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James M. Church - One of the best experts on this subject based on the ideXlab platform.
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Short-term outcomes of laparoscopic versus open total colectomy with Ileorectal Anastomosis: a case-matched analysis from a nationwide database.
Techniques in coloproctology, 2016Co-Authors: Akin Onder, James M. Church, Cigdem Benlice, Hermann Kessler, Emre GorgunAbstract:Background In the current study, we aimed to compare peri- and postoperative 30-day outcomes of patients undergoing laparoscopic versus open total colectomy with Ileorectal Anastomosis in a case-matched design using data procedure-targeted database.
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Risk of rectal cancer in patients after colectomy and Ileorectal Anastomosis for familial adenomatous polyposis: a function of available surgical options.
Diseases of the colon and rectum, 2003Co-Authors: James M. Church, E. Mcgannon, Carol A. Burke, Olivia Pastean, Bryan ClarkAbstract:PURPOSE: One of the concerns with colectomy and Ileorectal Anastomosis as a prophylactic procedure for patients with familial adenomatous polyposis is the risk of metachronous rectal cancer, estimated at from 12 to 43 percent. These estimates are based largely on surgeries performed at a time when the only alternative option to Ileorectal Anastomosis for patients with severe familial adenomatous polyposis was proctocolectomy and ileostomy. This study was designed to test the hypothesis that in the pouch era severe polyposis is now treated by proctocolectomy and ileal pouch-anal Anastomosis. Ileorectal Anastomosis is performed mostly in mildly affected patients and will therefore carry a very low risk of metachronous rectal cancer. METHODS: Patients undergoing primary prophylactic surgery for familial adenomatous polyposis between 1950 and 1999 were categorized according to the year of their surgery: prepouch era (before 1983) or pouch era (after 1983). Patients undergoing colectomy and Ileorectal Anastomosis were the focus of the study, and rate of proctectomy and the incidence of rectal cancer were recorded for each group. Data on the severity of the polyposis for each group were abstracted. RESULTS: A total of 197 patients underwent Ileorectal Anastomosis, 62 in the prepouch era (median follow-up, 212 months; interquartile range, 148 months) and 135 in the pouch era (median follow-up, 60 months; interquartile range, 80 months). Patients in the prepouch era came to surgery at the same median age as those in the pouch era (median age 23.0 years, interquartile ranges 15.5 years for prepouch and 17 years for pouch). Similar proportions of patients in the prepouch era had severe polyposis (49 percent) as in the pouch era (44 percent), although all severely affected patients had an Ileorectal Anastomosis in the prepouch era vs. 39 percent in the pouch era. Twenty (32 percent) prepouch-era patients underwent proctectomy compared with three (2 percent) pouch-era patients. No pouch-era patient had rectal cancer on follow-up; eight (12.9 percent) prepouch-era patients did. CONCLUSION: Although follow-up is shorter, Ileorectal Anastomosis for familial adenomatous polyposis performed since 1983 carries a much lower rate of rectal cancer and proctectomy than Ileorectal Anastomosis performed before this time, when restorative proctocolectomy was not an option. This is related, at least in part, to a greater number of patients with severe polyposis having their rectum initially spared.
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Laparoscopic total abdominal colectomy with Ileorectal Anastomosis for familial adenomatous polyposis.
Diseases of the colon and rectum, 1997Co-Authors: Jeffrey W. Milsom, James M. Church, Kirk A. Ludwig, Antonio Garcia-ruizAbstract:PURPOSE: This study was undertaken to describe our results in a series of patients undergoing total abdominal colectomy with Ileorectal Anastomosis (TAC/IRA) using laparoscopic techniques in patients with familial adenomatous polyposis (FAP) and rectal-sparing. Young patients with FAP requiring TAC/IRA may be ideal candidates for minimally invasive surgery, because they are generally thin and have benign disease. They might benefit maximally from the theoretic advantages of these techniques. METHODS: We have performed laparoscopic TAC/IRA in 16 FAP patients (10 females; mean age, 18 years). Procedures were entirely intracorporeal, with a 3-cm to 6-cm specimen extraction incision. RESULTS: Median operative time was 232 (range, 156–285) minutes, and blood loss 175 (range, 50–675) ml. The only intraoperative complication, a twisted Ileorectal Anastomosis, was noted intraoperatively and revised. There were no conversions to conventional laparotomy. Median postoperative interval to passage of flatus was three days,1–4 and for bowel movements it was three days.1–4 Median hospital stay was five days.3–11 One case of early postoperative small-bowel obstruction was treated nonoperatively, and one case of brachial plexus neuropraxia resolved spontaneously. CONCLUSIONS: Based on this preliminary experience, we believe laparoscopic TAC/ IRA can be a safe and effective treatment for selected patients with FAP. As techniques and instrumentation for laparoscopic colon surgery are perfected, this procedure will likely become an appealing option in the management of patients with FAP.
