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Victor W Fazio - One of the best experts on this subject based on the ideXlab platform.
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factors associated with septic complications after restorative Proctocolectomy
Annals of Surgery, 2010Co-Authors: Ravi P Kiran, Feza H Remzi, James M Church, Ian C Lavery, Andre Da Luz Moreira, Jeffery Hammel, Victor W FazioAbstract:Objective: Few studies have evaluated factors that may be associated with the development of septic complications after restorative Proctocolectomy. Therefore, the aim of this study is to evaluate preoperative and operative factors that might be associated with septic complications after restorative Proctocolectomy. Methods: Patients developing abdominal and pelvic septic complications after restorative Proctocolectomy were identified from a prospective database. Patients with subclinical leaks and ileostomy closure leak were not included in the septic complication group. A multivariable logistic regression model for sepsis was constructed using a forward stepwise selection with entry criterion of P 30 (P = 0.02, OR = 1.77), final pathologic diagnosis of ulcerative/indeterminate colitis (P = 0.02, OR = 2) or Crohn's disease (P = 0.02, OR = 3.6), intraoperative (P = 0.02, OR = 1.6), and postoperative transfusions (P = 0.01, OR = 1.9) were all independently associated with septic complications. We also demonstrated an independent association among individual surgeons (P = 0.04) with decreased septic complications. Conclusions: Body mass index greater than 30, final pathologic diagnosis of ulcerative/indeterminate colitis or Crohn's disease, intraoperative and postoperative transfusions, and surgeon were all independent factors associated with septic complications after restorative Proctocolectomy.
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comparison of outcomes after restorative Proctocolectomy with or without defunctioning ileostomy
Archives of Surgery, 2008Co-Authors: Gina K Westonpetrides, Victor W Fazio, Richard E Lovegrove, H S Tilney, Alexander G Heriot, John R Nicholls, N Mortensen, Paris P TekkisAbstract:Objective To evaluate postoperative adverse events and functional outcomes of patients undergoing restorative Proctocolectomy with or without proximal diversion. Data Sources The literature was searched by means of MEDLINE, Embase, Ovid, and Cochrane databases for all studies published from 1978 through July 15, 2005. Study Selection Comparative (randomized and nonrandomized) studies evaluating outcomes after restorative Proctocolectomy with or without ileostomy were included. Data Extraction Three authors independently extracted data by using operative variables, early and late adverse events, and functional outcomes between the 2 groups. Trials were assessed by means of the modified Newcastle-Ottawa Score. Random-effects meta-analytical techniques were used for analysis. Data Synthesis The review included 17 studies comprising 1486 patients (765 without ileostomy and 721 with ileostomy). There were no significant differences in functional outcomes between the 2 groups. The development of pouch-related leak was significantly higher in the no-ileostomy group (odds ratio, 2.37;P = .002). Small-bowel obstruction was more common in the stoma group but was not statistically significant (odds ratio, 0.65). The development of anastomotic stricture favored the no-stoma group (odds ratio, 0.31;P = .045). On sensitivity analysis, pelvic sepsis was significantly less common in patients whose ileostomies were defunctioned; however, this finding was not mirrored by a significant difference in ileal pouch failure in this subgroup. Conclusions Restorative Proctocolectomy without a diverting ileostomy resulted in functional outcomes similar to those of surgery with proximal diversion but was associated with an increased risk of anastomotic leak. Diverting ileostomy should be omitted in carefully selected patients only.
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a proposed classification of ileal pouch disorders and associated complications after restorative Proctocolectomy
Clinical Gastroenterology and Hepatology, 2008Co-Authors: Bo Shen, Feza H Remzi, Ian C Lavery, Bret A Lashner, Victor W FazioAbstract:Both medical and surgical therapies for ulcerative colitis have inherent advantages and disadvantages that must be balanced for patients with moderate to severe disease. Restorative Proctocolectomy with ileal pouch–anal anastomosis has become the surgical treatment of choice for the majority of patients with ulcerative colitis who require Proctocolectomy. However, adverse sequelae of mechanical, inflammatory, functional, neoplastic, and metabolic conditions related to the pouch can occur postoperatively. Recognition and familiarization of the disease conditions related to the ileal pouch can be challenging for practicing gastroenterologists. Accurate diagnosis and classification of the disease conditions are imperative for proper management and prognosis.
