scholarly journals Proctocolectomy and Ileostomy for Ulcerative Colitis: The Longer Term Story

1989 ◽  
Vol 82 (7) ◽  
pp. 386-387 ◽  
Author(s):  
R K S Phillips ◽  
J K Ritchie ◽  
P R Hawley
Keyword(s):  
Ulcerative Colitis ◽  
Large Bowel ◽  
Elective Surgery ◽  
Ileoanal Pouch ◽  
Total Proctocolectomy ◽  
First Year ◽  
One Stage ◽  
Ileoanal Pouch Anastomosis ◽  
Conventional Ileostomy

Elective surgery for ulcerative colitis usually involves the removal of the entire large bowel with either a conventional ileostomy or the formation of an ileoanal pouch anastomosis. Seventy patients undergoing a one stage elective total proctocolectomy and ileostomy between 1976 (the first year an ileoanal pouch was carried out in this hospital) and 1986 have been studied. We have confirmed that proctocolectomy and ileostomy for ulcerative colitis is not the trouble free operation many presume it to be when considering the alternative of an ileoanal pouch.

scholarly journals Adaptive Returns of Deficient Systemic Plasma Immunoglobulin G Levels as Rehabilitation Biomarker After Emergency Colectomy for Fulminant Ulcerative Colitis

2017 ◽  
Vol 10 ◽  
pp. 117955221774669
Author(s):  
Alexander T Hawkins ◽  
Jun W Um ◽  
Amosy E M’Koma
Keyword(s):  
Ulcerative Colitis ◽  
Immunoglobulin G ◽  
Elective Surgery ◽  
Loop Ileostomy ◽  
Ileoanal Pouch ◽  
Lymphoid Tissues ◽  
Emergency Colectomy ◽  
Terminal Ileostomy ◽  
Pouch Operation ◽  
Quiescent Disease

Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for ulcerative colitis (UC). Emergency colectomies are performed for fulminant colitis (ie, toxic megacolon, profuse bleeding, perforation, or sepsis). The RPC and IPAA involve manipulation of the proximal ileum, which may influence the essential physiological function of gut-associated lymphoid tissues. Circulating plasma immunoglobulin G (p-IgG) deficiency is observed in patients with fulminant UC. In addition, increased levels have been reported in colonic tissues of active UC compared with quiescent disease. We aimed to examine levels of p-IgG for clinical evaluation following emergency colectomies in patients with fulminant UC compared with patients with quiescent disease having elective RPC operations. In total 45 patients received an ileoanal pouch (IAP) due to UC. In all, 27 patients were men and 18 were women. The mean age was 34 years (range: 18-55). Because of fulminant UC, 26 patients had emergency subtotal colectomies with terminal ileostomy (TI). During second operation, the rectum was excised, and an IAP with diverting loop ileostomy (DLI) was performed. Nineteen patients had elective operations and had colectomies performed in conjunction with the pouch operation. Mucosectomy was performed in all groups. As a last procedure, the DLI was closed. Blood samples for immunoglobulin G (IgG) analyses were collected from each patient before the colectomy, after the colectomy with TI (before construction of the pouch), during the period with pouches (prior to DLI closure), and at 1, 2, and 3 years and at mean 13.7 years (range: 10-20) after DLI closure. Immunoglobulin G was determined by immunonephelometric assay technique. The statistics were analyzed by analysis of variance and linear regression. Preoperatively, p-IgG was significantly lower in the patients who had emergency operations compared with the group that had elective operations, 9.9 ± 3.0 vs 11.5 ± 3.3 g/L ( P < .03). During the manipulative period with TI and/or DLI, the p-IgG levels were increased in both points, but the increase was not statistically significant ( P = .26 and P = .19). During functional IAP at 1, 2, and 3 years and at mean 13.7 years (range: 10-20), there was a statistical increase in p-IgG levels ( P < .002, P < .005, P < .005, and P < .0001) compared with preoperative levels. These changes did not correlate with episodes of pouchitis ( P = .51). In patients having elective operations, p-IgG did not change preoperatively. After 12 months with functional pouches, the p-IgG levels were similar in both groups to the elective patient group preoperatively. In conclusion, p-IgG was found to be significantly lower in the emergency surgery patients compared with the elective surgery group preoperatively. This difference was probably due to increased losses and impaired gut lymphoid tissue production of IgG in the acute fulminant phase of UC. After 12 months of DLI closure, significant differences were no longer found between the emergency and elective surgery groups. Restoration and increased p-IgG levels after RPC would be due to an exaggerated response to make up for lower precolectomy values and may be interpreted as a rehabilitation biomarker.

scholarly journals Pouchitis

1998 ◽  
Vol 7 (3) ◽  
pp. 175-181 ◽  
Author(s):  
W. R. Schouten
Keyword(s):  
Ulcerative Colitis ◽  
Small Bowel ◽  
Chronic Inflammation ◽  
Clinical Course ◽  
Bacterial Overgrowth ◽  
Ileoanal Pouch ◽  
Continent Ileostomy ◽  
Endoscopic Findings ◽  
Ileoanal Pouch Anastomosis

Pouchitis is a major long-term complication of the continent ileostomy as well as the ileoanal pouch anastomosis. When diagnosed on the basis of clinical, endoscopic and histologic features, this syndrome has been demonstrated almost exclusively in patients with ulcerative colitis. The clinical course, the endoscopic findings and the histologic abnormalities resemble those of ulcerative colitis. The association with extra-intestinal manifestations further supports the hypothesis that pouchitis represents ulcerative colitis in the small bowel. All ileal reservoirs show bacterial overgrowth, especially of anaerobes. As a response to this altered intraluminal environment chronic inflammation and incomplete colonic metaplasia occur. The efficiency of metronidazole does suggest that bacteriological factors play an important role in the pathogenesis of pouchitis.

Ulcerative Colitis: Biological Therapy or Ileoanal Pouch Anastomosis?

2017 ◽  
Vol 225 (4) ◽  
pp. e14
Author(s):  
Julio F. Leite ◽  
Ana S. Oliveira ◽  
Manuel Rosete ◽  
Antonio C. Manso ◽  
Francisco Portela ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Biological Therapy ◽  
Ileoanal Pouch ◽  
Ileoanal Pouch Anastomosis

W1090 Prospective Observation of Quality of Life in Patients with Ulcerative Colitis Undergoing the Ileoanal Pouch Anastomosis

2009 ◽  
Vol 136 (5) ◽  
pp. A-651
Author(s):  
Jeanne Tung ◽  
William A. Faubion ◽  
Edward V. Loftus ◽  
Eric Tibesar ◽  
John H. Pemberton ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ulcerative Colitis ◽  
Ileoanal Pouch ◽  
Ileoanal Pouch Anastomosis

Mesenteric lengthening in ileoanal pouch anastomosis for ulcerative colitis

1998 ◽  
Vol 41 (7) ◽  
pp. 862-866 ◽  
Author(s):  
Ph. Martel ◽  
N. Majery ◽  
B. Savigny ◽  
A. Sezeur ◽  
D. Gallot ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Ileoanal Pouch ◽  
Ileoanal Pouch Anastomosis
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