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H. E. Myrvold - One of the best experts on this subject based on the ideXlab platform.
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history of the Continent Ileostomy
2019Co-Authors: H. E. Myrvold, Leif HulténAbstract:The evolution of the Continent Ileostomy –“ The Kock pouch” - demonstrates that the education in basic research with its technical applications is an important prerequisite for the progress and success of clinical experiments.
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long term surgical load in patients with ileal pouch anal anastomosis
Colorectal Disease, 2009Co-Authors: Hans H. Wasmuth, Gerd Trano, Arne Wibe, Birger Henning Endreseth, Astrid Rydning, H. E. MyrvoldAbstract:Background The conventional Ileostomy can be avoided. Many attempts have been performed. The first successful solution was the Continent Ileostomy- Kock pouch. The high rate of complications and revisions some experienced forced surgeon to try to restore the continence by the mechanism of the anus involving an ileal pouch. Both procedures afterwards documented excellent functional outcome, but the complication rates were not negligible and the long-term failure rate were increasing. Different surgical refinements were done and the risk factors for complications and failures were investigated as experience and materials increased. Restoring of the integrity of anal function and the succsess of the ileal pouch-anal anastomosis shadowed the practise of the forerunner: the Continent Ileostomy reservoir. This latter procedure was more demanding and seemed in the first year of ileal pouchanal anastomosis era to have significant more complications and revisional surgery. The worldwide adoption of the pelvic pouch decreased the need for the Continent Ileostomy and a vicious circle evolved. Today only few centres perform the procedure. Patients who are not suitable for ileal anal-pouch anastomosis are seldom offered the possibility of having a Continent Ileostomy. Aims The aims of the study was to investigate surgical load, complications and long-term functional outcome and to define factors which affect these subjects in patients operated with ileal pouch-anal anastomosis, Continent Ileostomy or both in one single surgical department during the same period and without any institutional learning curve, and furthermore, to compare and contrast the two options. Material and methods From 1984 to 2005(7) 304 (315) patients were operated with IPAA at St. Olavs Hospital (earlier: Regional Hospital of Trondheim). From 1983 to 2002(7) 50 (65) patients had a Continent Ileostomy constructed. This was an observational study in the scope of surveillance and quality assurance. All patients were offered a planed regularly annual outpatient clinic follow up programme including a prospective standardised interview on clinical outcome. This was a supplement to clinical investigation with endoscopy and consecutive documentation of complications and other factors affecting the patients’ health. Data were recorded in the medical chart. In this system, all patients had recorded dataset. However, the intervals between data recordings differ and the intervals increased by time. All inpatients data were included. Standard descriptive statistical analysis and simple associations were undertaken. Handling longitudinal data with limited cases, varying time intervals was done in a Times Series Cross Sectional data model, analysed, and adjusted for several factors affecting functional outcome. Multivariable analysis was done. Results The estimated failure rate at 20 years was 11.4% for ileal pouch-anal anastomosis and 11.6% for Continent Ileostomy. Salvage procedures rates were 31% vs. 38%, respectively (p=0.06). The salvage procedures in IPAA included local procedures and redoes with laparotomy. Salvage procedures in CI were related to the function of the nipple valve, mainly nipple valve sliding and less frequent stenosis or fistulas. Complications rates were high. In pelvic pouch surgery, half of the patients would need re-operations in 20 years. Ten percentages had early anastomotic separation without septic complications. Four percentages had early pelvic septic complications. Fistulas and sepsis at the anastomotic site were the main severe complications, often leading to pouch failure. Closing of the loop Ileostomy was accompanied with complications in six percentages. In the patients (48) who did not have a covering stoma the overall complications rate did not differ from those with a loop Ileostomy, although nine needed a secondary stoma. Covering stoma seems to postpone anastomotic complications. Handsewn anastomosis had more strictures, but otherwise the complications rates were similar to stapled anastomosis. Patients having the diagnosis changed to Crohn`s diseases had more complications and higher failure rate. Early anastomotic complications were associated with long-term complications. In patients with Continent Ileostomy the nipple valve sliding is the main cause of revision. One third needed revision once or several times. At 20 years follow-up, half of the patients would need surgery due to complications. Although many patients with CI need several revisions, all patients were Continent at the last follow up with a stable intubation frequency of 3 – 5 per 24 hour. The failure of the pelvic pouch is the end of severe complications. Two third of the failures had the pouch excision or permanent Ileostomy with the pouch in situ. One third underwent a conversion to CI, with equal surgical and functional outcome as other patients with CI. In IPAA, bowel movements at day were between 5-6 at day and 0-1 at night. The rates of more or less frequent incontinence were about 10%, and 41% and 55% had reported soling at day and night respectively. The long-term functional outcome did not deteriorate with time: ie. observational time, as an independent factor did not influence outcome. Factors influencing the outcome were found but the impact of gender, age, protective stoma, hand-sewn anastomosis and early complications were negligible. Pouchitis did significantly influence functional outcome negatively, but did not create deterioration over time. Estimated pouchitis rate in IPAA was 43% for more than 20 years. The onset of the first pouchitis appears mostly in the 5-6 first years after surgery. The crude rate was 35% and 6% of the patients had chronic pouchitis. Severe/chronic pouchitis was associated with primary sclerosing cholangitis, but not with pyoderma gangrenousum or diagnosed joint affections. Idiopathic pouchitis were absent among patients with familial adenomatous polyposis. In Continent Ileostomy the rate of pouchitis was 26%. Conclusion The complications in both the pelvic pouch surgery and the surgery of Continent Ileostomy are considerable. Although not similar the surgical load are in the same order of magnitude. For the Continent Ileostomy revisional surgery are to be expected. The failure rate of both procedures are high and in long-term similar. The long-term functional outcome are however stabile and excellent. The failed pelvic pouch can be converted to a Continent Ileostomy in selected and motivated patients. The entity of pouchitis is conflicting and has to be divided into several different entities both on clinical, constitutional and other differentiating features. Patients with PSC should be informed of a possible higher risk of severe and chronic pouchitis after IPAA.
