexual life had normalized considerably after surgery.
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| 4. |
- Buntzen, S, et al.
(författare)
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The effect of pelvic nerve stimulation on recto-anal motility in the cat.
- 1996
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Ingår i: Journal of the autonomic nervous system. - 0165-1838. ; 61:3, s. 243-7
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Tidskriftsartikel (refereegranskat)abstract
- Rectal and anal motility responses to pharmacological manipulation of neuro-transmission and graded efferent electrical pelvic nerve stimulation were investigated in alpha-1-chloralose anaesthetized cats. N omega-nitro-L-arginine (L-NNA), a competitive inhibitor of nitric oxide synthase, did not influence spontaneous rectal and anal motility. No significant change in anal pressure or rectal tone was observed after sectioning the pelvic nerves in animals pretreated with L-NNA. The effect of pelvic nerve stimulation on anal tone was varying and depended upon the intensity of stimulation and the prevailing anal tone. A reduction of anal tone on pelvic nerve stimulation was consistently converted to an increase of anal tone after pretreatment with L-NNA. The rectal response to pelvic nerve stimulation was unchanged by L-NNA. Residual increase of anal tone observed on pelvic nerve stimulation after L-NNA and noradrenergic blockade was partly sensitive to hexamethonium and abolished by atropine. The results suggest that there is no tonic influence on rectal and anal motility via nitric oxide mechanisms. On the other hand, the reduction of anal tone on high intensity pelvic nerve stimulation seemed to be dependent on the release of nitric oxide. An excitatory cholinergic component of the smooth muscle contractility of the feline anal canal, partly sensitive to hexamethonium, was demonstrated to be conveyed in the pelvic nerves.
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| 5. |
- Börjesson, Lars, 1963, et al.
(författare)
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The failed pelvic pouch: conversion to a continent ileostomy
- 2004
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Ingår i: Techniques in coloproctology. - 1123-6337. ; 8:2, s. 102-5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Excision of the ileal pouch-anal anastomosis (IPAA) with construction of a conventional ileostomy is in general the ultimate procedure after unsuccessful salvage surgery. Conversion of the IPAA to a continent ileostomy (CI) is an alternative. METHODS: The clinical outcome of 13 patients operated with conversion of IPAA into CI was evaluated. Median follow-up was 6 years. One patient was lost to follow-up. RESULTS: There were two failures with pouch excision. At follow-up, ten patients with intact CI were fully continent and none needed to use a stoma appliance. Revisional surgery had been required in 8 patients. CONCLUSIONS: Conversion of a failed IPAA into CI is a feasible procedure that may be considered an alternative to Brooke's ileostomy in motivated patients. The operation should ideally be done in specialized units.
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| 6. |
- Börjesson, Lars, 1963, et al.
(författare)
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The risk of dysplasia and cancer in the ileal pouch mucosa after restorative proctocolectomy for ulcerative proctocolitis is low: a long-term term follow-up study
- 2004
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Ingår i: Colorectal disease. - 1462-8910. ; 6:6, s. 494-8
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Some of the rare complications reported in patients with an ileopouch anal anastomosis (IPAA) after coloectomy for chronic ulcerative colitis are dysplasia and carcinoma. The supposed pathway is for the ileal pouch mucosa to go through adaptational changes then is to progress through the phases of chronic pouchitis, dysplasia and subsequently to adenocarcinoma. In many of these studies however, the dysplasia-cancer sequence is inconclusive since the carcinoma might have developed from the ileal mucosa itself or from residual viable rectal mucosa left behind. The purpose of this study was therefore to study the long-term ileal mucosal adaptation patterns and the incidence and grading of dysplasia in the ileal pouch mucosa in patients previously operated on for ulcerative proctocolitis. PATIENTS AND METHODS: Forty-five patients who had been operated on with an IPAA (25 males/20 females), with a median age of 54 years (range 34-76), were invited for clinical examination and pouch endoscopy including mucosal biopsies. The duration of their colitis until surgery was median 6 years (range 1-28) and the time median interval from start of disease until time of follow up 24.8 years (range 17-46). Three independent pathologists from two different centres reviewed sequential mucosal biopsies taken from separate sites of the pouch for dysplasia and mucosal adaptation patterns. RESULTS: The type C pattern with a severe inflammation in lamina propria together with severe atrophy of villi, sometimes with ulceration and granulation tissue, was observed by the two pathologists from one centre in 15 of 45 (33.3%) patients and in 11 (24.4%) of 45 by the third pathologist, respectively. As regards dysplasia one pathologist group evaluated 2/45 (4.4%) cases as low-grade dysplasia while the third pathologist considered one of these cases as indefinite for dysplasia and one as reactive. There was in this respect full agreement between the two centres in 43 (95.6%) of 45 cases. Neither high-grade dysplasia nor invasive carcinoma was diagnosed. CONCLUSION: Dysplastic transformation within the ileal pouch mucosa in patients operated for ulcerative proctocolitis is rare even after a long follow-up. These results are reassuring for both patients and surgeons. There seem to be no solid grounds to support routine surveillance for dysplasia in the ileal pouch mucosa in these patients. The surveillance for neoplastic changes in the remaining muscular/epithelial cuff is a separate issue however.
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| 7. |
- Delaini, G G, et al.
