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Roger R. Dozois - One of the best experts on this subject based on the ideXlab platform.
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Familial adenomatous polyposis. Results after Ileal Pouch-Anal Anastomosis in teenagers. Commentaries. Authors' reply
Diseases of The Colon & Rectum, 2020Co-Authors: Yann Parc, Bruce G. Wolff, John H. Pemberton, Roger R. Dozois, Y R Parc, G Moslein, J E King, James M. Church, R. K. S. Phillips, J H PembertonAbstract:PURPOSE: Virtually all untreated patients with familial adenomatous polyposis develop colorectal carcinoma. Thus, prophylactic colectomy is indicated. Detractors of Ileal Pouch-Anal Anastomosis prefer ileorectal Anastomosis for teenagers because of the potential negative impact of Ileal Pouch-Anal Anastomosis on quality of life. The aim of this study was to assess the effects on quality of life of Ileal Pouch-Anal Anastomosis in teenagers with familial adenomatous polyposis. METHODS: Between 1981 and 1998, 48 teenagers underwent Ileal Pouch-Anal Anastomosis for familial adenomatous polyposis. One patient had proctectomy and Ileal Pouch-Anal Anastomosis after previous ileorectal Anastomosis. A temporary diverting loop ileostomy was established in 42 patients (87.5 percent). One patient had colonic carcinoma diagnosed preoperatively. Two other patients were found to have unsuspected rectal cancer at surgery. Mean follow-up (± standard deviation) in 43 patients was 80.5 ± 42 months. RESULTS: There was no immediate postoperative mortality. Postoperative complications included pelvic sepsis (3 patients; 1 requiring reoperation) and bleeding (1 patient; no surgery required). One patient died of metastatic colonic carcinoma. Ten patients required reoperation, seven had bowel obstruction, one had portal hypertension, and two required an ileostomy. The mean (± standard deviation) daytime and nighttime stool frequency was 4 ± 1.5 and 1 ± 1, respectively. One patient reported daytime and nighttime incontinence, and two patients reported nighttime incontinence only. No patient experienced impotence or retrograde ejaculation. Social, sexual, sport, housework, recreation, family, travel, and work activities were improved or unchanged in 82.5, 87, 80, 90, 80, 92.5, 77.5, and 89 percent of patients, respectively. Three male patients fathered children, and three female patients had a total of six children after normal pregnancies and deliveries. CONCLUSION: The impact of Ileal Pouch-Anal Anastomosis on quality of life was favorable in the majority of teenagers. The risk of rectal cancer should be the major consideration before proposing an operation to teenagers with familial adenomatous polyposis.
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Ileal Pouch-Anal Anastomosis in patients with colorectal cancer: long-term functional and oncologic outcomes.
Diseases of The Colon & Rectum, 2015Co-Authors: Elisabetta Radice, Bruce G. Wolff, John H. Pemberton, Roger R. Dozois, Heidi Nelson, Richard M. Devine, Santhat Nivatvongs, J. Basil J. Fozard, Duane M. IlstrupAbstract:When colorectal cancer complicates chronic ulcerative colitis or familial adenomatous polyposis, the role of Ileal Pouch-Anal Anastomosis is uncertain because of concerns that the procedure may compromise oncologic therapy and that oncologic therapy may compromise Ileal Pouch-Anal Anastomosis function. AIM: This study was undertaken to investigate the impact both of Ileal Pouch-Anal Anastomosis on cancer outcomes and of cancer treatments on Ileal Pouch-Anal Anastomosis function. PATIENTS AND METHODS: Of 1,616 patients undergoing Ileal Pouch-Anal Anastomosis for chronic ulcerative colitis or familial adenomatous polyposis (1981–1994), 77 patients were identified with adenocarcinoma of the colon (56), rectum (17), or both (4). Data were obtained from an Ileal Pouch-Anal Anastomosis registry, case notes, and postal and telephone surveys. RESULTS: Mean age of the 77 index patients was 37 (range, 13–60) years. Stage distribution was as follows: Stage 0, 9; Stage I, 31; Stage II, 15; Stage III, 22 patients. Twelve patients died with systemic disease (6 with a local component) after a mean follow-up of 6 (range, 2–15) years. Twenty-two patients received adjuvant therapy (chemotherapy, 16; radiotherapy, 2; both, 4 patients). Chemotherapy complications requiring dose reduction or interruption occurred in three (15 percent) patients. One patient developed radiation enteritis (17 percent). Pouch failure occurred in 16 percent of cancer patients, compared with 7 percent for the overall registry. There were no differences between cancer and non-cancer groups in operative complications, median stool frequency, incontinence, pad usage, or pouchitis. CONCLUSIONS: Although pouch failure is more common, Ileal Pouch-Anal Anastomosis can be performed in the setting of colorectal cancer without significant impact on oncologic outcome or long-term Ileal Pouch-Anal Anastomosis function.