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failed pelvic pouch substituted by Continent Ileostomy
Colorectal Disease, 2009Co-Authors: Hans H. Wasmuth, Gerd Trano, Arne Wibe, Birger Henning Endreseth, Astrid Rydning, H. E. MyrvoldAbstract:Background The conventional Ileostomy can be avoided. Many attempts have been performed. The first successful solution was the Continent Ileostomy- Kock pouch. The high rate of complications and revisions some experienced forced surgeon to try to restore the continence by the mechanism of the anus involving an ileal pouch. Both procedures afterwards documented excellent functional outcome, but the complication rates were not negligible and the long-term failure rate were increasing. Different surgical refinements were done and the risk factors for complications and failures were investigated as experience and materials increased. Restoring of the integrity of anal function and the succsess of the ileal pouch-anal anastomosis shadowed the practise of the forerunner: the Continent Ileostomy reservoir. This latter procedure was more demanding and seemed in the first year of ileal pouchanal anastomosis era to have significant more complications and revisional surgery. The worldwide adoption of the pelvic pouch decreased the need for the Continent Ileostomy and a vicious circle evolved. Today only few centres perform the procedure. Patients who are not suitable for ileal anal-pouch anastomosis are seldom offered the possibility of having a Continent Ileostomy. Aims The aims of the study was to investigate surgical load, complications and long-term functional outcome and to define factors which affect these subjects in patients operated with ileal pouch-anal anastomosis, Continent Ileostomy or both in one single surgical department during the same period and without any institutional learning curve, and furthermore, to compare and contrast the two options. Material and methods From 1984 to 2005(7) 304 (315) patients were operated with IPAA at St. Olavs Hospital (earlier: Regional Hospital of Trondheim). From 1983 to 2002(7) 50 (65) patients had a Continent Ileostomy constructed. This was an observational study in the scope of surveillance and quality assurance. All patients were offered a planed regularly annual outpatient clinic follow up programme including a prospective standardised interview on clinical outcome. This was a supplement to clinical investigation with endoscopy and consecutive documentation of complications and other factors affecting the patients’ health. Data were recorded in the medical chart. In this system, all patients had recorded dataset. However, the intervals between data recordings differ and the intervals increased by time. All inpatients data were included. Standard descriptive statistical analysis and simple associations were undertaken. Handling longitudinal data with limited cases, varying time intervals was done in a Times Series Cross Sectional data model, analysed, and adjusted for several factors affecting functional outcome. Multivariable analysis was done. Results The estimated failure rate at 20 years was 11.4% for ileal pouch-anal anastomosis and 11.6% for Continent Ileostomy. Salvage procedures rates were 31% vs. 38%, respectively (p=0.06). The salvage procedures in IPAA included local procedures and redoes with laparotomy. Salvage procedures in CI were related to the function of the nipple valve, mainly nipple valve sliding and less frequent stenosis or fistulas. Complications rates were high. In pelvic pouch surgery, half of the patients would need re-operations in 20 years. Ten percentages had early anastomotic separation without septic complications. Four percentages had early pelvic septic complications. Fistulas and sepsis at the anastomotic site were the main severe complications, often leading to pouch failure. Closing of the loop Ileostomy was accompanied with complications in six percentages. In the patients (48) who did not have a covering stoma the overall complications rate did not differ from those with a loop Ileostomy, although nine needed a secondary stoma. Covering stoma seems to postpone anastomotic complications. Handsewn anastomosis had more strictures, but otherwise the complications rates were similar to stapled anastomosis. Patients having the diagnosis changed to Crohn`s diseases had more complications and higher failure rate. Early anastomotic complications were associated with long-term complications. In patients with Continent Ileostomy the nipple valve sliding is the main cause of revision. One third needed revision once or several times. At 20 years follow-up, half of the patients would need surgery due to complications. Although many patients with CI need several revisions, all patients were Continent at the last follow up with a stable intubation frequency of 3 – 5 per 24 hour. The failure of the pelvic pouch is the end of severe complications. Two third of the failures had the pouch excision or permanent Ileostomy with the pouch in situ. One third underwent a conversion to CI, with equal surgical and functional outcome as other patients with CI. In IPAA, bowel movements at day were between 5-6 at day and 0-1 at night. The rates of more or less frequent incontinence were about 10%, and 41% and 55% had reported soling at day and night respectively. The long-term functional outcome did not deteriorate with time: ie. observational time, as an independent factor did not influence outcome. Factors influencing the outcome were found but the impact of gender, age, protective stoma, hand-sewn anastomosis and early complications were negligible. Pouchitis did significantly influence functional outcome negatively, but did not create deterioration over time. Estimated pouchitis rate in IPAA was 43% for more than 20 years. The onset of the first pouchitis appears mostly in the 5-6 first years after surgery. The crude rate was 35% and 6% of the patients had chronic pouchitis. Severe/chronic pouchitis was associated with primary sclerosing cholangitis, but not with pyoderma gangrenousum or diagnosed joint affections. Idiopathic pouchitis were absent among patients with familial adenomatous polyposis. In Continent Ileostomy the rate of pouchitis was 26%. Conclusion The complications in both the pelvic pouch surgery and the surgery of Continent Ileostomy are considerable. Although not similar the surgical load are in the same order of magnitude. For the Continent Ileostomy revisional surgery are to be expected. The failure rate of both procedures are high and in long-term similar. The long-term functional outcome are however stabile and excellent. The failed pelvic pouch can be converted to a Continent Ileostomy in selected and motivated patients. The entity of pouchitis is conflicting and has to be divided into several different entities both on clinical, constitutional and other differentiating features. Patients with PSC should be informed of a possible higher risk of severe and chronic pouchitis after IPAA.
