The place for colectomy and ileorectal anastomosis: a valid surgical option for ulcerative colitis?

Börjesson, Lars; Lundstam, Ulf; Øresland, Tom; Brevinge, Hans; Hultén, L.

doi:10.1007/s10151-006-0286-x

Cited by 48 publications

(31 citation statements)

References 23 publications

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“…However, these data are not confirmed by more recent experiences [2, 3, 18]. Even if in literature rectal compliance is not a validated parameter for the postoperative development of intractable proctitis, in our opinion it is one of the most important features to indicate IRA.…”

Section: Discussioncontrasting

confidence: 61%

“…It was shown that dysplasia in the rectum progressively increases from 9% at 10 years to 25% at 20 years after IRA [5]. However, the overall incidence of rectal cancer after IRA varies in literature, ranging from 0 to 8% [2, 3, 5, 6, 19]. Lepistö and Järvinen and Leijonmarck et al reported an incidence of 0%, respectively, in 20 and 51 patients, after a mean follow-up of 18 and 13 years, respectively [2, 6].…”

Section: Discussionmentioning

confidence: 99%

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Could Total Colectomy with Ileorectal Anastomosis Be an Alternative to Total Proctocolectomy with Ileal Pouch-Anal Anastomosis in Selected Ulcerative Colitis Patients?

Tonelli

Martino

Giudici

2016

Gastroenterology Research and Practice

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Purpose. To evaluate ileorectal anastomosis (IRA) in selected ulcerative colitis patients. Methods. Early and late complications after IRA and IPAA were investigated. Bowel function and quality of life were assessed. Functional and QoL studies were performed as a matched pair analysis, comparing 98 patients who underwent IRA versus 98 patients who underwent IPAA. Results. In IRA group, 2 patients (1.6%) developed anastomotic l dysplasia (HGD) developed in 3 patients dysplasia (HGD) developed in 3 patients eakage, 1 patient (0.8%) had intestinal obstruction, and 2 patients (1.6%) had abdominal hematoma. Mean follow-up was 11.5 (range: 2–24.3) years. Failure of IRA occurred in 19 patients (15.1%); in 12 patients (9.5%), failure was related to severe proctitis, in 3 patients (2.4%), it was related to the development of high-grade dysplasia, and in 4 patients (3.2%), it was related to the development of rectal cancer. About functional results, stool consistency [liquid (6.7% of IRA patients versus 29% of IPAA patients; p = 0.003)], daily soiling (0% versus 6%; p = 0.01), and nocturnal soiling (6% versus 25.5%; p = 0.03) were statistically different. Only 1% of IRA patients versus 11% of IPAA patients had episodes of perianal inflammation (p = 0.007). CGQoL was 0.72 (±0.14, SD) in IRA patients and 0.75 (±0.11, SD) in IPAA patients (p = ns). Conclusion. In selected patients, IRA is an appropriate surgical option, with low morbidity, comparable quality of life, and better functional results than IPAA.

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Could Total Colectomy with Ileorectal Anastomosis Be an Alternative to Total Proctocolectomy with Ileal Pouch-Anal Anastomosis in Selected Ulcerative Colitis Patients?

Tonelli

Martino

Giudici

2016

Gastroenterology Research and Practice

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“…There is a physiological decrease in sphincter function in older persons, which may lead to worse bowel control. These observations led some authors to recommend ileo-rectal anastomosis in elderly UC patients [14,15]. …”

Section: Discussionmentioning

confidence: 99%

Complications and functional outcomes of restorative proctocolectomy for ulcerative colitis in the elderly

et al. 2013

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BackgroundRestorative proctocolectomy with ileopouch-anal anastomosis (IPAA) is the treatment of choice for intractable or complicated ulcerative colitis (UC). Debate exists concerning outcomes of IPAA in the elderly and literature data are scarce. We report our experience of IPAA in older population.MethodsWe gathered data on a prospective database of patients undergoing IPAA for UC over 70 years of age in our Unit from January 1990 through January 2010. Patients were compared with randomly selected younger controls on a 1:3 ratio. Patients underwent IPAA in 2 or 3 stages. Demographical data, disease characteristics, comorbidities, concomitant medications, peri-operative management, intra- and post-operative complications were analyzed. Function and quality of life were assessed by clinical visit and Inflammatory Bowel Disease Questionnaire 1 and 3 years after ileostomy takedown.ResultsTwenty-seven elderly patients underwent IPAA for UC in the study period; these were compared with 81 younger controls. The former had more comorbidities and higher ASA score. All patients underwent loop-ileostomy closure. There were no differences between groups concerning the rate of major complications, but elderly patients more frequently had nuisances due to stoma output. Younger patients experienced significantly more episodes of small bowel obstruction. No significant differences in bowel control and health-related quality of life was observed, except for an higher rate of elderly patients taking antidiarrhoeals at 1-year follow-up; this observation was not confirmed at 3-year follow-up. A minimal decrease in continence was observed, but this did not affect overall satisfaction.ConclusionsIPAA can be safely offered to selected elderly UC patients who are strongly motivated and with no clinical disturbances of continence. In experienced hands no differences are likely to be expected concerning complications, quality of life and function. Results are stable with time and comparable to those of younger patients.

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“…248 the benefits of total abdominal colectomy with ileoproctostomy are its relative simplicity and predictability compared with iPaa. [250][251][252][253] in addition, the theoretical risk of developing cancer in the remaining rectum should be considered when counseling the patient about surgical options. 249 the disadvantages are related to the long-term durability of the procedure.…”

Section: Total Abdominal Colectomy With Ileoproctostomy Maymentioning

confidence: 99%

Practice Parameters for the Surgical Treatment of Ulcerative Colitis

Ross

Steele

Varma

et al. 2014

Diseases of the Colon &Amp; Rectum

162

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The place for colectomy and ileorectal anastomosis: a valid surgical option for ulcerative colitis?

Abstract: Employed on a selective basis, IRA is a safe procedure with low mortality and morbidity and good prospects for success in many patients with UC. The patients must be prepared to submit to life-long rectoscopy surveillance.

Cited by 48 publications

References 23 publications

Could Total Colectomy with Ileorectal Anastomosis Be an Alternative to Total Proctocolectomy with Ileal Pouch-Anal Anastomosis in Selected Ulcerative Colitis Patients?

Could Total Colectomy with Ileorectal Anastomosis Be an Alternative to Total Proctocolectomy with Ileal Pouch-Anal Anastomosis in Selected Ulcerative Colitis Patients?

Complications and functional outcomes of restorative proctocolectomy for ulcerative colitis in the elderly

Practice Parameters for the Surgical Treatment of Ulcerative Colitis

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