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Ileal Pouch-Anal Anastomosis without temporary, diverting ileostomy
Diseases of The Colon & Rectum, 2012Co-Authors: Amanda M. Metcalf, Roger R. Dozois, Keith A. Kelly, Bruce G. WolffAbstract:Of two hundred patients undergoing proctocolectomy with Ileal Pouch-Anal Anastomosis, all but nine have had temporary diverting ileostomies. Of these nine patients, eight had successful results. One patient developed abdominal sepsis due to jejunal volvulus and perforation after she had returned home, and at surgery the pouch was excised. Ileal Pouch-Anal Anastomosis without a temporary diverting ileostomy can be performed safely by surgeons experienced with this procedure in carefully selected patients.
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Pregnancy and Delivery Before and After Ileal Pouch-Anal Anastomosis for Inflammatory Bowel Disease: Immediate and Long-Term Consequences and Outcomes
Diseases of the Colon & Rectum, 2004Co-Authors: Dieter Hahnloser, Bruce G. Wolff, John H. Pemberton, Dirk Larson, Jeffrey Harrington, Ridzuan Farouk, Roger R. DozoisAbstract:PURPOSE: This study was designed to evaluate pregnancy, delivery, and functional outcome in females before and after Ileal Pouch-Anal Anastomosis for chronic ulcerative colitis. METHODS: From a prospective database of 1,454 patients who underwent Ileal Pouch-Anal Anastomosis for chronic ulcerative colitis between 1981 and 1995, a standardized questionnaire was sent to all female patients aged 40 years or younger at the time of Ileal Pouch-Anal Anastomosis (n = 544). RESULTS: The response rate was 83 percent (450/544) with a mean follow-up after Ileal Pouch-Anal Anastomosis of 13 years. A total of 141 females were pregnant after the chronic ulcerative colitis diagnosis, but before Ileal Pouch-Anal Anastomosis (236 pregnancies; mean, 1.7) and 87 percent delivered vaginally. A mean of five (range, 1–16) years after Ileal Pouch-Anal Anastomosis, 135 females were pregnant (232 pregnancies; mean, 1.7). Comparison of pregnancy and delivery before and after Ileal Pouch-Anal Anastomosis in the same females (n = 37) showed no difference in birth weight, duration of labor, pregnancy/delivery complications, vaginal delivery rates (59 percent before vs . 54 percent after Ileal Pouch-Anal Anastomosis), and unplanned cesarean section (19 vs.14 percent). Planned cesareans occurred only after Ileal Pouch-Anal Anastomosis and were prompted by obstetrical concerns in only one of eight. Pouch function at first follow-up after delivery (mean, 7 months) was similar to pregravida function. After Ileal Pouch-Anal Anastomosis, daytime stool frequency was the same after delivery as pregravida (5.4 vs . 5.4, not significant) but was increased at the time of last follow-up (68 months after delivery; 5.4 vs . 6.4; P < 0.001). The rate of occasional fecal incontinence also was higher (20 percent after Ileal Pouch-Anal Anastomosis and 21 percent pregravida vs . 36 percent at last follow-up; P = 0.01). No difference in functional outcome was noted compared with females who were never pregnant after Ileal Pouch-Anal Anastomosis (n = 307). Age and becoming pregnant did not affect the probability of pouch-related complications, such as stricture, pouchitis, and obstruction. CONCLUSIONS: Successful pregnancy and vaginal delivery occur routinely in females with chronic ulcerative colitis before and after Ileal Pouch-Anal Anastomosis. The method of delivery should be dictated by obstetrical considerations. Pouch function and the incidence of complications in females with pregnancies seem largely unaffected long-term.