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surgical load and long term outcome for patients with kock Continent Ileostomy
Colorectal Disease, 2007Co-Authors: Hans H. Wasmuth, Gerd Trano, Arne Wibe, Birger Henning Endreseth, Astrid Rydning, M Svinsas, H. E. MyrvoldAbstract:Background The conventional Ileostomy can be avoided. Many attempts have been performed. The first successful solution was the Continent Ileostomy- Kock pouch. The high rate of complications and revisions some experienced forced surgeon to try to restore the continence by the mechanism of the anus involving an ileal pouch. Both procedures afterwards documented excellent functional outcome, but the complication rates were not negligible and the long-term failure rate were increasing. Different surgical refinements were done and the risk factors for complications and failures were investigated as experience and materials increased. Restoring of the integrity of anal function and the succsess of the ileal pouch-anal anastomosis shadowed the practise of the forerunner: the Continent Ileostomy reservoir. This latter procedure was more demanding and seemed in the first year of ileal pouchanal anastomosis era to have significant more complications and revisional surgery. The worldwide adoption of the pelvic pouch decreased the need for the Continent Ileostomy and a vicious circle evolved. Today only few centres perform the procedure. Patients who are not suitable for ileal anal-pouch anastomosis are seldom offered the possibility of having a Continent Ileostomy. Aims The aims of the study was to investigate surgical load, complications and long-term functional outcome and to define factors which affect these subjects in patients operated with ileal pouch-anal anastomosis, Continent Ileostomy or both in one single surgical department during the same period and without any institutional learning curve, and furthermore, to compare and contrast the two options. Material and methods From 1984 to 2005(7) 304 (315) patients were operated with IPAA at St. Olavs Hospital (earlier: Regional Hospital of Trondheim). From 1983 to 2002(7) 50 (65) patients had a Continent Ileostomy constructed. This was an observational study in the scope of surveillance and quality assurance. All patients were offered a planed regularly annual outpatient clinic follow up programme including a prospective standardised interview on clinical outcome. This was a supplement to clinical investigation with endoscopy and consecutive documentation of complications and other factors affecting the patients’ health. Data were recorded in the medical chart. In this system, all patients had recorded dataset. However, the intervals between data recordings differ and the intervals increased by time. All inpatients data were included. Standard descriptive statistical analysis and simple associations were undertaken. Handling longitudinal data with limited cases, varying time intervals was done in a Times Series Cross Sectional data model, analysed, and adjusted for several factors affecting functional outcome. Multivariable analysis was done. Results The estimated failure rate at 20 years was 11.4% for ileal pouch-anal anastomosis and 11.6% for Continent Ileostomy. Salvage procedures rates were 31% vs. 38%, respectively (p=0.06). The salvage procedures in IPAA included local procedures and redoes with laparotomy. Salvage procedures in CI were related to the function of the nipple valve, mainly nipple valve sliding and less frequent stenosis or fistulas. Complications rates were high. In pelvic pouch surgery, half of the patients would need re-operations in 20 years. Ten percentages had early anastomotic separation without septic complications. Four percentages had early pelvic septic complications. Fistulas and sepsis at the anastomotic site were the main severe complications, often leading to pouch failure. Closing of the loop Ileostomy was accompanied with complications in six percentages. In the patients (48) who did not have a covering stoma the overall complications rate did not differ from those with a loop Ileostomy, although nine needed a secondary stoma. Covering stoma seems to postpone anastomotic complications. Handsewn anastomosis had more strictures, but otherwise the complications rates were similar to stapled anastomosis. Patients having the diagnosis changed to Crohn`s diseases had more complications and higher failure rate. Early anastomotic complications were associated with long-term complications. In patients with Continent Ileostomy the nipple valve sliding is the main cause of revision. One third needed revision once or several times. At 20 years follow-up, half of the patients would need surgery due to complications. Although many patients with CI need several revisions, all patients were Continent at the last follow up with a stable intubation frequency of 3 – 5 per 24 hour. The failure of the pelvic pouch is the end of severe complications. Two third of the failures had the pouch excision or permanent Ileostomy with the pouch in situ. One third underwent a conversion to CI, with equal surgical and functional outcome as other patients with CI. In IPAA, bowel movements at day were between 5-6 at day and 0-1 at night. The rates of more or less frequent incontinence were about 10%, and 41% and 55% had reported soling at day and night respectively. The long-term functional outcome did not deteriorate with time: ie. observational time, as an independent factor did not influence outcome. Factors influencing the outcome were found but the impact of gender, age, protective stoma, hand-sewn anastomosis and early complications were negligible. Pouchitis did significantly influence functional outcome negatively, but did not create deterioration over time. Estimated pouchitis rate in IPAA was 43% for more than 20 years. The onset of the first pouchitis appears mostly in the 5-6 first years after surgery. The crude rate was 35% and 6% of the patients had chronic pouchitis. Severe/chronic pouchitis was associated with primary sclerosing cholangitis, but not with pyoderma gangrenousum or diagnosed joint affections. Idiopathic pouchitis were absent among patients with familial adenomatous polyposis. In Continent Ileostomy the rate of pouchitis was 26%. Conclusion The complications in both the pelvic pouch surgery and the surgery of Continent Ileostomy are considerable. Although not similar the surgical load are in the same order of magnitude. For the Continent Ileostomy revisional surgery are to be expected. The failure rate of both procedures are high and in long-term similar. The long-term functional outcome are however stabile and excellent. The failed pelvic pouch can be converted to a Continent Ileostomy in selected and motivated patients. The entity of pouchitis is conflicting and has to be divided into several different entities both on clinical, constitutional and other differentiating features. Patients with PSC should be informed of a possible higher risk of severe and chronic pouchitis after IPAA.
Hans H. Wasmuth - One of the best experts on this subject based on the ideXlab platform.
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long term surgical load in patients with ileal pouch anal anastomosis
Colorectal Disease, 2009Co-Authors: Hans H. Wasmuth, Gerd Trano, Arne Wibe, Birger Henning Endreseth, Astrid Rydning, H. E. MyrvoldAbstract:Background The conventional Ileostomy can be avoided. Many attempts have been performed. The first successful solution was the Continent Ileostomy- Kock pouch. The high rate of complications and revisions some experienced forced surgeon to try to restore the continence by the mechanism of the anus involving an ileal pouch. Both procedures afterwards documented excellent functional outcome, but the complication rates were not negligible and the long-term failure rate were increasing. Different surgical refinements were done and the risk factors for complications and failures were investigated as experience and materials increased. Restoring of the integrity of anal function and the succsess of the ileal pouch-anal anastomosis shadowed the practise of the forerunner: the Continent Ileostomy reservoir. This latter procedure was more demanding and seemed in the first year of ileal pouchanal anastomosis era to have significant more complications and revisional surgery. The worldwide adoption of the pelvic pouch decreased the need for the Continent Ileostomy and a vicious circle evolved. Today only few centres perform the procedure. Patients who are not suitable for ileal anal-pouch anastomosis are seldom offered the possibility of having a Continent Ileostomy. Aims The aims of the study was to investigate surgical load, complications and long-term functional outcome and to define factors which affect these subjects in patients operated with ileal pouch-anal anastomosis, Continent Ileostomy or both in one single surgical department during the same period and without any institutional learning curve, and furthermore, to compare and contrast the two options. Material and methods From 1984 to 2005(7) 304 (315) patients were operated with IPAA at St. Olavs Hospital (earlier: Regional Hospital of Trondheim). From 1983 to 2002(7) 50 (65) patients had a Continent Ileostomy constructed. This was an observational study in the scope of surveillance and quality assurance. All patients were offered a planed regularly annual outpatient clinic follow up programme including a prospective standardised interview on clinical outcome. This was a supplement to clinical