scholarly journals Hyperspectral Imaging: A New Intraoperative Tool for Pouch Assessment in Patients Undergoing Restorative Proctocolectomy

2021 ◽  
pp. 1-7
Author(s):  
Boris Jansen-Winkeln ◽  
Jonathan P. Takoh ◽  
Claire Chalopin ◽  
Marianne Maktabi ◽  
Orestis Lyros ◽  
...  
Keyword(s):  
Hyperspectral Imaging ◽  
Restorative Proctocolectomy ◽  
Near Infrared ◽  
Ileal Pouch ◽  
Postoperative Course ◽  
Non Invasive ◽  
Anal Anastomosis ◽  
J Pouch ◽  
Pouch Operation ◽  
Contact Free

<b><i>Introduction:</i></b> Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a challenging operation. Especially the mobilization of the pouch into the pelvis can be complex. Adequate perfusion of the pouch is required for optimal healing and functioning. <b><i>Methods:</i></b> With hyperspectral imaging (HSI) wavelengths between 500 and 1,000 nm can be analyzed in addition to visible light and by reflecting patterns. This intraoperative procedure is non-invasive, contact-free, and no contrast medium is needed. Fifteen patients undergoing IPAA were examined prospectively, and the pouch was evaluated by HSI intraoperatively. HSI was measured in standardized fashion at 4 defined locations of the J-pouch. Each measurement took about 10 s. The clinical postoperative course was assessed in all patients and correlated to the intraoperative HSI findings. <b><i>Results:</i></b> Mean near-infrared perfusion and oxygenation of patients showed values ≥74% for all defined pouch areas, revealing good blood supply. Three minor anastomotic leaks were detected by standard pouchoscopy in the postoperative course, which could be treated conservatively with endosponge therapy. <b><i>Conclusion:</i></b> HSI values of perfusion and oxygenation of the IPAA were high. The leak rate is associated with redo procedures. This is reflected by the current literature and most likely related to the higher complexity of the revisional pouch operation. HSI has proved itself as a quick and effective new intraoperative tool to evaluate pouch perfusion objectively and quantitatively.

scholarly journals Two-time perforation of the ileal J-pouch 6 and 18 years after restorative proctocolectomy and ileal pouch–anal anastomosis for familial adenomatous polyposis: a case report

2022 ◽  
Vol 8 (1) ◽  
Author(s):  
Kengo Shibata ◽  
Shota Ebinuma ◽  
Sodai Sakamoto ◽  
Asami Suzuki ◽  
Yasunobu Terasaki ◽  
...  
Keyword(s):  
Familial Adenomatous Polyposis ◽  
Restorative Proctocolectomy ◽  
Ileal Pouch ◽  
Anastomotic Stricture ◽  
Abdominal Cavity ◽  
Ileal Pouch Anal Anastomosis ◽  
Intraluminal Pressure ◽  
Adenomatous Polyposis ◽  
Anal Anastomosis ◽  
J Pouch

Abstract Background Perforation of the ileal J-pouch after restorative proctocolectomy and ileal pouch–anal anastomosis are extremely rare. There has been no report of perforation of the ileal J-pouch occurring twice over several years. We report the first case of perforation at 6 and 18 years following restorative proctocolectomy. Case presentation The patient was a 52-year-old man who underwent a two-stage restorative proctocolectomy with a hand-sewn ileal J-pouch anal anastomosis due to familial adenomatous polyposis and sigmoid colon cancer at 34 years of age. At the age of 40, he underwent ileal pouch resection at its blind end, abdominal drainage, and anastomotic dilatation. The patient had a perforation of the blind end of the ileal J-pouch from increased intraluminal pressure, with anastomotic stricture and pervasive peritonitis. The patient had no symptoms for a few years; however, 18 years after the initial surgery and 12 years after the first perforation, the patient presented with severe abdominal pain. Computed tomography demonstrated pneumoperitoneum; accordingly, laparotomy was performed. Upon opening the abdominal cavity, contaminated ascites and inflammatory changes were documented involving the ileum. A 2-mm perforation involving the blind end of the ileal J-pouch was also observed and repaired, followed by temporary loop ileostomy creation. Postoperative endoscopy revealed an ulcer in the ileal J-pouch and a stricture located directly at the anastomosis. Conclusions The blind end of the J-pouch repeatedly perforated over the years due to recurrent anastomotic stricture. Regular surveillance is, therefore, considered necessary for the release of stricture, maintenance of anastomotic patency, and prevention of ileal J-pouch perforation.

scholarly journals Pouchitis: extracolonic manifestation of ulcerative colitis?