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incidence and subsequent impact of pelvic abscess after Ileal pouch anal Anastomosis for chronic ulcerative colitis
Diseases of The Colon & Rectum, 1998Co-Authors: Ridzuan Farouk, John H. Pemberton, Roger R. Dozois, Dirk R. LarsonAbstract:PURPOSE: This study was designed to measure the impact of pelvic abscess on eventual pouch failure and functional outcome after Ileal Pouch-Anal Anastomosis in patients with chronic ulcerative colitis. PATIENTS AND METHODS: The outcome of 1,508 patients who underwent Ileal Pouch-Anal Anastomosis for chronic ulcerative colitis at the Mayo Clinic was determined from a central patient registry; data were collected prospectively. RESULTS: Seventy-three patients developed a pelvic abscess as a complication of Ileal Pouch-Anal Anastomosis. Pouch failure occurred in 19 (26 percent). Forty-eight patients (55 percent) required transabdominal salvage surgery, 6 (8 percent) underwent local surgery, and the remaining 27 (37 percent) were treated nonsurgically. Wound infection was more common in patients who experienced pelvic abscess. The majority of pouch failures secondary to pelvic abscess formation occurred within two years of Ileal Pouch-Anal Anastomosis. Daytime incontinence, the use of a protective pad, and the need for constipating or bulking medication were significantly more common among patients who had an abscess but kept their reservoir. Ability to perform work and domestic activities and to undertake recreational activities were significantly more restricted among these patients. CONCLUSIONS: Pouch failure occurs in one-fourth of patients who retain their pouch despite pelvic abscess after Ileal Pouch-Anal Anastomosis. Among patients who retain their pouch despite postoperative pelvic abscess, functional outcome and quality of life are significantly poorer than in patients in whom no sepsis occurred.
Feza H Remzi - One of the best experts on this subject based on the ideXlab platform.
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Crohn’s Colitis and Ileal Pouch Anal Anastomosis
Difficult Decisions in Colorectal Surgery, 2017Co-Authors: Colin Peirce, Feza H RemziAbstract:Traditionally, the Ileal pouch anal Anastomosis (IPAA) operation has not been offered to patients with Crohn’s disease (CD). Patients with Crohn’s colitis are often excluded from undergoing IPAA related to a number of key concerns: the risk of developing recurrent disease in the pouch necessitating pouch excision with possible ensuing short bowel syndrome, coupled with the risks of significant pouch dysfunction and the need for long-term medical therapy. However, surgical dogma is being challenged in more recent times with authors now reporting encouraging outcomes following IPAA in patients with either a preoperative or postoperative diagnosis of Crohn’s colitis.
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Characteristics of learning curve in minimally invasive Ileal Pouch-Anal Anastomosis in a single institution.
Surgical Endoscopy and Other Interventional Techniques, 2016Co-Authors: Ahmet Rencuzogullari, Emre Gorgun, Luca Stocchi, Meagan Costedio, Hermann Kessler, Feza H RemziAbstract:Background Previous work from our institution has characterized the learning curve for open Ileal Pouch-Anal Anastomosis (IPAA). The purpose of the present study was to assess the learning curve of minimally invasive IPAA.
