Restorative Proctocolectomy for Ulcerative Colitis in 1985–2009

Abstract

Background and Aims:Restorative proctocolectomy is the most common operation in patients with ulcerative colitis. the aim was to evaluate long-term changes in our operative treatment and early and late complications related to restorative proctocolectomy. Results: the indication for surgery was active chronic colitis in 168 (47.7%), acute colitis in 159 (45.2%), and cancer or dysplasia in 25 (7.1%) patients. ileal pouch-anal anastomosis was performed using hand-sewn anastomosis with mucosectomy in 283 patients and stapled anastomosis in 69. a shift from hand-sewn to stapler ileal pouch-anal anastomosis took place in 2005. covering ileostomy was carried out in 133 (37.8%) patients. there were 82 (23.3%) J-pouch-related complications. the operative mortality was 0.3%. there were significantly fewer leakages and early re-operations when covering ileostomy was used than when it was omitted: 6.0% versus 16.4% (p = 0.004), 4.5% versus 11.9% (p = 0.02), respectively. there were more strictures in hand-sewn than in stapled ileal pouch-anal anastomoses (17.6% vs. 0%, p = 0.001). Pouchitis occurred at least once in 134 (38.1%) patients.Conclusion: the ileal pouch-anal anastomosis technique used in restorative proctocolectomy had changed over the past years from hand-sewn to stapled anastomosis. covering ileostomy seemed to protect against major complications. Pouchitis was the most common late complication.

Routine Pouchoscopy Prior to Ileostomy Takedown May Not Be Necessary in Patients with Chronic Ulcerative Colitis

“…Helavirta et al [3] reported a similar rate of SBOs at 6.0% in 352 UC patients with IPAA between 1985 and 2009. The literature also reports a similar rate of occurrence of pelvic sepsis, between 3 and 25%, depending on the definition, compared to our series [3,7,8,9].…”

“…Helavirta et al [3] reported a similar rate of SBOs at 6.0% in 352 UC patients with IPAA between 1985 and 2009. The literature also reports a similar rate of occurrence of pelvic sepsis, between 3 and 25%, depending on the definition, compared to our series [3,7,8,9]. Among long-term complications, pouchitis was the most common, accounting for between 23.5 and 48% and is comparable to our overall occurrence of pouchitis [3,8,9,10].…”

Colitis ulcerosa minimálisan invazív sebészi kezelése – hosszú távú eredmények

“…Szövődményeinket áttekintve a pouch gyulladásos folyamata az egyik leggyakrabban észlelt probléma volt. Egy angol összefoglaló közleményben az IPAA-t követő komplikációkat a pouch gyulladása vezeti, hasonló eredményre jutott egy nagy esetszámmal dolgozó fi nn tanulmány is [37,38].…”

Laparoscopic surgical treatment for ulcerative colitis

“…In several studies, prior biological therapy was considered to have a negative effect on the results of the surgical treatment in UC [39,40] , although this is not supported by other observations [5,41,42] or a most recent case-matched study [43] . During the mean follow-up of 47 [44,45] . The research by Bartels et al revealed that the incidence of adhesions and postoperative hernias was significantly higher following emergency open colectomies performed because of UC [46] .…”

“…One of the most common complication in the long term after IPAA surgery performed because of UC is pouchitis [47,48] . A total of 17 cases of pouchitis were recorded in our study, corresponding to 40% of the patients with a pouch.…”