1999 ◽  
Vol 54 (5) ◽  
pp. 155-158 ◽  
Author(s):  
William Gemio Jacobsen Teixeira ◽  
José Hyppólito da Silva ◽  
Magaly Gemio Teixeira ◽  
Maristela Almeida ◽  
João Elias Calache ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Restorative Proctocolectomy ◽  
Ileal Pouch ◽  
Growth Failure ◽  
Ileal Pouch Anal Anastomosis ◽  
Frequent Complication ◽  
Anal Anastomosis ◽  
J Pouch ◽  
The One

Pouchitis is the most frequent complication of ileal pouch-anal anastomosis for treatment of ulcerative colitis. There are several possible explanations. Among them, we focus on the one that considers pouchitis as an extracolonic manifestation of ulcerative colitis. The aim of this study was to investigate the association between pouchitis and extra-intestinal manifestations (EIM), which are frequent in these patients. Sixty patients underwent restorative proctocolectomy with an ileal J pouch (IPAA) from September 1984 to December 1998. Pouchitis was defined by clinical, endoscopic, and histologic criteria. The following extra-intestinal manifestations were studied: articular, cutaneous, hepatobiliary, ocular, genitourinary, and growth failure. Thirteen patients, of which 10 were female (76.9%), developed one or more episodes of pouchitis. Twelve patients of this group (92.3%) presented some kind of extra-intestinal manifestation, 4 pre-operatively (exclusively), 2 post-operatively (exclusively), and 6 both pre- and post-operatively (1.7 per patient). Twenty patients (42.7%) of the 47 without pouchitis did not present extra-intestinal manifestations; 10/35 (28.5%) of females had pouchitis, compared to 3/35 (12.0%) of men. Pouchitis was more frequent among females, though not statistically significant. EIM increases the risk of pouchitis. Pouchitis is related to EIM in 92.3 % of cases, corroborating the hypothesis that it could be an extracolonic manifestation of ulcerative colitis.

scholarly journals Restorative Proctocolectomy: When to Propose and When to Avoid

2021 ◽  
Author(s):  
Marisa D. Santos
Keyword(s):  
Ulcerative Colitis ◽  
Familial Adenomatous Polyposis ◽  
Restorative Proctocolectomy ◽  
Ileal Pouch ◽  
Adenomatous Polyposis ◽  
Entire Colon ◽  
Anal Anastomosis ◽  
Colon And Rectum ◽  
Complex Surgery ◽  
Over Time

Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA) is a surgical procedure performed when excising the entire colon and rectum is need and reconstitution of the intestinal transit through an ileal pouch is made with anastomosis to the anus. It is mainly used to treat patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC). It is a complex surgery with potential complications, and the functional outcomes can be worse over time. So, it is essential to select the appropriate patient, proceed to a correct surgical technique, and know-how to deal with and solve the main ileal pouch complications. This chapter intends to be a reflection on this subject.

Restorative proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis revisited

2006 ◽  
Vol 5 (3) ◽  
pp. 241-260 ◽  
Author(s):  
Alex Kartheuser ◽  
Pierre Stangherlin ◽  
Dimitri Brandt ◽  
Christophe Remue ◽  
Christine Sempoux
Keyword(s):  
Familial Adenomatous Polyposis ◽  
Restorative Proctocolectomy ◽  
Ileal Pouch ◽  
Ileal Pouch Anal Anastomosis ◽  
Adenomatous Polyposis ◽  
Anal Anastomosis
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