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the outcome after restorative Proctocolectomy with or without defunctioning ileostomy
Diseases of The Colon & Rectum, 2006Co-Authors: Feza H Remzi, Miriam Preen, Victor W Fazio, Emre Gorgun, James M Church, Boon Swee Ooi, Jeff Hammel, Khaled M Madbouly, Ian C LaveryAbstract:Purpose:Controversy exists regarding the safety for omission of diverting ileostomy in restorative Proctocolectomy because of fears of increased septic complications. This study was designed to evaluate the outcomes of restorative Proctocolectomy in a consecutive series of patients by comparing post
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the outcome after restorative Proctocolectomy with or without defunctioning ileostomy
Diseases of The Colon & Rectum, 2006Co-Authors: Feza H Remzi, Miriam Preen, Victor W Fazio, Emre Gorgun, James M Church, Boon Swee Ooi, Jeff Hammel, Khaled M Madbouly, Ian C LaveryAbstract:Controversy exists regarding the safety for omission of diverting ileostomy in restorative Proctocolectomy because of fears of increased septic complications. This study was designed to evaluate the outcomes of restorative Proctocolectomy in a consecutive series of patients by comparing postoperative complications, functional results, and quality of life in patients with and without diverting ileostomy. Data regarding demographics, length of stay, surgical characteristics, and complications were reviewed and recorded according to the presence (n= 1,725) or absence (n = 277) of a diverting ileostomy at the time of pelvic pouch surgery. Criteria for omission of ileostomy included: stapled anastomosis, tension-free anastomosis, intact tissue rings, good hemostasis, absence of airleaks, malnutrition, toxicity, anemia, and prolonged consumption of steroids. Functional outcome and quality of lifeindicators were prospectively recorded and compared. Patients in the ileostomy group had greater body surface area and older mean age at time of surgery, were taking greater doses of steroids preoperatively, and required more blood transfusions at the time of surgery compared with the one-stage (P 0.05). Early postoperative ileus was more common in the one-stage group (P < 0.001). There were no differences between the groups in quality of life and functional outcomes. For carefully selected patients undergoing restorative Proctocolectomy with ileal pouch-anal anastomosis, omission of diverting ileostomy is a safe procedure that does not lead to an increase inseptic complications or mortality. Quality of life and functional results are similar to those who undergo ileal pouch-anal anastomosis with diversion, provided that certain selection factors are considered.
Feza H Remzi - One of the best experts on this subject based on the ideXlab platform.
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single port laparoscopic total Proctocolectomy with ileal pouch anal anastomosis initial operative experience
Surgical Endoscopy and Other Interventional Techniques, 2011Co-Authors: Daniel P Geisler, Hasan T Kirat, Feza H RemziAbstract:Background Single-port laparoscopic surgery (SPLS) has been used in urologic, gynecologic, general, and colorectal surgery. We herein report our experience with the use of SPLS for total Proctocolectomy with ileal pouch-anal anastomosis (RP/IPAA).