investigation with endoscopy and consecutive documentation of complications and other factors affecting the patients’ health. Data were recorded in the medical chart. In this system, all patients had recorded dataset. However, the intervals between data recordings differ and the intervals increased by time. All inpatients data were included. Standard descriptive statistical analysis and simple associations were undertaken. Handling longitudinal data with limited cases, varying time intervals was done in a Times Series Cross Sectional data model, analysed, and adjusted for several factors affecting functional outcome. Multivariable analysis was done. Results The estimated failure rate at 20 years was 11.4% for ileal pouch-anal anastomosis and 11.6% for Continent Ileostomy. Salvage procedures rates were 31% vs. 38%, respectively (p=0.06). The salvage procedures in IPAA included local procedures and redoes with laparotomy. Salvage procedures in CI were related to the function of the nipple valve, mainly nipple valve sliding and less frequent stenosis or fistulas. Complications rates were high. In pelvic pouch surgery, half of the patients would need re-operations in 20 years. Ten percentages had early anastomotic separation without septic complications. Four percentages had early pelvic septic complications. Fistulas and sepsis at the anastomotic site were the main severe complications, often leading to pouch failure. Closing of the loop Ileostomy was accompanied with complications in six percentages. In the patients (48) who did not have a covering stoma the overall complications rate did not differ from those with a loop Ileostomy, although nine needed a secondary stoma. Covering stoma seems to postpone anastomotic complications. Handsewn anastomosis had more strictures, but otherwise the complications rates were similar to stapled anastomosis. Patients having the diagnosis changed to Crohn`s diseases had more complications and higher failure rate. Early anastomotic complications were associated with long-term complications. In patients with Continent Ileostomy the nipple valve sliding is the main cause of revision. One third needed revision once or several times. At 20 years follow-up, half of the patients would need surgery due to complications. Although many patients with CI need several revisions, all patients were Continent at the last follow up with a stable intubation frequency of 3 – 5 per 24 hour. The failure of the pelvic pouch is the end of severe complications. Two third of the failures had the pouch excision or permanent Ileostomy with the pouch in situ. One third underwent a conversion to CI, with equal surgical and functional outcome as other patients with CI. In IPAA, bowel movements at day were between 5-6 at day and 0-1 at night. The rates of more or less frequent incontinence were about 10%, and 41% and 55% had reported soling at day and night respectively. The long-term functional outcome did not deteriorate with time: ie. observational time, as an independent factor did not influence outcome. Factors influencing the outcome were found but the impact of gender, age, protective stoma, hand-sewn anastomosis and early complications were negligible. Pouchitis did significantly influence functional outcome negatively, but did not create deterioration over time. Estimated pouchitis rate in IPAA was 43% for more than 20 years. The onset of the first pouchitis appears mostly in the 5-6 first years after surgery. The crude rate was 35% and 6% of the patients had chronic pouchitis. Severe/chronic pouchitis was associated with primary sclerosing cholangitis, but not with pyoderma gangrenousum or diagnosed joint affections. Idiopathic pouchitis were absent among patients with familial adenomatous polyposis. In Continent Ileostomy the rate of pouchitis was 26%. Conclusion The complications in both the pelvic pouch surgery and the surgery of Continent Ileostomy are considerable. Although not similar the surgical load are in the same order of magnitude. For the Continent Ileostomy revisional surgery are to be expected. The failure rate of both procedures are high and in long-term similar. The long-term functional outcome are however stabile and excellent. The failed pelvic pouch can be converted to a Continent Ileostomy in selected and motivated patients. The entity of pouchitis is conflicting and has to be divided into several different entities both on clinical, constitutional and other differentiating features. Patients with PSC should be informed of a possible higher risk of severe and chronic pouchitis after IPAA.
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Durability of ileal pouch-anal anastomosis and Continent Ileostomy.
Diseases of The Colon & Rectum, 2009Co-Authors: Hans H. Wasmuth, Helge E. MyrvoldAbstract:PURPOSE:This study was designed to evaluate pouch durability and salvage in patients undergoing Continent Ileostomy and ileal pouch–anal anastomosis.METHODS:Three hundred seventeen patients undergoing ileal pouch–anal anastomosis and 63 undergoing Continent Ileostomy were evaluated in a prospective
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failed pelvic pouch substituted by Continent Ileostomy
Colorectal Disease, 2009Co-Authors: Hans H. Wasmuth, Gerd Trano, Arne Wibe, Birger Henning Endreseth, Astrid Rydning, H. E. MyrvoldAbstract:Background The conventional Ileostomy can be avoided. Many attempts have been performed. The first successful solution was the Continent Ileostomy- Kock pouch. The high rate of complications and revisions some experienced forced surgeon to try to restore the continence by the mechanism of the anus involving an ileal pouch. Both procedures afterwards documented excellent functional outcome, but the complication rates were not negligible and the long-term failure rate were increasing. Different surgical refinements were done and the risk factors for complications and failures were investigated as experience and materials increased. Restoring of the integrity of anal function and the succsess of the ileal pouch-anal anastomosis shadowed the practise of the forerunner: the Continent Ileostomy reservoir. This latter procedure was more demanding and seemed in the first year of ileal pouchanal anastomosis era to have significant more complications and revisional surgery. The worldwide adoption of the pelvic pouch decreased the need for the Continent Ileostomy and a vicious circle evolved. Today only few centres perform the procedure. Patients who are not suitable for ileal anal-pouch anastomosis are seldom offered the possibility of having a Continent Ileostomy. Aims The aims of the study was to investigate surgical load, complications and long-term functional outcome and to define factors which affect these subjects in patients operated with ileal pouch-anal anastomosis, Continent Ileostomy or both in one single surgical department during the same period and without any institutional learning curve, and furthermore, to compare and contrast the two options. Material and methods From 1984 to 2005(7) 304 (315) patients were operated with IPAA at St. Olavs Hospital (earlier: Regional Hospital of Trondheim). From 1983 to 2002(7) 50 (65) patients had a Continent Ileostomy constructed. This was an observational study in the scope of surveillance and quality assurance. All patients were offered a planed regularly annual outpatient clinic follow up programme including a prospective standardised interview on clinical outcome. This was a supplement to clinical investigation with endoscopy and consecutive documentation of complications and other factors affecting the patients’ health. Data were recorded in the medical chart. In this system, all patients had recorded dataset. However, the intervals between data recordings differ and the intervals increased by time. All inpatients data were included. Standard descriptive statistical analysis and simple associations were undertaken. Handling longitudinal data with limited cases, varying time intervals was done in a Times Series Cross Sectional data model, analysed, and adjusted for several factors affecting functional outcome. Multivariable analysis was done. Results The estimated failure rate at 20 years was 11.4% for ileal pouch-anal anastomosis and 11.6% for Continent Ileostomy. Salvage procedures rates were 31% vs. 38%, respectively (p=0.06). The salvage procedures in IPAA included local procedures and redoes with laparotomy. Salvage procedures in CI were related to the function of the nipple valve, mainly nipple valve sliding and less frequent stenosis or fistulas. Complications rates were high. In pelvic pouch surgery, half of the patients would need re-operations in 20 years. Ten percentages had early anastomotic separation without septic complications. Four percentages had early pelvic septic complications. Fistulas and sepsis at the anastomotic site were the main severe complications, often leading to pouch failure. Closing of the loop Ileostomy was accompanied with complications in six percentages. In the patients (48) who did not have a covering stoma the overall complications rate did not differ from those with a loop Ileostomy, although nine needed a secondary stoma. Covering stoma seems to postpone anastomotic complications. Handsewn anastomosis had more strictures, but otherwise the complications rates were similar to stapled anastomosis. Patients having the diagnosis changed to Crohn`s diseases had more complications and higher failure rate. Early anastomotic complications were associated with long-term complications. In patients