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Outcome of Ileorectal Anastomosis for Crohn's colitis.
Diseases of the colon and rectum, 1992Co-Authors: Walter E. Longo, John R. Oakley, Ian C. Lavery, James M. Church, Victor W. FazioAbstract:One hundred thirty-one patients underwent Ileorectal Anastomosis (IRA) for Crohn's colitis. Preoperatively, 84 patients (63 percent) were found to have mild or moderate proctitis and 47 (37 percent) had rectal sparing. Sixty-eight (52 percent) had associated small bowel disease, and 20 (15 percent) had perianal disease. Sixty-five IRAs were performed at the time of subtotal colectomy, while 56 were done after previous surgery. Anastomotic leaks occurred in four patients. There were no operative deaths. Thirteen patients (10 percent) with protecting stomas never underwent closure. Among the remaining 118 patients with functioning IRAs, 30 (23 percent) required later proctectomy and 16 (13 percent) required proximal diversion, with the mean period with a functioning IRA in these 46 patients being 4.1 years (range, 6.2 months–12.7 years). An additional 13 patients required preanastomotic resection and neo-IRA, and 11 required proximal small bowel resection. The mean duration of function of all 118 IRAs was 9.2 years. At the time of review, after a mean follow-up of 9.5 years, 72 patients (61 percent) retained a functioning IRA, with 44 being free of disease, while 28 were being treated with steroids or antidiarrheal medication. The mean stool frequency was 4.7 per day. In patients with Crohn's colitis, IRA should be considered as an alternative to proctocolectomy if the rectum is not severely diseased and sphincter function is not compromised.
Robin S Mcleod - One of the best experts on this subject based on the ideXlab platform.
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Long-term outcome of colectomy and Ileorectal Anastomosis for Crohn's colitis.
Diseases of the colon and rectum, 2011Co-Authors: James M. O’riordan, Zane Cohen, Brenda I. O’connor, Harden Huang, J. C. Victor, Robert Gryfe, Helen Macrae, Robin S McleodAbstract:BACKGROUND:Ileorectal Anastomosis is an important surgical option for patients with Crohn's colitis with relative rectal sparing.OBJECTIVE:This study aimed to audit outcomes of Ileorectal Anastomosis for Crohn's and factors associated with proctectomy and reoperation.DESIGN:This retrospective study
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Comparison of ileal pouch-anal Anastomosis and Ileorectal Anastomosis in patients with familial adenomatous polyposis
Diseases of The Colon & Rectum, 1999Co-Authors: Claudio Soravia, Brenda I. O'connor, Lazar V. Klein, Terri Berk, Zane Cohen, Robin S McleodAbstract:PURPOSE: The aim of this study was to evaluate the surgical complications and long-term outcome and assess the functional results and quality of life after Ileorectal Anastomosis and ileal pouch-anal Anastomosis in patients with familial adenomatous polyposis. METHODS: From 1980 to 1997, 131 patients with familial adenomatous polyposis were operated on or were followed up or both at the Familial Gastrointestinal Cancer Registry at Mount Sinai Hospital. Demographic and operative data were prospectively collected in the ileal pouch-anal Anastomosis group, and retrospectively in the Ileorectal Anastomosis group. A questionnaire or telephone interview or both were undertaken to evaluate functional outcome and quality of life. RESULTS: The Ileorectal Anastomosis group consisted of 60 patients (mean age, 31 years; mean follow-up, 7.7 years). In the ileal pouch-anal Anastomosis group there were 50 patients (mean age, 35 years; mean follow-up, 6 years). There were no statistically significant differences with respect to anastomotic leak rate in ileal pouch-anal Anastomosisvs. Ileorectal Anastomosis (12vs. 3 percent;P=0.21), risk of small-bowel obstruction (24vs. 15 percent;P=0.58), and risk of intra-abdominal sepsis (3vs. 2 percent;P=0.86). Reoperation rate was similar in the two groups (14vs. 16 percent;P=0.94). Twenty-one patients (37 percent) with Ileorectal Anastomosis were converted to ileal pouch-anal Anastomosis (12 patients) or proctocolectomy (9 patients), because of rectal cancer (5 patients), dysplasia (1 patient), or uncontrollable rectal polyps (15 patients). Two pelvic pouches were excised, and another one was defunctioned. Information regarding functional results and quality of life was obtained in 40 patients (66.6 percent) in the Ileorectal Anastomosis group and in 43 patients (86 percent) in the ileal pouch-anal Anastomosis group. Patients with Ileorectal Anastomosis had a significantly better functional outcome with regard to nighttime continence and perineal skin irritation. But otherwise, functional results and quality of life were similar. CONCLUSIONS: Although Ileorectal Anastomosis has a better functional outcome, ileal pouch-anal Anastomosis may be preferable because of the lower long-term failure rate. Ileorectal Anastomosis is still an option in patients with familial adenomatous polyposis with rectal polyp sparing and good compliance for follow-up.
