Regeneration of Rectal Mucosa and Recurrent Polyposis Coli After Total Colectomy and Ileoanal Anastomosis

Wolfstein, I

doi:10.1001/archsurg.1982.01380330095024

Cited by 39 publications

(5 citation statements)

References 13 publications

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“…Concern has been repeatedly expressed about the potential for recurrence of dysplasia and/or neoplasia in ihe remaining rectal mucosa, often left at the dentate line to help preserve discriminatory sensation and thus aid in continence [16, 32.33]. Several reports have substantiated this fear by demonstrating recurrence of neoplasia in this area [34]. Although the threat of mucosal regeneration is a potential risk.…”

Section: Discussionmentioning

confidence: 99%

The S ileal pouch‐anal anastomosis

1987

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In order to determine the results with the S ileal pouch-anal anastomosis, 116 consecutive patients who had undergone total abdominal colectomy with rectal mucosectomy and endorectal ileal pouch-anal anastomosis were assessed following ileostomy closure. In 11 patients (9.5%) pouch removal and/or conversion to permanent ileostomy was necessary because of Crohn's disease (3), pelvic sepsis (3), pouchitis (2), incontinence (2), or perineal fistula (1). Although no postoperative mortality was experienced, one or more complications was experienced in 87 patients. These consisted mainly of small bowel obstruction in 35%, pouchitis in 22%, anastomotic stricture in 14%, pelvic sepsis in 9.5%, and perianal abscess or fistula in 5%. Laparotomy was required in 29% of patients mostly for resolution of small bowel obstruction. Follow-up in the remaining 105 patients ranged from 5 to 67 months with a mean of 28 months following ileostomy closure. Stool frequency was 6.6 bowel movements per day and 1.4 bowel movements per night. Eighty-nine percent evacuated their pouches spontaneously, and 61% did not require the use of medication for bowel movement regulation. Major daytime incontinence occurred in 4 %, while 15% reported nocturnal incontinence. Minor incontinence was experienced by 30% and 48% during daytime and nighttime, respectively. Despite a myriad of complications, 96% of patients unhesitatingly stated that they would undergo the procedure again so that they could avoid a permanent stoma. We conclude that restorative proctocolectomy utilizing the ileal S pouch-anal anastomosis is an acceptable procedure that should be considered as a viable choice in the treatment of chronic ulcerative colitis and familial polyposis requiring surgical intervention.Currently, the procedure of restorative proctocolectomy with ileal pouch-anal anastomosis is fast replacing total proctocolectomy with ileostomy as the procedure of choice in the operative management of chronic ulcerative colitis and familial polyposis. As with the latter procedure, the risk of carcinoma arising in the diseased bowel is eradicated. Retention of the anal sphincter mechanism which allows preservation of continence, however, eliminates the need for the creation of a permanent ileostomy and its associated psychological and physical problems.The concept underlying this rather involved procedure is not new. It originated in the 1940's when rectal mucosal stripping with total colectomy and a straight ileal anal anastomosis was performed by Ravitch and Sabiston [1]. Thereafter, several authors [2-5] advocated its use. It was soon realized that the rapid flow of ileal contents into the anal canal was a major

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Section: Discussionmentioning

confidence: 99%

The S ileal pouch‐anal anastomosis

1987

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“…Rectal sparing may be present in up to 60-70% of patients with AAC and PMC [21,65]. This is clinically important since proctoscopy alone may not detect these changes [10,17,21,65,68,[70][71][72]. Flexible sigmoidoscopy should be cautiously performed to confirm the diagnosis of PMC in all patients only exception is a toxic patient where high risk for perforation may exist as the disease progresses [52,[67][68][69][74][75][76][77].…”

Section: Endoscopymentioning

confidence: 99%

“…In a 10-year prospective study, damaged bowel and create a protective proximal stoma [7,17]. Since rectal sparing may be present in the majority Olson et al [56] reported that 15% of 908 patients with C. difficile infection did not require any therapy, whereas of patients, the rectum can be preserved [19,21,72].…”

