scholarly journals Continent Ileostomy as an Alternative to End Ileostomy

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Xian-rui Wu ◽  
Hao-xian Ke ◽  
Ravi P. Kiran ◽  
Bo Shen ◽  
Ping Lan
Keyword(s):  
Gold Standard ◽  
Ileal Pouch ◽  
Physiological Function ◽  
Standard Procedure ◽  
Poor Quality ◽  
Continent Ileostomy ◽  
High Rate ◽  
Total Proctocolectomy ◽  
Anal Anastomosis

Continent ileostomy (CI) was once a prevalent surgical technique for patients who required total proctocolectomy but then gave way to ileal pouch-anal anastomosis (IPAA) after 1980. Although IPAA has been the gold standard procedure preferred by most patients when total proctocolectomy is required, due to its imitation of physiological function of rectum and preserved function of anus, various complications have been observed with a relatively high rate of morbidity that could affect pouch longevity. Once serious complications such as pelvic abscesses and/or fistula occur, the pouch often needs to be removed. In addition, for some patients with a shortened small intestine or foreshortened mesentery, it is impossible for the ileal pouch to reach the pelvic floor, thus making the creation of an IPAA difficult. Previously, most of these patients would be referred for an end ileostomy, with an associated poor quality of life. In this circumstance, we propose that CI may deserve a reappraisal and serve as an alternative. In this article, we review the indications, contraindications, technique evolution, and outcomes of CI.

scholarly journals Potential problems of partial resection for colitis-associated cancer in a patient with ulcerative colitis: case report

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Yuki Horio ◽  
Motoi Uchino ◽  
Takako Kihara ◽  
Toshihiro Bando ◽  
Ryuichi Kuwahara ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Endoscopic Resection ◽  
Ileal Pouch ◽  
Standard Procedure ◽  
Partial Resection ◽  
Total Proctocolectomy ◽  
Potential Problems ◽  
Partial Colectomy ◽  
A Site ◽  
Anal Site

Abstract Total proctocolectomy and an ileal pouch-anal anastomosis are recommended as the standard procedure for ulcerative colitis (UC)-colitis-associated cancer (CAC). However, several studies have reported the partial colectomy and endoscopic resection of UC-CAC in recent years. We present a surgical case of UC-CAC that was detected at a site that had not been diagnosed preoperatively, and we report potential problems of partial colectomy and endoscopic resection through this case. Considerations of synchronous and metachronous cancer/dysplasia are important before partial resection is planned for CAC in UC. Moreover, it should be noted that endoscopic resection at the anal site can be a risk factor for pouch surgery failure due to fibrosis after resection.

Management, Functional Outcomes and Quality of Life After Development of Pelvic Sepsis in Patients Undergoing Re-Do Ileal Pouch Anal Anastomosis

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Eren Esen ◽  
Michael J. Grieco ◽  
Arman Erkan ◽  
Erman Aytac ◽  
Alton G. Sutter ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Functional Outcomes ◽  
Ileal Pouch ◽  
Ileal Pouch Anal Anastomosis ◽  
Pelvic Sepsis ◽  
Anal Anastomosis

Postoperative Steroid Taper Is Associated With Pelvic Sepsis After Ileal Pouch-anal Anastomosis

2018 ◽  
Vol 25 (8) ◽  
pp. 1383-1389 ◽  
Author(s):  
Kaitlin A Ritter ◽  
John P Burke ◽  
Luca Stocchi ◽  
Alexandra Aiello ◽  
Stefan Holubar ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Multivariate Analysis ◽  
Ileal Pouch ◽  
Ileal Pouch Anal Anastomosis ◽  
Pelvic Sepsis ◽  
Oral Steroid ◽  
Total Proctocolectomy ◽  
Steroid Use ◽  
Anal Anastomosis ◽  
Inflammatory Bowel