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Functional outcome of conversion of Ileorectal Anastomosis to ileal pouch-anal Anastomosis in patients with familial adenomatous polyposis and ulcerative colitis.
Diseases of The Colon & Rectum, 1999Co-Authors: Claudio Soravia, Brenda I. O'connor, Terri Berk, Robin S Mcleod, Zane CohenAbstract:PURPOSE: The aim of this study was to review the functional outcome in 20 patients with familial adenomatous polyposis and ulcerative colitis who were converted from Ileorectal Anastomosis to ileal pouch-anal Anastomosis. METHODS: From 1985 to 1997, 12 patients with familial adenomatous polyposis (5 males; mean age, 39.1 years) and 8 patients with ulcerative colitis (5 males; mean age, 36.7 years) underwent conversion from Ileorectal Anastomosis to ileal pouch-anal Anastomosis. Clinical and operative data were analyzed retrospectively. Functional results were obtained by telephone interview in 16 patients (94 percent) after pouch construction. Four patients were not interviewed (2 were deceased, 1 was lost to follow-up, and 1 was not reachable). RESULTS: Indications for conversion were uncontrollable rectal polyps (10 patients) and colonic cancer found in the pathology specimen after Ileorectal Anastomosis in patients with familial adenomatous polyposis (2 patients), intractable proctitis (5 patients), colonic cancer found in the pathology specimen of patients with ulcerative colitis after Ileorectal Anastomosis (2 patients), and rectal dysplasia (1 patients). Mean follow-up time was 5 (range, 1–11) years. Ileal pouch-anal Anastomosis was handsewn in 14 patients, and the remaining cases were double-stapled in 4 patients with ulcerative colitis. No intraoperative difficulties were reported in 13 cases; technical problems were related to adhesions (3 cases), difficult rectal dissection (2 cases), and stapler-related difficulties (2 cases). Postoperative complications after ileal pouch-anal Anastomosis included small-bowel obstruction (4 patients) and ileal pouch-anal Anastomosis leak (1 patient). Patients with Ileorectal Anastomosisvs. those with ileal pouch-anal Anastomosis had a better functional outcome with regard to nighttime continence (14 (88 percent)vs. 6 (38 percent) patients) and average bowel movements (
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functional outcome of conversion of Ileorectal Anastomosis to ileal pouch anal Anastomosis in patients with familial adenomatous polyposis and ulcerative colitis
Diseases of The Colon & Rectum, 1999Co-Authors: Claudio Soravia, Terri Berk, Robin S Mcleod, Brenda I Oconnor, Zane CohenAbstract:PURPOSE: The aim of this study was to review the functional outcome in 20 patients with familial adenomatous polyposis and ulcerative colitis who were converted from Ileorectal Anastomosis to ileal pouch-anal Anastomosis. METHODS: From 1985 to 1997, 12 patients with familial adenomatous polyposis (5 males; mean age, 39.1 years) and 8 patients with ulcerative colitis (5 males; mean age, 36.7 years) underwent conversion from Ileorectal Anastomosis to ileal pouch-anal Anastomosis. Clinical and operative data were analyzed retrospectively. Functional results were obtained by telephone interview in 16 patients (94 percent) after pouch construction. Four patients were not interviewed (2 were deceased, 1 was lost to follow-up, and 1 was not reachable). RESULTS: Indications for conversion were uncontrollable rectal polyps (10 patients) and colonic cancer found in the pathology specimen after Ileorectal Anastomosis in patients with familial adenomatous polyposis (2 patients), intractable proctitis (5 patients), colonic cancer found in the pathology specimen of patients with ulcerative colitis after Ileorectal Anastomosis (2 patients), and rectal dysplasia (1 patients). Mean follow-up time was 5 (range, 1–11) years. Ileal pouch-anal Anastomosis was handsewn in 14 patients, and the remaining cases were