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functional outcomes and complications after restorative proctocolectomy and Ileal pouch anal Anastomosis in the pediatric population
Journal of The American College of Surgeons, 2014Co-Authors: Yavuz Ozdemir, Emre Gorgun, Erman Aytac, Ravi P Kiran, Hasan H Erem, David K Magnuson, Feza H RemziAbstract:Background Data regarding the long-term outcomes of restorative proctocolectomy and Ileal pouch anal Anastomosis including pouch function and quality of life in the pediatric population are limited in pediatric patients. Study Design Indications for surgery, complications, long-term function, and quality of life were evaluated in pediatric patients undergoing Ileal pouch anal Anastomosis. Assessment of quality of life was performed using the Cleveland Global Quality of Life score. Results There were 433 patients with a mean age of 18.04 ± 2.9 years. Final pathologic diagnoses were ulcerative colitis or indeterminate colitis (78.3%), familial adenomatous polyposis (15.7%), Crohn's disease (5.1%), and others (0.9%). There were 237 patients (54.7%) who underwent total proctocolectomy and Ileal pouch anal Anastomosis; 196 (45.3%) underwent initial subtotal colectomy followed by completion proctectomy with Ileal pouch anal Anastomosis. Anastomosis was stapled in 352 patients (81.3%) and hand-sewn in 81 (18.7%) patients. Mean follow-up was 108.5 ± 78.4 months. At the most recent follow-up, mean Cleveland Global Quality of Life score was 0.8 ± 0.2 and numbers of daytime and night-time bowel movements were 5.3 ± 3.1 and 1.6 ± 1.3, respectively. The majority of the patients (86.8%) were fully continent or only complained of rare incontinence. Most patients had no seepage (day, 84.3%; night, 72.4%) and did not wear any pads (day, 89.3%; night, 84.3%). Most denied dietary (71.3%), social (84.8%), work (85.7%), or sexual restrictions (87.6%) at the time of last follow-up. There were 92.7% of patients who said they would undergo Ileal pouch anal Anastomosis again and 95.2% would recommend surgery to others. Conclusions Restorative proctocolectomy with Ileal pouch anal Anastomosis can be performed in pediatric patients with acceptable morbidity and is associated with good long-term results in terms of gastrointestinal function, quality of life, and patient satisfaction.
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Screening and diagnosis of prostate cancer in patients with Ileal Pouch-Anal Anastomosis: consensus from an expert panel.
The American Journal of Gastroenterology, 2011Co-Authors: Bo Shen, Feza H Remzi, Kenneth W. Angermeier, Seymour KatzAbstract:Screening and Diagnosis of Prostate Cancer in Patients with Ileal Pouch–Anal Anastomosis: Consensus From an Expert Panel
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Association between immune-associated disorders and adverse outcomes of Ileal Pouch-Anal Anastomosis.
The American Journal of Gastroenterology, 2009Co-Authors: Bo Shen, Feza H Remzi, Ian C Lavery, Benjamin Nutter, Ana E. Bennett, Bret A. Lashner, Aaron Brzezinski, Marlene L. Bambrick, Elaine Queener, Victor W FazioAbstract:Association Between Immune-Associated Disorders and Adverse Outcomes of Ileal Pouch-Anal Anastomosis
Duane M. Ilstrup - One of the best experts on this subject based on the ideXlab platform.
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Ileal Pouch-Anal Anastomosis in patients with colorectal cancer: long-term functional and oncologic outcomes.
Diseases of The Colon & Rectum, 2015Co-Authors: Elisabetta Radice, Bruce G. Wolff, John H. Pemberton, Roger R. Dozois, Heidi Nelson, Richard M. Devine, Santhat Nivatvongs, J. Basil J. Fozard, Duane M. IlstrupAbstract:When colorectal cancer complicates chronic ulcerative colitis or familial adenomatous polyposis, the role of Ileal Pouch-Anal Anastomosis is uncertain because of concerns that the procedure may compromise oncologic therapy and that oncologic therapy may compromise Ileal Pouch-Anal Anastomosis function. AIM: This study was undertaken to investigate the impact both of Ileal Pouch-Anal Anastomosis on cancer outcomes and of cancer treatments on Ileal Pouch-Anal Anastomosis function. PATIENTS AND METHODS: Of 1,616 patients undergoing Ileal Pouch-Anal Anastomosis for chronic ulcerative colitis or familial adenomatous polyposis (1981–1994), 77 patients were identified with adenocarcinoma of the colon (56), rectum (17), or both (4). Data were obtained from an Ileal Pouch-Anal Anastomosis registry, case notes, and postal and telephone surveys. RESULTS: Mean age of the 77 index patients was 37 (range, 13–60) years. Stage distribution was as follows: Stage 0, 9; Stage I, 31; Stage II, 15; Stage III, 22 patients. Twelve patients died with systemic disease (6 with a local component) after a mean follow-up of 6 (range, 2–15) years. Twenty-two patients received adjuvant therapy (chemotherapy, 16; radiotherapy, 2; both, 4 patients). Chemotherapy complications requiring dose reduction or interruption occurred in three (15 percent) patients. One patient developed radiation enteritis (17 percent). Pouch failure occurred in 16 percent of cancer patients, compared with 7 percent for the overall registry. There were no differences between cancer and non-cancer groups in operative complications, median stool frequency, incontinence, pad usage, or pouchitis. CONCLUSIONS: Although pouch failure is more common, Ileal Pouch-Anal Anastomosis can be performed in the setting of colorectal cancer without significant impact on oncologic outcome or long-term Ileal Pouch-Anal Anastomosis function.