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single incision laparoscopic total Proctocolectomy with ileopouch anal anastomosis
Colorectal Disease, 2010Co-Authors: Daniel P Geisler, E T Condon, Feza H RemziAbstract:Aim We present our initial experience of a single port laparoscopic total Proctocolectomy with ileoanal J pouch anastomosis. The single incision laparoscopic surgery (SIL), (Covidien, Norwalk, Connecticut, USA) device with a multichannel cannula and specially designed curved laparoscopic instrumentation were used. Method A patient with familial adenomatous polyposis underwent restorative proctocoectomy. A colonoscopy had demonstrated nearly 1000 polyps in the colon with several 1-cm polyps in the rectum. The abdomen was entered through a 2.5 cm incision sited preoperatively for the temporary ileostomy. The single port device was inserted and a total Proctocolectomy was performed. Ligation of the vessels was performed with the Ligasure (Covidien). The colon and rectum were extracted through the SIL site. An 18-cm ileoanal J pouch was created extracorporeally. The pouch anal anastomosis was performed intracorporeally and a diverting loop ileostomy created through the SIL port site. Results The operating time was 172 min. Blood loss was 100 ml and the hospital stay was 4 days without any complication. The patient had a virtually scar-less abdomen other than the site of the loop ileostomy. Conclusion Single port laparoscopic surgery may allow complex colorectal surgery to be performed resulting in a virtually scar-less procedure.
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factors associated with septic complications after restorative Proctocolectomy
Annals of Surgery, 2010Co-Authors: Ravi P Kiran, Feza H Remzi, James M Church, Ian C Lavery, Andre Da Luz Moreira, Jeffery Hammel, Victor W FazioAbstract:Objective: Few studies have evaluated factors that may be associated with the development of septic complications after restorative Proctocolectomy. Therefore, the aim of this study is to evaluate preoperative and operative factors that might be associated with septic complications after restorative Proctocolectomy. Methods: Patients developing abdominal and pelvic septic complications after restorative Proctocolectomy were identified from a prospective database. Patients with subclinical leaks and ileostomy closure leak were not included in the septic complication group. A multivariable logistic regression model for sepsis was constructed using a forward stepwise selection with entry criterion of P 30 (P = 0.02, OR = 1.77), final pathologic diagnosis of ulcerative/indeterminate colitis (P = 0.02, OR = 2) or Crohn's disease (P = 0.02, OR = 3.6), intraoperative (P = 0.02, OR = 1.6), and postoperative transfusions (P = 0.01, OR = 1.9) were all independently associated with septic complications. We also demonstrated an independent association among individual surgeons (P = 0.04) with decreased septic complications. Conclusions: Body mass index greater than 30, final pathologic diagnosis of ulcerative/indeterminate colitis or Crohn's disease, intraoperative and postoperative transfusions, and surgeon were all independent factors associated with septic complications after restorative Proctocolectomy.
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a proposed classification of ileal pouch disorders and associated complications after restorative Proctocolectomy
Clinical Gastroenterology and Hepatology, 2008Co-Authors: Bo Shen, Feza H Remzi, Ian C Lavery, Bret A Lashner, Victor W FazioAbstract:Both medical and surgical therapies for ulcerative colitis have inherent advantages and disadvantages that must be balanced for patients with moderate to severe disease. Restorative Proctocolectomy with ileal pouch–anal anastomosis has become the surgical treatment of choice for the majority of patients with ulcerative colitis who require Proctocolectomy. However, adverse sequelae of mechanical, inflammatory, functional, neoplastic, and metabolic conditions related to the pouch can occur postoperatively. Recognition and familiarization of the disease conditions related to the ileal pouch can be challenging for practicing gastroenterologists. Accurate diagnosis and classification of the disease conditions are imperative for proper management and prognosis.
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the outcome after restorative Proctocolectomy with or without defunctioning ileostomy
Diseases of The Colon & Rectum, 2006Co-Authors: Feza H Remzi, Miriam Preen, Victor W Fazio, Emre Gorgun, James M Church, Boon Swee Ooi, Jeff Hammel, Khaled M Madbouly, Ian C LaveryAbstract:Purpose:Controversy exists regarding the safety for omission of diverting ileostomy in restorative Proctocolectomy because of fears of increased septic complications. This study was designed to evaluate the outcomes of restorative Proctocolectomy in a consecutive series of patients by comparing post
Miriam Preen - One of the best experts on this subject based on the ideXlab platform.