double-stapled in 4 patients with ulcerative colitis. No intraoperative difficulties were reported in 13 cases; technical problems were related to adhesions (3 cases), difficult rectal dissection (2 cases), and stapler-related difficulties (2 cases). Postoperative complications after ileal pouch-anal Anastomosis included small-bowel obstruction (4 patients) and ileal pouch-anal Anastomosis leak (1 patient). Patients with Ileorectal Anastomosisvs. those with ileal pouch-anal Anastomosis had a better functional outcome with regard to nighttime continence (14 (88 percent)vs. 6 (38 percent) patients) and average bowel movements (<6/day; 12 (75 percent)vs. 4 (25 percent) patients). Complete daytime continence, 15 (94 percent)vs. 10 (62 percent) patients, was similar in the two groups. Physical and emotional well-being were similarly rated as very good to excellent. CONCLUSIONS: In patients with familial adenomatous polyposis and ulcerative colitis with Ileorectal Anastomosis, conversion to ileal pouch-anal Anastomosis may be required. In view of the risk of rectal cancer or intractable proctitis, patients seem to accept the conversion in spite of poorer bowel function.
Pär Myrelid - One of the best experts on this subject based on the ideXlab platform.
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Ileorectal Anastomosis Versus IPAA for the Surgical Treatment of Ulcerative Colitis: A Markov Decision Analysis.
Diseases of the colon and rectum, 2020Co-Authors: Anthony De Buck Van Overstraeten, Mantaj S. Brar, Sepehr Khorasani, Fahima Dossa, Pär MyrelidAbstract:BACKGROUND Ileorectal Anastomosis in patients with ulcerative colitis results in decreased postoperative morbidity and better functional outcome but leads to increased risk for rectal cancer compared with IPAA. OBJECTIVE This study aims to compare Ileorectal Anastomosis with IPAA in ulcerative colitis by using a decision model. DESIGN A Markov simulation model was designed to simulate clinical events of Ileorectal Anastomosis and IPAA over a time horizon of 40 years with time cycles of 1 year. All probabilities and utilities were derived from observational studies, identified after a systematic literature search using MEDLINE. Primary outcomes were life-years and quality-adjusted life-years. Deterministic and probabilistic sensitivity analyses were performed. SETTINGS A decision model using Markov simulation was designed. PATIENTS The base case was a 35-year-old patient with ulcerative colitis and a relatively preserved rectum. MAIN OUTCOMES MEASURES The primary outcome measures were (quality-adjusted) life-years. RESULTS The model resulted in lower life-years (36.22 vs 37.02) and higher quality-adjusted life-years (33.42 vs 31.57) for Ileorectal Anastomosis. This was confirmed after probabilistic sensitivity analysis. The model was sensitive to the utility of Ileorectal Anastomosis, IPAA, and end-ileostomy. A higher proportion of patients with Ileorectal Anastomosis will develop rectal cancer (7.6% vs 3.2%) and 43.5% of all patients with Ileorectal Anastomosis will end with an ileostomy as opposed to 23.0% of all patients with IPAA. LIMITATIONS The study was limited by characteristics inherent to modeling studies, including assumptions necessary to build the model, data input based on best available but often limited evidence, and unavoidable extra- and interpolation of data. CONCLUSIONS Ileorectal Anastomosis was the preferred treatment option when quality-adjusted life-years were the outcome, with higher life-years for IPAA. This model highlights that both surgical strategies are useful in patients who have ulcerative colitis with a relatively spared rectum. See Video Abstract at http://links.lww.com/DCR/B249. Anastomosis ILEORRECTAL VERSUS Anastomosis ANAL CON RESERVORIO ILEAL EN EL TRATAMIENTO QUIRURGICO DE LA COLITIS ULCEROSA: ANALISIS DE DECISION DE MARKOV: Las Anastomosis ileorrectales en pacientes con colitis ulcerosa