with Continent Ileostomy the nipple valve sliding is the main cause of revision. One third needed revision once or several times. At 20 years follow-up, half of the patients would need surgery due to complications. Although many patients with CI need several revisions, all patients were Continent at the last follow up with a stable intubation frequency of 3 – 5 per 24 hour. The failure of the pelvic pouch is the end of severe complications. Two third of the failures had the pouch excision or permanent Ileostomy with the pouch in situ. One third underwent a conversion to CI, with equal surgical and functional outcome as other patients with CI. In IPAA, bowel movements at day were between 5-6 at day and 0-1 at night. The rates of more or less frequent incontinence were about 10%, and 41% and 55% had reported soling at day and night respectively. The long-term functional outcome did not deteriorate with time: ie. observational time, as an independent factor did not influence outcome. Factors influencing the outcome were found but the impact of gender, age, protective stoma, hand-sewn anastomosis and early complications were negligible. Pouchitis did significantly influence functional outcome negatively, but did not create deterioration over time. Estimated pouchitis rate in IPAA was 43% for more than 20 years. The onset of the first pouchitis appears mostly in the 5-6 first years after surgery. The crude rate was 35% and 6% of the patients had chronic pouchitis. Severe/chronic pouchitis was associated with primary sclerosing cholangitis, but not with pyoderma gangrenousum or diagnosed joint affections. Idiopathic pouchitis were absent among patients with familial adenomatous polyposis. In Continent Ileostomy the rate of pouchitis was 26%. Conclusion The complications in both the pelvic pouch surgery and the surgery of Continent Ileostomy are considerable. Although not similar the surgical load are in the same order of magnitude. For the Continent Ileostomy revisional surgery are to be expected. The failure rate of both procedures are high and in long-term similar. The long-term functional outcome are however stabile and excellent. The failed pelvic pouch can be converted to a Continent Ileostomy in selected and motivated patients. The entity of pouchitis is conflicting and has to be divided into several different entities both on clinical, constitutional and other differentiating features. Patients with PSC should be informed of a possible higher risk of severe and chronic pouchitis after IPAA.
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surgical load and long term outcome for patients with kock Continent Ileostomy
Colorectal Disease, 2007Co-Authors: Hans H. Wasmuth, Gerd Trano, Arne Wibe, Birger Henning Endreseth, Astrid Rydning, M Svinsas, H. E. MyrvoldAbstract:Background The conventional Ileostomy can be avoided. Many attempts have been performed. The first successful solution was the Continent Ileostomy- Kock pouch. The high rate of complications and revisions some experienced forced surgeon to try to restore the continence by the mechanism of the anus involving an ileal pouch. Both procedures afterwards documented excellent functional outcome, but the complication rates were not negligible and the long-term failure rate were increasing. Different surgical refinements were done and the risk factors for complications and failures were investigated as experience and materials increased. Restoring of the integrity of anal function and the succsess of the ileal pouch-anal anastomosis shadowed the practise of the forerunner: the Continent Ileostomy reservoir. This latter procedure was more demanding and seemed in the first year of ileal pouchanal anastomosis era to have significant more complications and revisional surgery. The worldwide adoption of the pelvic pouch decreased the need for the Continent Ileostomy and a vicious circle evolved. Today only few centres perform the procedure. Patients who are not suitable for ileal anal-pouch anastomosis are seldom offered the possibility of having a Continent Ileostomy. Aims The aims of the study was to investigate surgical load, complications and long-term functional outcome and to define factors which affect these subjects in patients operated with ileal pouch-anal anastomosis, Continent Ileostomy or both in one single surgical department during the same period and without any institutional learning curve, and furthermore, to compare and contrast the two options. Material and methods From 1984 to 2005(7) 304 (315) patients were operated with IPAA at St. Olavs Hospital (earlier: Regional Hospital of Trondheim). From 1983 to 2002(7) 50 (65) patients had a Continent Ileostomy constructed. This was an observational study in the scope of surveillance and quality assurance. All patients were offered a planed regularly annual outpatient clinic follow up programme including a prospective standardised interview on clinical outcome. This was a supplement to clinical investigation with endoscopy and consecutive documentation of complications and other factors affecting the patients’ health. Data were recorded in the medical chart. In this system, all patients had recorded dataset. However, the intervals between data recordings differ and the intervals increased by time. All inpatients data were included. Standard descriptive statistical analysis and simple associations were undertaken. Handling longitudinal data with limited cases, varying time intervals was done in a Times Series Cross Sectional data model, analysed, and adjusted for several factors affecting functional outcome. Multivariable analysis was done. Results The estimated failure rate at 20 years was 11.4% for ileal pouch-anal anastomosis and 11.6% for Continent Ileostomy. Salvage procedures rates were 31% vs. 38%, respectively (p=0.06). The salvage procedures in IPAA included local procedures and redoes with laparotomy. Salvage procedures in CI were related to the function of the nipple valve, mainly nipple valve sliding and less frequent stenosis or fistulas. Complications rates were high. In pelvic pouch surgery, half of the patients would need re-operations in 20 years. Ten percentages had early anastomotic separation without septic complications. Four percentages had early pelvic septic complications. Fistulas and sepsis at the anastomotic site were the main severe complications, often leading to pouch failure. Closing of the loop Ileostomy was accompanied with complications in six percentages. In the patients (48) who did not have a covering stoma the overall complications rate did not differ from those with a loop Ileostomy, although nine needed a secondary stoma. Covering stoma seems to postpone anastomotic complications. Handsewn anastomosis had more strictures, but otherwise the complications rates were similar to stapled anastomosis. Patients having the diagnosis changed to Crohn`s diseases had more complications and higher failure rate. Early anastomotic complications were associated with long-term complications. In patients with Continent Ileostomy the nipple valve sliding is the main cause of revision. One third needed revision once or several times. At 20 years follow-up, half of the patients would need surgery due to complications. Although many patients with CI need several revisions, all patients were Continent at the last follow up with a stable intubation frequency of 3 – 5 per 24 hour. The failure of the pelvic pouch is the end of severe complications. Two third of the failures had the pouch excision or permanent Ileostomy with the pouch in situ. One third underwent a conversion to CI, with equal surgical and functional outcome as other patients with CI. In IPAA, bowel movements at day were between 5-6 at day and 0-1 at night. The rates of more or less frequent incontinence were about 10%, and 41% and 55% had reported soling at day and night respectively. The long-term functional outcome did not deteriorate with time: ie. observational time, as an independent factor did not influence outcome. Factors influencing the outcome were found but the impact of gender, age, protective stoma, hand-sewn anastomosis and early complications were negligible. Pouchitis did significantly influence functional outcome negatively, but did not create deterioration over time. Estimated pouchitis rate in IPAA was 43% for more than 20 years. The onset of the first pouchitis appears mostly in the 5-6 first years after surgery. The crude rate was 35% and 6% of the patients had chronic pouchitis. Severe/chronic pouchitis was associated with primary sclerosing cholangitis, but not with pyoderma gangrenousum or diagnosed joint affections. Idiopathic pouchitis were absent among patients with familial adenomatous polyposis. In Continent Ileostomy the rate of pouchitis was 26%. Conclusion The complications in both the pelvic pouch surgery and the surgery of Continent Ileostomy are considerable. Although not similar the surgical load are in the same order of magnitude. For the Continent Ileostomy revisional surgery are to be expected. The failure rate of both procedures are high and in long-term similar. The long-term functional outcome are however stabile and excellent. The failed pelvic pouch can be converted to a Continent Ileostomy in selected and motivated patients. The entity of pouchitis is conflicting and has to be divided into several different entities both on clinical, constitutional and other differentiating features. Patients with PSC should be informed of a possible higher risk of severe and chronic pouchitis after IPAA.