AbstractObjectiveWe hypothesized that postoperative oral steroid taper after ileal pouch-anal anastomosis for inflammatory bowel disease would not be associated with pelvic septic complications.BackgroundRecent data has emphasized the possible association between biologic medication use and pelvic sepsis following ileal pouch-anal anastomosis. Limited contemporary data exist examining the effects of steroid use on these complications.MethodsConsecutive patients undergoing ileal pouch-anal anastomosis for inflammatory bowel disease at a single institution from January 2009 to December 2013 were included. Factors associated with anastomotic leak and pelvic sepsis were assessed using univariate and multivariate analysis.ResultsA total of 686 patients were included (mean age 39.5 years, 59% males). Postoperative oral steroid taper was associated with both anastomotic leak and pelvic sepsis on univariate analysis. Stress dose intravenous steroid use was not associated with complications. Multivariate analysis indicated total proctocolectomy (odds ratio [OR] 2.2; confidence interval [CI] 1.01–4.7, P = 0.047), and postoperative oral steroid taper (OR 2.3; CI 1.06–5.1; P = 0.035) as independent factors significantly associated with pelvic sepsis.ConclusionsProlonged postoperative oral steroid taper after ileal pouch-anal anastomosis should be avoided. If preoperative steroid weaning is not possible before a planned total proctocolectomy and ileal pouch-anal anastomosis, patients should undergo an initial total abdominal colectomy.

scholarly journals O-25: Long-term function and quality of life after ileal pouch-anal anastomosis; better in younger patients?

2014 ◽  
Vol 8 ◽  
pp. S424 ◽  
Author(s):  
J.M. Bakia ◽  
P.H.A. Bours ◽  
D.M.A.E. Jonkers ◽  
L.W.E. van Heurn ◽  
M.J. Pierik ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ileal Pouch ◽  
Ileal Pouch Anal Anastomosis ◽  
Younger Patients ◽  
Term Function ◽  
Anal Anastomosis

Transanal Ileal Pouch-Anal Anastomosis for Ulcerative Colitis has Comparable Long-Term Functional Outcomes to Transabdominal Approach: A Multicentre Comparative Study

2019 ◽  
Vol 14 (6) ◽  
pp. 726-733 ◽  
Author(s):  
Pramodh Chandrasinghe ◽  
Michele Carvello ◽  
Karin Wasmann ◽  
Caterina Foppa ◽  
Pieter Tanis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ulcerative Colitis ◽  
Functional Outcomes ◽  
Ileal Pouch ◽  
Cohort Analysis ◽  
Ileal Pouch Anal Anastomosis ◽  
Global Quality Of Life ◽  
Anal Anastomosis

Abstract Background The transanal approach to ileal pouch-anal anastomosis [Ta-IPAA] provides better access to the lower pelvis with lower short-term morbidity in ulcerative colitis [UC]. The aim of this study was to assess the long-term functional outcomes after Ta-IPAA vs transabdominal IPAA [Abd-IPAA] in UC. Methods A multicentre cohort analysis was performed between March 2002 and September 2017. Patient characteristics, surgical details and postoperative outcomes were compared. CGQL [Cleveland global quality of life] score at 12 months with a functioning pouch was considered the primary end point. Results A total of 374 patients [100 Ta-IPAA vs 274 Abd-IPAA] were included. Ta-IPAA demonstrated a comparable overall quality of life [CGQL score] to Abd-IPAA [0.75 ± 0.11 vs 0.71 ± 0.14; respectively, p = 0.1]. Quality of life [7.71 ± 1.17 vs 7.30 ± 1.46; p = 0.04] and energy-level items [7.16 ± 1.52 vs 6.66 ± 1.68; p = 0.03] were significantly better after Ta-IPAA, while the quality of health item was comparable [7.68 ± 1.26 vs 7.64 ± 1.44; p = 0.96]. Analysis excluding anastomotic leaks did not change the overall CGQL scores. Stool frequencies [>10/24 h: 22% vs 21%; p = 1.0] and the rate of a single episode of major incontinence during the following 12-month period [27% vs 26%; p = 0.89] were similar. The differences in 30-day morbidity rates [33% vs 41%; p = 0.2] and anastomotic leak rates were not significant [6% vs 13%; p = 0.09]. Conclusions This study provides evidence of comparable long-term functional outcome and quality of life after Ta-IPAA and Abd-IPAA for UC.

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