se encuentran asociadas con la disminucion de la morbilidad postoperatoria y un mejor resultado funcional, pero conducen a un mayor riesgo de cancer de recto cuando se las compara con casos de confeccion de un reservorio ileo-anal.Comparar las Anastomosis ileorrectales con la Anastomosis de un reservorio ileo-anal en casos de colitis ulcerosa, utilizando un modelo de procesos de decision.Se diseno un modelo de proceso de Markov para simular eventos clinicos en casos de Anastomosis ileorrectales y Anastomosis de reservorios ileo-anales en un horizonte temporal de 40 anos comprendiendo ciclos temporales de 1 ano. Todas las probabilidades y utilidades se derivaron de estudios observacionales, identificados despues de una busqueda sistematica de literatura usando MEDLINE. Los resultados primarios fueron anos de vida y los anos ajustados a la calidad de vida. Se realizaron los analisis de sensibilidad determinada y de probabilistica.Se diseno un modelo de decision utilizando el proceso de simulacion de Markov.El caso base fue el de un paciente de 35 anos con colitis ulcerosa y con un recto relativamente sano.El resultado principal fue la medida de los anos de vida (con ajuste en la calidad de vida).El modelo resulto en menos anos de vida (36.22 frente a 37.02) y anos de vida de menor calidad (33.42 frente a 31.57) para los casos de Anastomosis ileorrectales. Esto se confirmo despues del analisis de sensibilidad probabilistica. El modelo era sensible a la utilidad de la Anastomosis ileorrectal, la Anastomosis del reservorio ileo-anal y la ileostomia terminal. Una mayor proporcion de pacientes con Anastomosis Ileorectales desarrollaran cancer de recto (7,6% frente a 3,2%) y el 43,5% de todos los pacientes con Anastomosis ileorrectales terminaran con una ileostomia en comparacion con el 23,0% de todos los pacientes con un reservorio ileo-anal.El analisis estuvo limitado por las caracteristicas inherentes a los estudios de modelado, incluidas las suposiciones necesarias para construir el modelo, la entrada de datos basada en la mejor evidencia disponible pero a menudo limitada y la extrapolacion e interpolacion inevitable de datos.Las Anastomosis ileorrectales fueron la opcion de tratamiento preferida cuando el resultado fue ajustado en anos con calidad de vida, con anos de vida mas larga para la Anastomosis de reservorios ileo-anales. Este modelo destaca que ambas estrategias quirurgicas son utiles en pacientes con colitis ulcerosa con rectos relativamente sanos. Consulte Video Resumen en http://links.lww.com/DCR/B249.
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The Ileorectal Anastomosis in Ulcerative Colitis
The Ileoanal Pouch, 2018Co-Authors: Pär Myrelid, Disa KalmanAbstract:The ileoanal pouch has been the accepted restorative procedure for ulcerative colitis but this can be associated with complications and issues related to function. Preserving the rectum has inherent benefits but this has to be weighed against the risk of proctitis and its associated issues. This chapter aims to examine the emerging role of Ileorectal Anastomosis in ulcerative colitis as an alternative to the ileoanal pouch and describes functional outcomes and prognosis.
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Ileorectal Anastomosis in comparison with ileal pouch anal Anastomosis in reconstructive surgery for ulcerative colitis--a single institution experience.
Journal of Crohn's & colitis, 2013Co-Authors: Peter Andersson, Rickard Norblad, Johan D. Söderholm, Pär MyrelidAbstract:INTRODUCTION:Ileal pouch anal Anastomosis (IPAA) is the standard procedure for reconstruction after colectomy for ulcerative colitis (UC). However, Ileorectal Anastomosis (IRA) as an alternative ha ...
Zane Cohen - One of the best experts on this subject based on the ideXlab platform.
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Long-term outcome of colectomy and Ileorectal Anastomosis for Crohn's colitis.