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pouchitis after Ileal pouch anal Anastomosis for ulcerative colitis occurs with increased frequency in patients with associated primary sclerosing cholangitis
Gut, 1996Co-Authors: C R Penna, Roger R. Dozois, William J. Sandborn, William J. Tremaine, Nicholas F. Larusso, Cathy D. Schleck, Duane M. IlstrupAbstract:Primary sclerosing cholangitis (PSC), present in 5% of patients with ulcerative colitis, may be associated with pouchitis after Ileal Pouch-Anal Anastomosis. The cumulative frequency of pouchitis in patients with and without PSC who underwent Ileal Pouch-Anal Anastomosis for ulcerative colitis was determined. A total of 1097 patients who had an Ileal Pouch-Anal Anastomosis for ulcerative colitis, 54 with associated PSC, were studied. Pouchitis was defined by clinical criteria in all patients and by clinical, endoscopic, and histological criteria in 83% of PSC patients and 85% of their matched controls. PSC was defined by clinical, radiological, and pathological findings. One or more episodes of pouchitis occurred in 32% of patients without PSC and 63% of patients with PSC. The cumulative risk of pouchitis at one, two, five, and 10 years after Ileal Pouch-Anal Anastomosis was 15.5%, 22.5%, 36%, and 45.5% for the patients without PSC and 22%, 43%, 61%, and 79% for the patients with PSC. In the PSC group, the risk of pouchitis was not related to the severity of liver disease. In conclusion, the strong correlation between PSC and pouchitis suggest a common link in their pathogenesis.
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Complications and risk factors after Ileal Pouch-Anal Anastomosis for ulcerative colitis associated with primary sclerosing cholangitis.
Annals of Surgery, 1993Co-Authors: Alex H. Kartheuser, Roger R. Dozois, Duane M. Ilstrup, Russell H. Wiesner, Nicholas F. Larusso, Cathy D. SchleckAbstract:The study determined predictive factors for postoperative complications and outcome after Ileal Pouch-Anal Anastomosis in patients with ulcerative colitis and primary sclerosing cholangitis. Patients with ulcerative colitis and primary sclerosing cholangitis treated by colectomy and ileostomy are at high risk of troublesome bleeding from peristomal varices. Postoperative complications and outcome were assessed in 40 patients with ulcerative colitis and sclerosing cholangitis who received in Ileal Pouch-Anal Anastomosis between January 1981 and February 1990. Immediate postoperative and remote ileoanal Anastomosis-related complications were high but related directly to the severity of liver disease. No patient had perianastomotic anal bleeding. In patients with both ulcerative colitis and primary sclerosing cholangitis, Ileal Pouch-Anal Anastomosis is safe and is not associated with perianastomotic bleeding.
Cathy D. Schleck - One of the best experts on this subject based on the ideXlab platform.
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pouchitis after Ileal pouch anal Anastomosis for ulcerative colitis occurs with increased frequency in patients with associated primary sclerosing cholangitis
Gut, 1996Co-Authors: C R Penna, Roger R. Dozois, William J. Sandborn, William J. Tremaine, Nicholas F. Larusso, Cathy D. Schleck, Duane M. IlstrupAbstract:Primary sclerosing cholangitis (PSC), present in 5% of patients with ulcerative colitis, may be associated with pouchitis after Ileal Pouch-Anal Anastomosis. The cumulative frequency of pouchitis in patients with and without PSC who underwent Ileal Pouch-Anal Anastomosis for ulcerative colitis was determined. A total of 1097 patients who had an Ileal Pouch-Anal Anastomosis for ulcerative colitis, 54 with associated PSC, were studied. Pouchitis was defined by clinical criteria in all patients and by clinical, endoscopic, and histological criteria in 83% of PSC patients and 85% of their matched controls. PSC was defined by clinical, radiological, and pathological findings. One or more episodes of pouchitis occurred in 32% of patients without PSC and 63% of patients with PSC. The cumulative risk of pouchitis at one, two, five, and 10 years after Ileal Pouch-Anal Anastomosis was 15.5%, 22.5%, 36%, and 45.5% for the patients without PSC and 22%, 43%, 61%, and 79% for the patients with PSC. In the PSC group, the risk of pouchitis was not related to the severity of liver disease. In conclusion, the strong correlation between PSC and pouchitis suggest a common link in their pathogenesis.