Feza H Remzi - One of the best experts on this subject based on the ideXlab platform.
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is conversion of a failed ipaa to a Continent Ileostomy a risk factor for long term failure
Diseases of The Colon & Rectum, 2019Co-Authors: Erman Aytac, David W Dietz, Jean Ashburn, Feza H RemziAbstract:BACKGROUND:A Continent Ileostomy may be offered to patients in hopes of avoiding permanent Ileostomy. Data on the outcomes of Continent Ileostomy patients with a history of a failed IPAA are limited.OBJECTIVE:This study aimed to assess whether a history of previous failed IPAA had an effect on conti
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long term outcomes after Continent Ileostomy creation in patients with crohn s disease
Diseases of The Colon & Rectum, 2017Co-Authors: Erman Aytac, David W Dietz, Jean Ashburn, Feza H RemziAbstract:Background Patients with Crohn's disease have a higher failure rate after ileal pouch surgery compared with their counterparts with ulcerative colitis. Objective We hypothesized that risk of Continent Ileostomy failure can be stratified based on the timing of Crohn's disease diagnosis and aimed to assess long-term outcomes. Design This was a retrospective cohort study. Settings The investigation took place in a high-volume, specialized colorectal surgery department. Patients Patients with Crohn's disease who underwent Continent Ileostomy surgery between 1978 and 2013 were evaluated. Main outcome measures Functional outcomes, postoperative complications, requirement of revision surgery, and Continent Ileostomy failure were analyzed. Results There were 48 patients (14 male patients) with a median age of 33 years at the time of Continent Ileostomy creation. Crohn's disease diagnosis was before Continent Ileostomy (intentional) in 15 or made in a delayed fashion at a median 4 years after Continent Ileostomy in 33 patients. Median follow-up was 19 years (range, 1-33 y) after index Continent Ileostomy creation. Major and minor revisions were performed in 40 (83%) and 13 patients (27%). Complications were fistula (n = 20), pouchitis (n = 16), valve slippage (n = 15), hernia (n = 9), afferent limb stricture (n = 9), difficult intubation (n = 8), incontinence (n = 7), bowel obstruction (n = 7), valve stricture (n = 5), leakage (n = 4), bleeding (n = 3), and valve prolapse (n = 3). Median Cleveland global quality-of-life score was 0.8. Continent Ileostomy failure occurred in 22 patients (46%). Based on Kaplan-Meier estimates, Continent Ileostomy survival was 48 % (95% CI, 33%-63%) at 20 years. Continent Ileostomy failure was similar regardless of timing of diagnosis of Crohn's disease (p = 0.533). Limitations This study was limited by its retrospective and nonrandomized nature. Conclusions Outcomes of Continent Ileostomy in patients with Crohn's disease are poor, regardless of the timing of diagnosis. Very careful consideration should be given by both the surgeon and the patient before undertaking this procedure in patients with Crohn's disease. See Video Abstract at http://links.lww.com/DCR/A327.
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outcomes for patients undergoing Continent Ileostomy after a failed ileal pouch anal anastomosis
Diseases of The Colon & Rectum, 2009Co-Authors: Lei Lian, Victor W. Fazio, Feza H Remzi, Bo Shen, David W Dietz, Ravi P KiranAbstract:PURPOSE:Continent Ileostomy is considered an alternative for patients with a failed ileal pouch-anal anastomosis. The aim of this study is to investigate outcomes for patients undergoing Continent Ileostomy after a failed ileal pouch-anal anastomosis at our institution.METHODS:Patients undergoing co
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long term outcome and quality of life after Continent Ileostomy
Diseases of The Colon & Rectum, 2006Co-Authors: G Nessar, Victor W. Fazio, Paris P Tekkis, Jason T Connor, Jane Bast, Allison Borkowski, Conor P Delaney, Feza H RemziAbstract:This study was designed to evaluate long-term outcomes for patients undergoing Kock Continent Ileostomy, identify factors associated with adverse outcomes, and compare changes in quality of life after removal of the reservoir. The records of all patients (n = 330) undergoing Continent Ileostomy at the Cleveland Clinic Foundation between 1974 and 2001 were reviewed. Patient-related, intraoperative, and postoperative factors were evaluated as predictor variables of long-term pouch survival. Quality of life was evaluated using the Continent Ileostomy surgery follow-up questionnaire and the Cleveland Global Quality of Life scale (n = 216). These were compared between patients with Continent Ileostomy (n = 181) and patients who underwent removal of the Continent Ileostomy and conversion to an end stoma (n = 35). The median patient follow-up was 11 (range, 1–27) years. The median revision-free pouch interval was 14 (95 percent confidence interval, 11–17) months. The 10-year and 20-year pouch survival was 87 and77 percent, respectively. Patients had an average of 3.7(range, 1–28) complications and 2.9 (range, 1–27) pouch revisions during follow-up. On multivariate analysis, Crohn's disease (hazard ratio = 4.5), female gender (hazard ratio = 2.4), fistula development (hazard ratio = 3), and body mass index (hazard ratio = 2.4 per 5 unit increase) were independent predictors of pouch failure. Quality of life measurements for patients with a Continent Ileostomy were higher on all scales in comparison with patients who had the Kock reservoir and then reverted to a Brooke Ileostomy. Despite the associated morbidity with Continent Ileostomy surgery, long-term results and quality of life were encouraging. Continent Ileostomy may be offered as an attractive long-term option to select patients whose only alternative is an end Ileostomy.
