| |
| Ileostomy Pouch |
| |
| |
|
| |
| |
| |
(source: Southern Medical Journal).
More Information (source: Southern Medical Journal).
|
12/31/1969 03:59 PM
|
|
Continent Ileostomy
|
The continent ileostomy, consisting of a valve and a pouch, makes available an alternative system in which intestinal discharge can be stored and controlled after coloproctectomy. Earlier concerns regarding valve slippage with resulting malfunction have been largely eliminated by recent modifications in the technique of valve contruction. A continent ileostomy was provided for 19 patients. In the first five, an antiperistaltic (Kock) valve was constructed and two had dessusception which necessitated reoperation. In the 16 cases in which an isoperistaltic valve was fashioned, there has been no slippage. These improvements, along with the significant enhancement of the quality of life, indicate a need to reexamine the advisability of providing a spout-type ileostomy in those cases favorable to the construction of a continent ileostomy.
(C) 1983 Southern Medical Association
|
|
12/31/1969 03:59 PM
|
|
Loop IleoStomy: A Reliable Method of Diversion
|
colon; Between September 1983 and March 1989, 36 loop ileostomies were performed on 34 patients (16 male and 18 female, mean age 36 years, range 11 to 68). Thirty-two patients had ileoanal pouch procedures (30 for ulcerative colitis and two for familial polyposis). One patient had a low anterior resection and another had a coloanal procedure. By the time of this review, 31 of the loop ileostomies were closed. The average time before closure was 5 months and the average length of follow-up was 37 months. All stomas were brought out through the rectus muscle in the right side of the abdomen, without ileal rotation, mesenteric fixation, or parastomal fascial sutures. A support rod was left in place for 3 to 4 weeks postoperatively. There were no major difficulties with skin irritation or appliance management and no instance of parastomal abscess and stoma retraction. Although no complications related to the ostomy or its closure were encountered in these patients, small bowel obstruction before closure (8 patients) or after takedown (5 patients) of the loop ileostomy required operative correction in one patient in each group.
(C) 1994 Southern Medical Association
|
|
12/31/1969 03:59 PM
|
|
Current Controversies in Pouch Surgery
|
Restorative proctocolectomy with ileal pouch anal anastomosis has become the most commonly used procedure for elective treatment of patients with mucosal ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in an attempt to obtain optimal functional results with low morbidity and mortality, and yet provide a cure for the disease. These modifications of the technique are discussed in this review, limited to the current points of controversy. We reviewed the current literature describing restorative proctocolectomy with ileal pouch anal anastomosis. The current "hot topics" for debate are transanal mucosectomy with hand-sewn anastomosis versus the double-stapled technique, the use of diverting ileostomy, indeterminate colitis, the role of laparoscopy, and indications for pouch surgery in the elderly. Longer follow-up of patients and increased knowledge and experience with pouch surgery, coupled with active prospective evaluation of the procedure are required to settle these issues. Patients must be fully informed to understand inherent risks of each choice.
(C) 2003 Southern Medical Association
|
|
12/31/1969 03:59 PM
|
|
Continent Intestinal Reservoir
|
colon; In this series, 170 patients have received a continent intestinal reservoir, with follow-up of one to eight years. In 126 a conventional ileostomy was converted to a continent intestinal reservoir, 38 at the time of coloproctectomy. Six had an unsatisfactory ileoanal or ileorectal anastomosis initially, and 26 (15%) required revisional surgery for problems involving the reservoir or valve. The incidence of valve slippage was 3%. Eighty-five percent achieved a normally functioning small bowel reservoir with one operation, and 19 more patients were added with one additional operation, for an ultimate good result of 96% with two operations at most. The average reservoir capacity is 400 ml, and most patients empty the pouch two or three times per day. Under favorable circumstances, the continent intestinal reservoir is preferable for most patients after coloproctectomy.
(C) 1987 Southern Medical Association
|
|
|
|
| |
|
|
|