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Complications and risk factors after Ileal Pouch-Anal Anastomosis for ulcerative colitis associated with primary sclerosing cholangitis.
Annals of Surgery, 1993Co-Authors: Alex H. Kartheuser, Roger R. Dozois, Duane M. Ilstrup, Russell H. Wiesner, Nicholas F. Larusso, Cathy D. SchleckAbstract:The study determined predictive factors for postoperative complications and outcome after Ileal Pouch-Anal Anastomosis in patients with ulcerative colitis and primary sclerosing cholangitis. Patients with ulcerative colitis and primary sclerosing cholangitis treated by colectomy and ileostomy are at high risk of troublesome bleeding from peristomal varices. Postoperative complications and outcome were assessed in 40 patients with ulcerative colitis and sclerosing cholangitis who received in Ileal Pouch-Anal Anastomosis between January 1981 and February 1990. Immediate postoperative and remote ileoanal Anastomosis-related complications were high but related directly to the severity of liver disease. No patient had perianastomotic anal bleeding. In patients with both ulcerative colitis and primary sclerosing cholangitis, Ileal Pouch-Anal Anastomosis is safe and is not associated with perianastomotic bleeding.
John H. Pemberton - One of the best experts on this subject based on the ideXlab platform.
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Familial adenomatous polyposis. Results after Ileal Pouch-Anal Anastomosis in teenagers. Commentaries. Authors' reply
Diseases of The Colon & Rectum, 2020Co-Authors: Yann Parc, Bruce G. Wolff, John H. Pemberton, Roger R. Dozois, Y R Parc, G Moslein, J E King, James M. Church, R. K. S. Phillips, J H PembertonAbstract:PURPOSE: Virtually all untreated patients with familial adenomatous polyposis develop colorectal carcinoma. Thus, prophylactic colectomy is indicated. Detractors of Ileal Pouch-Anal Anastomosis prefer ileorectal Anastomosis for teenagers because of the potential negative impact of Ileal Pouch-Anal Anastomosis on quality of life. The aim of this study was to assess the effects on quality of life of Ileal Pouch-Anal Anastomosis in teenagers with familial adenomatous polyposis. METHODS: Between 1981 and 1998, 48 teenagers underwent Ileal Pouch-Anal Anastomosis for familial adenomatous polyposis. One patient had proctectomy and Ileal Pouch-Anal Anastomosis after previous ileorectal Anastomosis. A temporary diverting loop ileostomy was established in 42 patients (87.5 percent). One patient had colonic carcinoma diagnosed preoperatively. Two other patients were found to have unsuspected rectal cancer at surgery. Mean follow-up (± standard deviation) in 43 patients was 80.5 ± 42 months. RESULTS: There was no immediate postoperative mortality. Postoperative complications included pelvic sepsis (3 patients; 1 requiring reoperation) and bleeding (1 patient; no surgery required). One patient died of metastatic colonic carcinoma. Ten patients required reoperation, seven had bowel obstruction, one had portal hypertension, and two required an ileostomy. The mean (± standard deviation) daytime and nighttime stool frequency was 4 ± 1.5 and 1 ± 1, respectively. One patient reported daytime and nighttime incontinence, and two patients reported nighttime incontinence only. No patient experienced impotence or retrograde ejaculation. Social, sexual, sport, housework, recreation, family, travel, and work activities were improved or unchanged in 82.5, 87, 80, 90, 80, 92.5, 77.5, and 89 percent of patients, respectively. Three male patients fathered children, and three female patients had a total of six children after normal pregnancies and deliveries. CONCLUSION: The impact of Ileal Pouch-Anal Anastomosis on quality of life was favorable in the majority of teenagers. The risk of rectal cancer should be the major consideration before proposing an operation to teenagers with familial adenomatous polyposis.
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Ileal Pouch-Anal Anastomosis in patients with colorectal cancer: long-term functional and oncologic outcomes.