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the outcome after restorative Proctocolectomy with or without defunctioning ileostomy
Diseases of The Colon & Rectum, 2006Co-Authors: Feza H Remzi, Miriam Preen, Victor W Fazio, Emre Gorgun, James M Church, Boon Swee Ooi, Jeff Hammel, Khaled M Madbouly, Ian C LaveryAbstract:Purpose:Controversy exists regarding the safety for omission of diverting ileostomy in restorative Proctocolectomy because of fears of increased septic complications. This study was designed to evaluate the outcomes of restorative Proctocolectomy in a consecutive series of patients by comparing post
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the outcome after restorative Proctocolectomy with or without defunctioning ileostomy
Diseases of The Colon & Rectum, 2006Co-Authors: Feza H Remzi, Miriam Preen, Victor W Fazio, Emre Gorgun, James M Church, Boon Swee Ooi, Jeff Hammel, Khaled M Madbouly, Ian C LaveryAbstract:Controversy exists regarding the safety for omission of diverting ileostomy in restorative Proctocolectomy because of fears of increased septic complications. This study was designed to evaluate the outcomes of restorative Proctocolectomy in a consecutive series of patients by comparing postoperative complications, functional results, and quality of life in patients with and without diverting ileostomy. Data regarding demographics, length of stay, surgical characteristics, and complications were reviewed and recorded according to the presence (n= 1,725) or absence (n = 277) of a diverting ileostomy at the time of pelvic pouch surgery. Criteria for omission of ileostomy included: stapled anastomosis, tension-free anastomosis, intact tissue rings, good hemostasis, absence of airleaks, malnutrition, toxicity, anemia, and prolonged consumption of steroids. Functional outcome and quality of lifeindicators were prospectively recorded and compared. Patients in the ileostomy group had greater body surface area and older mean age at time of surgery, were taking greater doses of steroids preoperatively, and required more blood transfusions at the time of surgery compared with the one-stage (P 0.05). Early postoperative ileus was more common in the one-stage group (P < 0.001). There were no differences between the groups in quality of life and functional outcomes. For carefully selected patients undergoing restorative Proctocolectomy with ileal pouch-anal anastomosis, omission of diverting ileostomy is a safe procedure that does not lead to an increase inseptic complications or mortality. Quality of life and functional results are similar to those who undergo ileal pouch-anal anastomosis with diversion, provided that certain selection factors are considered.
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surgical outcome in patients with primary sclerosing cholangitis undergoing ileal pouch anal anastomosis a case control study
Surgery, 2005Co-Authors: Emre Gorgun, Feza H Remzi, Miriam Preen, Elena Manilich, Bo Shen, Victor W FazioAbstract:Background The outcome of restorative Proctocolectomy in the setting of chronic ulcerative colitis complicated by primary sclerosing cholangitis (PSC) is not clear. The purpose of this study was to determine the surgical outcome, risk of dysplasia/cancer, morbidity/mortality, long-term results, and functional and quality of life results in patients with inflammatory bowel disease (IBD) and PSC who underwent restorative Proctocolectomy with ileal pouch–anal anastomosis and compare them in a case-matched study. Methods Patients with PSC-associated IBD undergoing restorative Proctocolectomy between 1983 and 2002 were included in the study. This study group was matched for age, gender, diagnosis, duration of disease, anastomosis technique, and proximal diversion to a cohort of IBD patients with no associated PSC who underwent restorative Proctocolectomy during the same period of time. Postoperative morbidity, incidence of neoplasia/cancer in the resected specimen, pouchitis, pouch failure, long-term mortality, and 5-year survival rates were compared between the groups. The functional and quality of life records were prospectively collected and compared between the groups. For each group, matched Kaplan-Meier survival analysis was also conducted comparing 5-year survival between the 2 cohorts, matching for diagnosis, duration of disease, age, gender, anastomosis type, and proximal diversion. Results Sixty-five patients with PSC and IBD underwent restorative Proctocolectomy with ileal pouch–anal anastomosis during the study period. Two hundred sixty IBD patients with no associated PSC who matched with the outlined criteria comprised the control group. The follow-up period was 68 ± 50 months for the PSC group and 102 ± 62 months for the control group. A higher incidence of cancer (14% vs 5%, P = .02) and dysplasia in the resected specimen (40% vs 7%, P Conclusions PSC-associated IBD patients after restorative Proctocolectomy have a higher risk of neoplasia/cancer in the resected specimen, postoperative pelvic sepsis, and higher long-term mortality. Functional and quality of life remains similar in IBD patients after restorative Proctocolectomy with or without associated PSC in the follow-up. However, patients with IBD and PSC have a significantly poorer survival than patients with no associated PSC after restorative Proctocolectomy.