(författare)
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[Abdominal rectopexy in the treatment of rectal prolapse: how to foresee the functional result]. : Rettopessia addominale per il trattamento del prolasso del retto: come prevedere il risultato funzionale.
- 1994
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Ingår i: Annali italiani di chirurgia. - 0003-469X. ; 65:2, s. 183-7
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Tidskriftsartikel (refereegranskat)abstract
- 21 patients (19 women) who underwent rectal prolapse repair were prospectively studied. At the one year follow-up, 6 of the eleven incontinent patients (54 per cent) regained full continence and while three of the remaining 5 patients improved they still referred occasional imperfection of continence. Resting anal pressure and maximal squeeze pressure were both significantly lower in the five patients who remained incontinent, 23 (17-31) mm Hg vs 50 (31-52) mm Hg (p < = 0.02) and 52 (17-75) mm Hg vs 108 (89-110) mm Hg (p < = 0.02), respectively. Moreover the manometric results showed evidence that in patients who remained incontinent, the anal pressure in response to rectal distention, was significantly lower than patients who regained continence (p < = 0.05) both before and after operation. We conclude that incontinent patients with rectal prolapse who exhibit a markedly low minimal residual anal pressure on recto-anal reflex inhibition are less likely to improve after rectopexy and that this preoperative test may be a useful predictor.
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| 8. |
- Delaini, G G, et al.
(författare)
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Is an ileal pouch an alternative for patients requiring surgery for Crohn's proctocolitis?
- 2005
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Ingår i: Techniques in coloproctology. - : Springer Science and Business Media LLC. - 1123-6337 .- 1128-045X. ; 9:3, s. 222-4
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Tidskriftsartikel (refereegranskat)abstract
- Most surgeons consider Crohn's colitis to be an absolute contraindication for a continent ileostomy, due to high complication and failure rates. This opinion may, however, be erroneous. The results may appear poor when compared with those after pouch surgery in patients with ulcerative colitis (UC), but the matter may well appear in a different light if the pouch patients are compared with Crohn's colitis patients who have had a proctocolectomy and a conventional ileostomy.We assessed the long-term outcomes in a series of patients with Crohn's colitis who had a proctocolectomy and a continent ileostomy (59 patients) or a conventional ileostomy (57 patients). The median follow-up time was 24 years for the first group and 27 years for the second group.The outcomes in the two groups of patients were largely similar regarding both mortality and morbidity; the rates of recurrent disease and reoperation with loss of small bowel were also similar between groups.The possibility of having a continent ileostomy, thereby avoiding a conventional ileostomy-even if only for a limited number of years--may be an attractive option for young, highly motivated patients.
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| 9. |
- Delaini, G G, et al.
(författare)
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The ileoanal pouch procedure in the long-term perspective: a critical review.
- 2005
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Ingår i: Techniques in coloproctology. - : Springer Science and Business Media LLC. - 1123-6337 .- 1128-045X. ; 9:3, s. 187-92
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Tidskriftsartikel (refereegranskat)abstract
- An ileo-pouch anal anastomosis (IPAA) has become the gold standard procedure for ulcerative colitis and familial adenomatous polyposis. Clinical results on the pelvic pouch procedure have often been encouraging; when confronted with the different surgical options, the majority of patients select IPAA as the best operation. However, even if IPAA is a great innovation, it is by no means the first choice for all patients. For patients old enough to join in a responsible discussion, the pros and cons of the various operations must be carefully described; the choice of surgical procedure must meet the patient's wishes and appear soundly based to the surgeon. The young age of most patients has to be considered and a long follow-up time is required to establish whether and, if so, to what extent the operation may adversely impact the patient's continence, sex life, fertility, and quality of life. The risk of cancer transformation in the residual rectal mucosa in the muscular or columnar cuff is another important factor that may influence the eventual decision. This article critically reviews our experience and the literature.
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| 10. |
- Duff, S E, et al.
(författare)
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Dysplasia in the ileoanal pouch.
- 2002
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Ingår i: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. - 1462-8910. ; 4:6, s. 420-9
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Tidskriftsartikel (refereegranskat)abstract
- Formation of an ileo-anal pouch is an accepted technique following colectomy in the surgical management of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). The configuration of pouches and anastomotic techniques has varied over the last two decades. The increased use of stapling devices in formation of the pouch-anal anastomosis avoids the need for endoanal mucosal stripping and may contribute to improved functional results, but leaves a 'columnar cuff' of residual rectal mucosa in situ. Concerns regarding the long-term safety of the ileo-anal pouch have been raised by reports of the occurrence of dysplasia in the pouch mucosa and 15 cases of adenocarcinoma. In UC, persistence of underlying disease in the residual rectal mucosa, anal transition zone and columnar cuff provides the site for development of dysplasia and malignancy. Pouchitis is unlikely to be a major cause of dysplasia or malignancy, as long-term follow-up of patients with Koch pouches has demonstrated. In FAP, any persistent rectal mucosa and mucosa of the small intestine is at risk of adenomatous dysplasia due to the genetic alterations causing the disease. Long-term surveillance should focus on all FAP pouch patients, and in UC patients should be directed towards the diagnosis of residual rectal mucosa in the area distal to the pouch anastomosis. Specialist histopathological opinion is essential in the diagnosis of dysplasia in the ileo-anal pouch.
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