Diseases of The Colon & Rectum, 2015Co-Authors: Elisabetta Radice, Bruce G. Wolff, John H. Pemberton, Roger R. Dozois, Heidi Nelson, Richard M. Devine, Santhat Nivatvongs, J. Basil J. Fozard, Duane M. IlstrupAbstract:When colorectal cancer complicates chronic ulcerative colitis or familial adenomatous polyposis, the role of Ileal Pouch-Anal Anastomosis is uncertain because of concerns that the procedure may compromise oncologic therapy and that oncologic therapy may compromise Ileal Pouch-Anal Anastomosis function. AIM: This study was undertaken to investigate the impact both of Ileal Pouch-Anal Anastomosis on cancer outcomes and of cancer treatments on Ileal Pouch-Anal Anastomosis function. PATIENTS AND METHODS: Of 1,616 patients undergoing Ileal Pouch-Anal Anastomosis for chronic ulcerative colitis or familial adenomatous polyposis (1981–1994), 77 patients were identified with adenocarcinoma of the colon (56), rectum (17), or both (4). Data were obtained from an Ileal Pouch-Anal Anastomosis registry, case notes, and postal and telephone surveys. RESULTS: Mean age of the 77 index patients was 37 (range, 13–60) years. Stage distribution was as follows: Stage 0, 9; Stage I, 31; Stage II, 15; Stage III, 22 patients. Twelve patients died with systemic disease (6 with a local component) after a mean follow-up of 6 (range, 2–15) years. Twenty-two patients received adjuvant therapy (chemotherapy, 16; radiotherapy, 2; both, 4 patients). Chemotherapy complications requiring dose reduction or interruption occurred in three (15 percent) patients. One patient developed radiation enteritis (17 percent). Pouch failure occurred in 16 percent of cancer patients, compared with 7 percent for the overall registry. There were no differences between cancer and non-cancer groups in operative complications, median stool frequency, incontinence, pad usage, or pouchitis. CONCLUSIONS: Although pouch failure is more common, Ileal Pouch-Anal Anastomosis can be performed in the setting of colorectal cancer without significant impact on oncologic outcome or long-term Ileal Pouch-Anal Anastomosis function.
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Sacral osteomyelitis after Ileal Pouch-Anal Anastomosis: report of four cases.
Diseases of The Colon & Rectum, 2006Co-Authors: William E. Taylor, Bruce G. Wolff, John H. Pemberton, Michael J. YaszemskiAbstract:PURPOSE: This study describes an institutional experience with sacral osteomyelitis after proctocolectomy and Ileal Pouch-Anal Anastomosis. METHODS: A total of 2,375 patients underwent Ileal Pouch-Anal Anastomosis at the Mayo Clinic between January 1981 and January 2002. In addition, we have served as a tertiary referral base for patients with complications after Ileal Pouch-Anal Anastomosis performed at other institutions. Review of our Ileal Pouch-Anal Anastomosis prospective database and directed search of the central pathology, microbiology, radiology, and surgical records at the Mayo Clinic was performed using these keywords: osteomyelitis, Ileal Pouch-Anal Anastomosis, inflammatory bowel disease, chronic ulcerative colitis, and Crohn's disease. RESULTS: Two of 2,375 patients (0.08 percent) with Ileal Pouch-Anal Anastomosis performed at our institution have had sacral osteomyelitis. In addition, two patients have been referred for continuing care after construction of an Ileal Pouch-Anal Anastomosis and diagnosis of sacral osteomyelitis at another institution. Two of the four patients maintained normal pouch function after sacral debridement and a period of fecal stream diversion. One patient remains diverted with resolved sacral osteomyelitis after debridement. The last patient died from squamous-cell cancer involving the sacrum. CONCLUSIONS: Sacral osteomyelitis is a rare and heretofore unreported complication of Ileal Pouch-Anal Anastomosis. Conservative measures using antibiotics alone proved unsuccessful, and delaying definitive management may have contributed to the degeneration of a chronic sacral abscess into squamous-cell cancer. With more aggressive treatment comprising sacral debridement, long-term antibiotics, and fecal diversion, pouch function can potentially be preserved.