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loop ileostomy closure after restorative Proctocolectomy outcome in 1 504 patients
Diseases of The Colon & Rectum, 2005Co-Authors: Kutt Sing Wong, Feza H Remzi, Miriam Preen, Emre Gorgun, Susana Arrigain, James M Church, Victor W FazioAbstract:PURPOSE:Routine use of a temporary loop ileostomy for diversion after restorative Proctocolectomy is controversial because of reported morbidity associated with its creation and closure. This study intended to review our experience with loop ileostomy closure after restorative Proctocolectomy and de
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loop ileostomy closure after restorative Proctocolectomy outcome in 1 504 patients
Diseases of The Colon & Rectum, 2005Co-Authors: Kutt Sing Wong, Feza H Remzi, Miriam Preen, Emre Gorgun, Susana Arrigain, James M Church, Victor W FazioAbstract:Routine use of a temporary loop ileostomy for diversion after restorative Proctocolectomy is controversial because of reported morbidity associated with its creation and closure. This study intended to review our experience with loop ileostomy closure after restorative Proctocolectomy and determine the complication rates. In addition, complication rates between handsewn and stapled closures were compared. Our Department Pelvic Pouch Database was queried and charts reviewed for all patients who had ileostomy closure after restorative Proctocolectomy from August 1983 to March 2002. A total of 1,504 patients underwent ileostomy closure after restorative Proctocolectomy during a 19-year period. The median length of hospitalization was three (range, 1–40) days and the overall complication rate was 11.4 percent. Complications included small-bowel obstruction (6.4 percent), wound infection (1.5 percent), abdominal septic complications (1 percent), and enterocutaneous fistulas (0.6 percent). Handsewn closure was performed in 1,278 patients (85 percent) and stapled closure in 226 (15 percent). No significant differences in complication rates and length of hospitalization were found between handsewn and stapled closure techniques. Our results demonstrated that ileostomy closure after restorative Proctocolectomy can be achieved with a low morbidity and a short hospitalization stay. In addition, we found that complication rates and length of hospitalization were similar between handsewn and stapled closures.
Willem A Bemelman - One of the best experts on this subject based on the ideXlab platform.
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a multicentre evaluation of risk factors for anastomotic leakage after restorative Proctocolectomy with ileal pouch anal anastomosis for inflammatory bowel disease
Journal of Crohns & Colitis, 2016Co-Authors: Saloomeh Sahami, Willem A Bemelman, Andre Dhoore, Sanne A L Bartels, Tonia Young Fadok, Pieter J Tanis, Robert Lindeboom, Anthony De Buck Van Overstraeten, Albert Wolthuis, Christianne J BuskensAbstract:Background: Anastomotic leakage is a major complication after restorative Proctocolectomy with ileal pouch-anal anastomosis [IPAA]. Identification of patients at high risk of leakage may influence surgical decision making. The aim of this study was to identify risk factors associated with anastomotic leakage after restorative Proctocolectomy with IPAA. Methods: Between September 1990 and January 2015, patients who underwent IPAA for inflammatory bowel disease [IBD] were identified from prospectively maintained databases of three tertiary referral centres. Retrospective chart review identified additional data on demographic and surgical variables. Multivariable regression models were developed to identify risk factors for anastomotic leakage. Separate analyses were performed for type of procedure. Results: A total of 640 patients \[56.9% male] were included, with a median age of 38 years [interquartile range 29–48]; 96 [15.0%] patients developed anastomotic leakage. Multivariable regression analysis demonstrated that being overweight (body mass index [BMI] > 25], (odds ratio [OR] 1.92; 95% confidence interval [CI] 1.15 – 3.18), and American Society of Anesthesiologists classification [ASA score > 2\] \[OR 1.91; 95% CI 1.03 – 3.54\] were independent risk factors for anastomotic leakage in patients who underwent a completion proctectomy. A disease course of > 5 years [OR 2.34; 95% CI 1.42 – 3.87] and concurrent combination of anti-tumour necrosis factor [TNF] and steroids [OR 6.40; 95% CI 1.76 – 23.20] were independent risk factors for anastomotic leakage in patients who underwent a Proctocolectomy and IPAA. Conclusions: Independent risk factors for anastomotic leakage in IBD patients undergoing IPAA are BMI >25, ASA score >2, disease course > 5 years, and concurrent steroid and anti-TNF treatment, with a different risk profile for one-stage Proctocolectomy and completion proctectomy procedures.