Diseases of the colon and rectum, 2011Co-Authors: James M. O’riordan, Zane Cohen, Brenda I. O’connor, Harden Huang, J. C. Victor, Robert Gryfe, Helen Macrae, Robin S McleodAbstract:BACKGROUND:Ileorectal Anastomosis is an important surgical option for patients with Crohn's colitis with relative rectal sparing.OBJECTIVE:This study aimed to audit outcomes of Ileorectal Anastomosis for Crohn's and factors associated with proctectomy and reoperation.DESIGN:This retrospective study
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Comparison of ileal pouch-anal Anastomosis and Ileorectal Anastomosis in patients with familial adenomatous polyposis
Diseases of The Colon & Rectum, 1999Co-Authors: Claudio Soravia, Brenda I. O'connor, Lazar V. Klein, Terri Berk, Zane Cohen, Robin S McleodAbstract:PURPOSE: The aim of this study was to evaluate the surgical complications and long-term outcome and assess the functional results and quality of life after Ileorectal Anastomosis and ileal pouch-anal Anastomosis in patients with familial adenomatous polyposis. METHODS: From 1980 to 1997, 131 patients with familial adenomatous polyposis were operated on or were followed up or both at the Familial Gastrointestinal Cancer Registry at Mount Sinai Hospital. Demographic and operative data were prospectively collected in the ileal pouch-anal Anastomosis group, and retrospectively in the Ileorectal Anastomosis group. A questionnaire or telephone interview or both were undertaken to evaluate functional outcome and quality of life. RESULTS: The Ileorectal Anastomosis group consisted of 60 patients (mean age, 31 years; mean follow-up, 7.7 years). In the ileal pouch-anal Anastomosis group there were 50 patients (mean age, 35 years; mean follow-up, 6 years). There were no statistically significant differences with respect to anastomotic leak rate in ileal pouch-anal Anastomosisvs. Ileorectal Anastomosis (12vs. 3 percent;P=0.21), risk of small-bowel obstruction (24vs. 15 percent;P=0.58), and risk of intra-abdominal sepsis (3vs. 2 percent;P=0.86). Reoperation rate was similar in the two groups (14vs. 16 percent;P=0.94). Twenty-one patients (37 percent) with Ileorectal Anastomosis were converted to ileal pouch-anal Anastomosis (12 patients) or proctocolectomy (9 patients), because of rectal cancer (5 patients), dysplasia (1 patient), or uncontrollable rectal polyps (15 patients). Two pelvic pouches were excised, and another one was defunctioned. Information regarding functional results and quality of life was obtained in 40 patients (66.6 percent) in the Ileorectal Anastomosis group and in 43 patients (86 percent) in the ileal pouch-anal Anastomosis group. Patients with Ileorectal Anastomosis had a significantly better functional outcome with regard to nighttime continence and perineal skin irritation. But otherwise, functional results and quality of life were similar. CONCLUSIONS: Although Ileorectal Anastomosis has a better functional outcome, ileal pouch-anal Anastomosis may be preferable because of the lower long-term failure rate. Ileorectal Anastomosis is still an option in patients with familial adenomatous polyposis with rectal polyp sparing and good compliance for follow-up.
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Functional outcome of conversion of Ileorectal Anastomosis to ileal pouch-anal Anastomosis in patients with familial adenomatous polyposis and ulcerative colitis.
Diseases of The Colon & Rectum, 1999Co-Authors: Claudio Soravia, Brenda I. O'connor, Terri Berk, Robin S Mcleod, Zane CohenAbstract:PURPOSE: The aim of this study was to review the functional outcome in 20 patients with familial adenomatous polyposis and ulcerative colitis who were converted from Ileorectal Anastomosis to ileal pouch-anal Anastomosis. METHODS: From 1985 to 1997, 12 patients with familial adenomatous polyposis (5 males; mean age, 39.1 years) and 8 patients with ulcerative colitis (5 males; mean age, 36.7 years) underwent conversion from Ileorectal Anastomosis to ileal pouch-anal Anastomosis. Clinical and operative data were analyzed retrospectively. Functional results were obtained by telephone interview in 16 patients (94 percent) after pouch construction. Four patients were not interviewed (2 were deceased, 1 was lost to follow-up, and 1 was not reachable). RESULTS: Indications for conversion were uncontrollable rectal polyps (10 patients) and colonic cancer found in the pathology specimen after Ileorectal Anastomosis in patients with familial adenomatous polyposis (2 patients), intractable proctitis (5 patients), colonic cancer found in the pathology specimen of patients with ulcerative colitis after Ileorectal Anastomosis (2 patients), and rectal dysplasia (1 patients). Mean follow-up time was 5 (range, 