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Pregnancy and Delivery Before and After Ileal Pouch-Anal Anastomosis for Inflammatory Bowel Disease: Immediate and Long-Term Consequences and Outcomes
Diseases of the Colon & Rectum, 2004Co-Authors: Dieter Hahnloser, Bruce G. Wolff, John H. Pemberton, Dirk Larson, Jeffrey Harrington, Ridzuan Farouk, Roger R. DozoisAbstract:PURPOSE: This study was designed to evaluate pregnancy, delivery, and functional outcome in females before and after Ileal Pouch-Anal Anastomosis for chronic ulcerative colitis. METHODS: From a prospective database of 1,454 patients who underwent Ileal Pouch-Anal Anastomosis for chronic ulcerative colitis between 1981 and 1995, a standardized questionnaire was sent to all female patients aged 40 years or younger at the time of Ileal Pouch-Anal Anastomosis (n = 544). RESULTS: The response rate was 83 percent (450/544) with a mean follow-up after Ileal Pouch-Anal Anastomosis of 13 years. A total of 141 females were pregnant after the chronic ulcerative colitis diagnosis, but before Ileal Pouch-Anal Anastomosis (236 pregnancies; mean, 1.7) and 87 percent delivered vaginally. A mean of five (range, 1–16) years after Ileal Pouch-Anal Anastomosis, 135 females were pregnant (232 pregnancies; mean, 1.7). Comparison of pregnancy and delivery before and after Ileal Pouch-Anal Anastomosis in the same females (n = 37) showed no difference in birth weight, duration of labor, pregnancy/delivery complications, vaginal delivery rates (59 percent before vs . 54 percent after Ileal Pouch-Anal Anastomosis), and unplanned cesarean section (19 vs.14 percent). Planned cesareans occurred only after Ileal Pouch-Anal Anastomosis and were prompted by obstetrical concerns in only one of eight. Pouch function at first follow-up after delivery (mean, 7 months) was similar to pregravida function. After Ileal Pouch-Anal Anastomosis, daytime stool frequency was the same after delivery as pregravida (5.4 vs . 5.4, not significant) but was increased at the time of last follow-up (68 months after delivery; 5.4 vs . 6.4; P < 0.001). The rate of occasional fecal incontinence also was higher (20 percent after Ileal Pouch-Anal Anastomosis and 21 percent pregravida vs . 36 percent at last follow-up; P = 0.01). No difference in functional outcome was noted compared with females who were never pregnant after Ileal Pouch-Anal Anastomosis (n = 307). Age and becoming pregnant did not affect the probability of pouch-related complications, such as stricture, pouchitis, and obstruction. CONCLUSIONS: Successful pregnancy and vaginal delivery occur routinely in females with chronic ulcerative colitis before and after Ileal Pouch-Anal Anastomosis. The method of delivery should be dictated by obstetrical considerations. Pouch function and the incidence of complications in females with pregnancies seem largely unaffected long-term.
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Ileal Pouch-Anal Anastomosis in patients with indeterminate colitis
Diseases of the Colon & Rectum, 2000Co-Authors: Chang Sik Yu, John H. Pemberton, Dirk LarsonAbstract:PURPOSE: Patients with chronic ulcerative colitis who undergo proctocolectomy and are found intraoperatively to harbor histologic signs suggesting Crohn's disease have indeterminate colitis; nonetheless, Ileal Pouch-Anal Anastomosis is usually performed. The aim of this study was to determine the long-term outcome of Ileal Pouch-Anal Anastomosis in patients with indeterminate colitis compared with a cohort of patients with chronic ulcerative colitis. METHOD: Review of an Ileal Pouch-Anal Anastomosis registry identified 1,437 patients with chronic ulcerative colitis and 82 patients with indeterminate colitis who underwent an Ileal Pouch-Anal Anastomosis between 1981 and 1995. The median follow-up was 83 (range, 1–192) months. Demographic data and functional outcomes were compared by chi-squared and Wilcoxon's rank-sum tests. Probabilities of complications and pouch failure were analyzed using Kaplan-Meier and log-rank techniques. Finally, Bonferroni adjustments were used for multiple comparisons. RESULTS: Patients with indeterminate colitis and chronic ulcerative colitis were comparable in terms of gender and length of follow-up. The mean age of the chronic ulcerative colitis group was higher (34 vs. 31; P