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evolving technique for Continent Ileostomy valveless pouch design
Techniques in Coloproctology, 2004Co-Authors: G Nessar, Feza H RemziAbstract:A Continent Ileostomy, or Kock pouch, is a useful option for patients with inflammatory bowel disease whose only alternative is an end Ileostomy. This technique has a high morbidity rate. Nipple valve slippage is the most common complication, causing incontinence or intubation problems. A novel, valveless Continent Ileostomy technique is described here. A porcine model was used to create the Continent Ileostomy. Two pouches were created and tested for integrity and continence using lactated Ringer's solution. Pouch pressure and volume were recorded in one pouch. The valveless Continent Ileostomy was successfully created twice, and both pouches were Continent. An intraluminal pressure of 30 mmHg and a volume of 225 ml were measured in one pouch. In this preliminary report of a valveless Continent Ileostomy, we had promising results. The future of this technique in clinical practice needs to be addressed with further studies.
David W Dietz - One of the best experts on this subject based on the ideXlab platform.
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is conversion of a failed ipaa to a Continent Ileostomy a risk factor for long term failure
Diseases of The Colon & Rectum, 2019Co-Authors: Erman Aytac, David W Dietz, Jean Ashburn, Feza H RemziAbstract:BACKGROUND:A Continent Ileostomy may be offered to patients in hopes of avoiding permanent Ileostomy. Data on the outcomes of Continent Ileostomy patients with a history of a failed IPAA are limited.OBJECTIVE:This study aimed to assess whether a history of previous failed IPAA had an effect on conti
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Continent Ileostomy after removal of a failed ipaa
2019Co-Authors: David W DietzAbstract:Ileal pouch-anal anastomosis (IPAA) is considered the reconstructive procedure of choice for patients who require total proctocolectomy (TPC) for treatment of ulcerative colitis (UC) [1, 2]. IPAA is also offered in some centers to highly-selected patients with indeterminate colitis and Crohn’s colitis requiring TPC [3–5]. While the vast majority of patients who undergo IPAA report good quality of life and high pouch retention rates [6, 7], approximately 10% will suffer complications leading to pouch excision [8]. These patients are usually presented with standard Ileostomy as the only option. However, in a few highly specialized centers throughout the world, creation of a Continent Ileostomy may be offered as a more palatable alternative to end Ileostomy.
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long term outcomes after Continent Ileostomy creation in patients with crohn s disease
Diseases of The Colon & Rectum, 2017Co-Authors: Erman Aytac, David W Dietz, Jean Ashburn, Feza H RemziAbstract:Background Patients with Crohn's disease have a higher failure rate after ileal pouch surgery compared with their counterparts with ulcerative colitis. Objective We hypothesized that risk of Continent Ileostomy failure can be stratified based on the timing of Crohn's disease diagnosis and aimed to assess long-term outcomes. Design This was a retrospective cohort study. Settings The investigation took place in a high-volume, specialized colorectal surgery department. Patients Patients with Crohn's disease who underwent Continent Ileostomy surgery between 1978 and 2013 were evaluated. Main outcome measures Functional outcomes, postoperative complications, requirement of revision surgery, and Continent Ileostomy failure were analyzed. Results There were 48 patients (14 male patients) with a median age of 33 years at the time of Continent Ileostomy creation. Crohn's disease diagnosis was before Continent Ileostomy (intentional) in 15 or made in a delayed fashion at a median 4 years after Continent Ileostomy in 33 patients. Median follow-up was 19 years (range, 1-33 y) after index Continent Ileostomy creation. Major and minor revisions were performed in 40 (83%) and 13 patients (27%). Complications were fistula (n = 20), pouchitis (n = 16), valve slippage (n = 15), hernia (n = 9), afferent limb stricture (n = 9), difficult intubation (n = 8), incontinence (n = 7), bowel obstruction (n = 7), valve stricture (n = 5), leakage (n = 4), bleeding (n = 3), and valve prolapse (n = 3). Median Cleveland global quality-of-life score was 0.8. Continent Ileostomy failure occurred in 22 patients (46%). Based on Kaplan-Meier estimates, Continent Ileostomy survival was 48 % (95% CI, 33%-63%) at 20 years. Continent Ileostomy failure was similar regardless of timing of diagnosis of Crohn's disease (p = 0.533). Limitations This study was limited by its retrospective and nonrandomized nature. Conclusions Outcomes of Continent Ileostomy in patients with Crohn's disease are poor, regardless of the timing of diagnosis. Very careful consideration should be given by both the surgeon and the patient before undertaking this procedure in patients with Crohn's disease. See Video Abstract at http://links.lww.com/DCR/A327.
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is there still a role for Continent Ileostomy in the surgical treatment of inflammatory bowel disease
Inflammatory Bowel Diseases, 2014Co-Authors: Erman Aytac, Jean Ashburn, David W DietzAbstract:The Continent Ileostomy (CI) was first described in 1969 as an important advancement in the surgical treatment of patients with ulcerative colitis, providing an option for fecal continence to patients who would otherwise require a conventional Ileostomy. The CI enjoyed a brief period of relative popularity during the 1970s before being displaced by today's gold standard for the surgical treatment of ulcerative colitis, the restorative proctocolectomy (ileal pouch-anal anastomosis [IPAA]). Although the CI is only rarely performed today, it still has a role to play in the treatment of patients with inflammatory bowel disease who have failed medical treatment. Current indications are patients with failed IPAAs who are not candidates for redo-IPAA, patients who require total proctocolectomy but cannot be reconstructed with IPAA, and patients with an existing conventional Ileostomy that is adversely affecting their quality of life. CI, however, is a complex procedure that carries significant risk of both postoperative complications and the need for reoperation over the long term due to slippage of the nipple valve. Patients being considered for this procedure should undergo extensive preoperative counseling and must have a thorough understanding of the associated risks and a realistic vision of anticipated benefits. In well-selected and properly motivated patients, however, CI can be durable in the majority with long-term pouch survival rates approaching 80%. Published data suggest that these patients enjoy greater quality of life than their counterparts with a conventional Ileostomy and that 95% would choose to undergo the procedure again or recommend it to another.