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total laparoscopic restorative Proctocolectomy are there advantages compared with the open and hand assisted approaches
Diseases of The Colon & Rectum, 2008Co-Authors: Sebastiaan W Polle, Mark I Van Berge Henegouwen, Frederik J M Slors, Miguel A Cuesta, Dirk J Gouma, Willem A BemelmanAbstract:Purpose A randomized, controlled trial comparing hand-assisted laparoscopic restorative Proctocolectomy with open surgery did not show an advantage for the laparoscopic approach. The trial was criticized because hand-assisted laparoscopic restorative Proctocolectomy was not considered a true laparoscopic Proctocolectomy. The objective of the present study was to assess whether total laparoscopic restorative Proctocolectomy has advantages over hand-assisted laparoscopic restorative Proctocolectomy with respect to early recovery.
James M Church - One of the best experts on this subject based on the ideXlab platform.
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factors associated with septic complications after restorative Proctocolectomy
Annals of Surgery, 2010Co-Authors: Ravi P Kiran, Feza H Remzi, James M Church, Ian C Lavery, Andre Da Luz Moreira, Jeffery Hammel, Victor W FazioAbstract:Objective: Few studies have evaluated factors that may be associated with the development of septic complications after restorative Proctocolectomy. Therefore, the aim of this study is to evaluate preoperative and operative factors that might be associated with septic complications after restorative Proctocolectomy. Methods: Patients developing abdominal and pelvic septic complications after restorative Proctocolectomy were identified from a prospective database. Patients with subclinical leaks and ileostomy closure leak were not included in the septic complication group. A multivariable logistic regression model for sepsis was constructed using a forward stepwise selection with entry criterion of P 30 (P = 0.02, OR = 1.77), final pathologic diagnosis of ulcerative/indeterminate colitis (P = 0.02, OR = 2) or Crohn's disease (P = 0.02, OR = 3.6), intraoperative (P = 0.02, OR = 1.6), and postoperative transfusions (P = 0.01, OR = 1.9) were all independently associated with septic complications. We also demonstrated an independent association among individual surgeons (P = 0.04) with decreased septic complications. Conclusions: Body mass index greater than 30, final pathologic diagnosis of ulcerative/indeterminate colitis or Crohn's disease, intraoperative and postoperative transfusions, and surgeon were all independent factors associated with septic complications after restorative Proctocolectomy.