Section: Medical Treatmentmentioning

confidence: 99%

<i>Clostridium difficile </i>Infection: Risk Factors, Medical and Surgical Management

Klingler¹,

Metzger²,

Seelig³

et al. 2000

Dig Dis

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Background:Clostridium difficile has become recognized as a cause of nosocomial infection which may progress to a fulminant disease. Methods: Literature review using electronic literature research back to 1966 utilizing Medline and Current Contents. All publications on antibiotic-associated diarrhea, antibiotic-associated colitis, and pseudomembranous colitis as well as C. difficile infection were included. We addressed established and potential risk factors for C. difficile disease such as an impaired immune system and cost benefits of different diagnostic tests. An algorithm is outlined for diagnosis and both medical and surgical management of mild, moderate and severe C. difficile disease. Results: Diagnosis of C. difficile infection should be suspected in patients with diarrhea, who have received antibiotics within 2 months or whose symptoms started after hospitalization. A stool specimen should be tested for the presence of leukocytes and C. difficile toxins. If this is negative and symptoms persist, stool should be tested with ‘rapid’ enzyme immunoabsorbent and stool cytotoxin assays, which are the most cost-effective tests. Endoscopy and other imaging studies are reserved for severe and rapidly progressive courses. Oral metronidazole or vancomycin are the antibiotics of choice. Surgery is rarely required for selected patients refractory to medical treatment. The threshold for surgery in severe cases with risk factors including an impaired immune system should be low. Conclusion:C. difficile infection has been recognized with increased frequency as a nosocomial infection. Early diagnosis with immunoassays of the stool and prompt medical therapy have a high cure rate. Metronidazole has supplanted oral vancomycin as the drug of first choice for treating C. difficile infections.

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“…Despite removal of the entire rectal mucosa, colonic metaplasia of the ileal mucosa was still observed, as in UC [224,225]. An increased rate of asymmetrical fission of the pouch crypts has been put forward to explain this hyperplasia [226].…”

Section: Underlying Mechanismsmentioning

confidence: 99%

Incidence and Risk Factors of Cancer in the Anal Transitional Zone and Ileal Pouch following Surgery for Ulcerative Colitis and Familial Adenomatous Polyposis

Cosquer

Buscail

Gilletta

et al. 2022

Cancers

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Proctocolectomy with ileal pouch-anal anastomosis is the intervention of choice for ulcerative colitis and familial adenomatous polyposis requiring surgery. One of the long-term complications is pouch cancer, having a poor prognosis. The risk of high-grade dysplasia and cancer in the anal transitional zone and ileal pouch after 20 years is estimated to be 2 to 4.5% and 3 to 10% in ulcerative colitis and familial polyposis, respectively. The risk factors for ulcerative colitis are the presence of pre-operative dysplasia or cancer, disease duration > 10 years and severe villous atrophy. For familial polyposis, the risk factors are the number of pre-operative polyps > 1000, surgery with stapled anastomosis and the duration of follow-up. In the case of ulcerative colitis, a pouchoscopy should be performed annually if one of the following is present: dysplasia and cancer at surgery, primary sclerosing cholangitis, villous atrophy and active pouchitis (every 5 years without any of these factors). In the case of familial polyposis, endoscopy is recommended every year including chromoendoscopy. Even if anal transitional zone and ileal pouch cancers seldom occur following proctectomy for ulcerative colitis and familial adenomatous polyposis, the high mortality rate associated with this complication warrants endoscopic monitoring.

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Regeneration of Rectal Mucosa and Recurrent Polyposis Coli After Total Colectomy and Ileoanal Anastomosis

Cited by 39 publications

References 13 publications

The S ileal pouch‐anal anastomosis

The S ileal pouch‐anal anastomosis

<i>Clostridium difficile </i>Infection: Risk Factors, Medical and Surgical Management

Incidence and Risk Factors of Cancer in the Anal Transitional Zone and Ileal Pouch following Surgery for Ulcerative Colitis and Familial Adenomatous Polyposis

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