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su1612 long term outcomes of Continent Ileostomy created in the pediatric age group
Gastroenterology, 2013Co-Authors: Erman Aytac, Victor W. Fazio, David W Dietz, Hasan H Erem, Jennifer Liang, Marsha Kay, Pokala R KiranAbstract:Background/aim: Continent Ileostomy (CI) is a surgically created intra-abdominal pouch in patients with a permanent end Ileostomy. CI is one of the few surgical options that may be offered to patients who were fated to live with a permanent Ileostomy, but want to avoid a stoma appliance at any cost. Data about durability, clinical and functional outcomes of CI created in pediatric patients are limited. In this study, we aimed to evaluate our 36-year operative experience on CI in pediatric patients with a 21 year median follow-up. Methods: Pediatric (≤21 years)* patients undergoing a CI procedure at a single institution from 19732009 were identified. CI revisions that required pouchotomy or re-construction following total or partial excision of CI were defined as major and those that did not require bowel resection were defined as minor revisions. CI failure was defined as excision of the pouch and formation of an end Ileostomy. Results: 49 patients (26 male), median age 18 (12-21) years and median body mass index 22 (16-38.6) underwent CI. 10 (20%) patients had a CI at the time of total proctocolectomy. 12 (25%) patients underwent conversion of an ileoanal pouch (IPAA) to a CI. The majority of the patients (n=39, 80%) had ulcerative colitis or indeterminate colitis at the time of CI creation; however Crohn's disease were diagnosed in 4 patients postoperatively. There were no intra-operative or early post-operative deaths. One patients who underwent CI excision seven years after CI creation due to complicated Crohn's disease, died ten years after CI excision. Median follow-up time was 21(range 1-38) years. Valve slippage (33%), small bowel obstruction (25%), pouchitis (25%) and fistula (23%) were the common complications (table). 37 patients (76%) underwent at least 1 revision procedure after CI creation. 36 (74%) patients underwent major revision and 6 (12%) patients underwent minor revisions. Median pouch intubation was 6 (range 4-10) times per day. Pouch failure occurred in 9 (18%) patients with 7 out of 9 cases being due to complications from Crohn's disease. Conclusions: CI is safe and durable in pediatric patients. Development of Crohn's disease after CI creation seems to be a risk factor for failure. Since likelihood of further revisions is high, patients with CI should be followedup regularly. * Council on Child and Adolescent Health. Age Limits of Pediatrics. Pediatrics 1988;81:736. Primary diagnosis, complications and follow-up details
T Oresland - One of the best experts on this subject based on the ideXlab platform.
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health related quality of life and pouch function in Continent Ileostomy patients a 30 year perspective
Diseases of The Colon & Rectum, 2004Co-Authors: Ina Berndtsson, T Oresland, Elisabet Lindholm, Leif HulténAbstract: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. 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. 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. 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. 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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the failed pelvic pouch conversion to a Continent Ileostomy
Techniques in Coloproctology, 2004Co-Authors: L Borjesson, T Oresland, Leif HulténAbstract: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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incidence and characteristics of pouchitis in the kock Continent Ileostomy and the pelvic pouch
Scandinavian Journal of Gastroenterology, 1993Co-Authors: G Svaninger, S Nordgren, T Oresland, L HultenAbstract:The incidence, the median time to first appearance, and the clinical pattern of pouchitis were prospectively studied in 180 patients operated on for ulcerative proctocolitis with a Continent Ileostomy (CI; 84 patients) and a pelvic pouch (PP; 96 patients). Median follow-up for CI patients was 8.5 years (range, 2-15 years) and for PP patients, 5 years (range, 1-8 years). Pouchitis, with symptoms severe enough to require treatment, developed in 33% (28 of 84) of CI and 47% (45 of 96) of PP patients. The cumulative risk of developing one or more episodes of pouchitis over a 5-year follow-up was 34% in CI patients and 51% in PP patients. The median time to first appearance of pouchitis was 5 and 12 months, respectively. Eighty-six per cent of CI patients with pouchitis (24 of 28) and 71% of PP patients (32 of 45) experienced their initial episode within the first 2 years. Sixty-four per cent (18 of 28) of the CI patients and 76% (34 of 45) of PP patients had one single or a few short-lasting episodes of pouch...
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incidence and characteristics of pouchitis in the kock Continent Ileostomy and the pelvic pouch
Scandinavian Journal of Gastroenterology, 1993Co-Authors: G Svaninger, S Nordgren, T Oresland, L HultenAbstract:The incidence, the median time to first appearance, and the clinical pattern of pouchitis were prospectively studied in 180 patients operated on for ulcerative proctocolitis with a Continent Ileostomy (CI; 84 patients) and a pelvic pouch (PP; 96 patients). Median follow-up for CI patients was 8.5 years (range, 2-15 years) and for PP patients, 5 years (range, 1-8 years). Pouchitis, with symptoms severe enough to require treatment, developed in 33% (28 of 84) of CI and 47% (45 of 96) of PP patients. The cumulative risk of developing one or more episodes of pouchitis over a 5-year follow-up was 34% in CI patients and 51% in PP patients. The median time to first appearance of pouchitis was 5 and 12 months, respectively. Eighty-six per cent of CI patients with pouchitis (24 of 28) and 71% of PP patients (32 of 45) experienced their initial episode within the first 2 years. Sixty-four per cent (18 of 28) of the CI patients and 76% (34 of 45) of PP patients had one single or a few short-lasting episodes of pouchitis with various symptom-free intervals, whereas 18% of patients in each group (5 of 28 CI patients, 8 of 45 PP patients) had frequent relapses. Most of these patients responded promptly to metronidazole treatment. Eighteen per cent (5 of 28) of CI patients and 6% (3 of 45) of PP patients had long-lasting episodes with a poor response to treatment. In this long-term study the pouch inflammation proved eventually to be Crohn's disease in four patients (2.2%).(ABSTRACT TRUNCATED AT 250 WORDS)
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the failing pelvic pouch conversion to Continent Ileostomy
International Journal of Colorectal Disease, 1992Co-Authors: L Hulten, S Fasth, T Hallgren, T OreslandAbstract:Excision of a failing pelvic pouch is often a great disappointment for the patient. It is also an unfortunate decision considering that a significant length of terminal ileum is sacrificed. Transformation of the pouch to a Continent Ileostomy is an alternative. Five patients with a malfunctioning pelvic pouch have had their pouch converted to a Continent Ileostomy. The operative technique is described.