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the outcome after restorative Proctocolectomy with or without defunctioning ileostomy
Diseases of The Colon & Rectum, 2006Co-Authors: Feza H Remzi, Miriam Preen, Victor W Fazio, Emre Gorgun, James M Church, Boon Swee Ooi, Jeff Hammel, Khaled M Madbouly, Ian C LaveryAbstract:Purpose:Controversy exists regarding the safety for omission of diverting ileostomy in restorative Proctocolectomy because of fears of increased septic complications. This study was designed to evaluate the outcomes of restorative Proctocolectomy in a consecutive series of patients by comparing post
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the outcome after restorative Proctocolectomy with or without defunctioning ileostomy
Diseases of The Colon & Rectum, 2006Co-Authors: Feza H Remzi, Miriam Preen, Victor W Fazio, Emre Gorgun, James M Church, Boon Swee Ooi, Jeff Hammel, Khaled M Madbouly, Ian C LaveryAbstract:Controversy exists regarding the safety for omission of diverting ileostomy in restorative Proctocolectomy because of fears of increased septic complications. This study was designed to evaluate the outcomes of restorative Proctocolectomy in a consecutive series of patients by comparing postoperative complications, functional results, and quality of life in patients with and without diverting ileostomy. Data regarding demographics, length of stay, surgical characteristics, and complications were reviewed and recorded according to the presence (n= 1,725) or absence (n = 277) of a diverting ileostomy at the time of pelvic pouch surgery. Criteria for omission of ileostomy included: stapled anastomosis, tension-free anastomosis, intact tissue rings, good hemostasis, absence of airleaks, malnutrition, toxicity, anemia, and prolonged consumption of steroids. Functional outcome and quality of lifeindicators were prospectively recorded and compared. Patients in the ileostomy group had greater body surface area and older mean age at time of surgery, were taking greater doses of steroids preoperatively, and required more blood transfusions at the time of surgery compared with the one-stage (P 0.05). Early postoperative ileus was more common in the one-stage group (P < 0.001). There were no differences between the groups in quality of life and functional outcomes. For carefully selected patients undergoing restorative Proctocolectomy with ileal pouch-anal anastomosis, omission of diverting ileostomy is a safe procedure that does not lead to an increase inseptic complications or mortality. Quality of life and functional results are similar to those who undergo ileal pouch-anal anastomosis with diversion, provided that certain selection factors are considered.
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loop ileostomy closure after restorative Proctocolectomy outcome in 1 504 patients
Diseases of The Colon & Rectum, 2005Co-Authors: Kutt Sing Wong, Feza H Remzi, Miriam Preen, Emre Gorgun, Susana Arrigain, James M Church, Victor W FazioAbstract:PURPOSE:Routine use of a temporary loop ileostomy for diversion after restorative Proctocolectomy is controversial because of reported morbidity associated with its creation and closure. This study intended to review our experience with loop ileostomy closure after restorative Proctocolectomy and de
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loop ileostomy closure after restorative Proctocolectomy outcome in 1 504 patients
Diseases of The Colon & Rectum, 2005Co-Authors: Kutt Sing Wong, Feza H Remzi, Miriam Preen, Emre Gorgun, Susana Arrigain, James M Church, Victor W FazioAbstract:Routine use of a temporary loop ileostomy for diversion after restorative Proctocolectomy is controversial because of reported morbidity associated with its creation and closure. This study intended to review our experience with loop ileostomy closure after restorative Proctocolectomy and determine the complication rates. In addition, complication rates between handsewn and stapled closures were compared. Our Department Pelvic Pouch Database was queried and charts reviewed for all patients who had ileostomy closure after restorative Proctocolectomy from August 1983 to March 2002. A total of 1,504 patients underwent ileostomy closure after restorative Proctocolectomy during a 19-year period. The median length of hospitalization was three (range, 1–40) days and the overall complication rate was 11.4 percent. Complications included small-bowel obstruction (6.4 percent), wound infection (1.5 percent), abdominal septic complications (1 percent), and enterocutaneous fistulas (0.6 percent). Handsewn closure was performed in 1,278 patients (85 percent) and stapled closure in 226 (15 percent). No significant differences in complication rates and length of hospitalization were found between handsewn and stapled closure techniques. Our results demonstrated that ileostomy closure after restorative Proctocolectomy can be achieved with a low morbidity and a short hospitalization stay. In addition, we found that complication rates and length of hospitalization were similar between handsewn and stapled closures.