1–11) years. Ileal pouch-anal Anastomosis was handsewn in 14 patients, and the remaining cases were double-stapled in 4 patients with ulcerative colitis. No intraoperative difficulties were reported in 13 cases; technical problems were related to adhesions (3 cases), difficult rectal dissection (2 cases), and stapler-related difficulties (2 cases). Postoperative complications after ileal pouch-anal Anastomosis included small-bowel obstruction (4 patients) and ileal pouch-anal Anastomosis leak (1 patient). Patients with Ileorectal Anastomosisvs. those with ileal pouch-anal Anastomosis had a better functional outcome with regard to nighttime continence (14 (88 percent)vs. 6 (38 percent) patients) and average bowel movements (
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functional outcome of conversion of Ileorectal Anastomosis to ileal pouch anal Anastomosis in patients with familial adenomatous polyposis and ulcerative colitis
Diseases of The Colon & Rectum, 1999Co-Authors: Claudio Soravia, Terri Berk, Robin S Mcleod, Brenda I Oconnor, Zane CohenAbstract:PURPOSE: The aim of this study was to review the functional outcome in 20 patients with familial adenomatous polyposis and ulcerative colitis who were converted from Ileorectal Anastomosis to ileal pouch-anal Anastomosis. METHODS: From 1985 to 1997, 12 patients with familial adenomatous polyposis (5 males; mean age, 39.1 years) and 8 patients with ulcerative colitis (5 males; mean age, 36.7 years) underwent conversion from Ileorectal Anastomosis to ileal pouch-anal Anastomosis. Clinical and operative data were analyzed retrospectively. Functional results were obtained by telephone interview in 16 patients (94 percent) after pouch construction. Four patients were not interviewed (2 were deceased, 1 was lost to follow-up, and 1 was not reachable). RESULTS: Indications for conversion were uncontrollable rectal polyps (10 patients) and colonic cancer found in the pathology specimen after Ileorectal Anastomosis in patients with familial adenomatous polyposis (2 patients), intractable proctitis (5 patients), colonic cancer found in the pathology specimen of patients with ulcerative colitis after Ileorectal Anastomosis (2 patients), and rectal dysplasia (1 patients). Mean follow-up time was 5 (range, 1–11) years. Ileal pouch-anal Anastomosis was handsewn in 14 patients, and the remaining cases were double-stapled in 4 patients with ulcerative colitis. No intraoperative difficulties were reported in 13 cases; technical problems were related to adhesions (3 cases), difficult rectal dissection (2 cases), and stapler-related difficulties (2 cases). Postoperative complications after ileal pouch-anal Anastomosis included small-bowel obstruction (4 patients) and ileal pouch-anal Anastomosis leak (1 patient). Patients with Ileorectal Anastomosisvs. those with ileal pouch-anal Anastomosis had a better functional outcome with regard to nighttime continence (14 (88 percent)vs. 6 (38 percent) patients) and average bowel movements (<6/day; 12 (75 percent)vs. 4 (25 percent) patients). Complete daytime continence, 15 (94 percent)vs. 10 (62 percent) patients, was similar in the two groups. Physical and emotional well-being were similarly rated as very good to excellent. CONCLUSIONS: In patients with familial adenomatous polyposis and ulcerative colitis with Ileorectal Anastomosis, conversion to ileal pouch-anal Anastomosis may be required. In view of the risk of rectal cancer or intractable proctitis, patients seem to accept the conversion in spite of poorer bowel function.
S. Ahmed - One of the best experts on this subject based on the ideXlab platform.
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Single incision laparoscopic total abdominal colectomy with Ileorectal Anastomosis for synchronous colon cancer.
Techniques in coloproctology, 2010Co-Authors: O. Bardakcioglu, S. AhmedAbstract:Single incision laparoscopy is currently performed mostly for basic laparoscopic procedures involving single abdominal quadrants. The aim of this case report is to show that single incision laparoscopic techniques can be utilized for complex abdominal laparoscopic procedures with a large target organ and a working space involving all quadrants of the abdominal cavity. A single incision laparoscopic total abdominal colectomy with an Ileorectal Anastomosis and intraoperative CO2 colonoscopy was performed for a patient with synchronous adenocarcinoma of the cecum and the sigmoid colon. The patient was discharged home on postoperative day 4 and had no immediate postoperative complications. Single incision laparoscopy is feasible for complex colorectal procedures. Some of the techniques used may be adapted further to achieve colonic resection via a natural orifice in the future.
