| |
| Ulcerative Colitis Pouch |
| J Pouch, Ileal J Pouch, Ileal j pouch reconstruction, ileal s pouch reconstruction & ileal w pouch reconstruction are also referred as ileal reservoir reconstruction, ileal pouch-anal anastomosis (IPAA), restorative proctocolectomy. Patient with medical conditions of ulcerative colitis or familial polypsis or certain types of colon cancer are subjected to ileal pouch reconstruction. The procedure results in removing colon & most of the rectum, leaving the anal sphincter muscle intact. J-pouch or reservoir is surgically constructed from the small intestine. An opening is made at the bottom of the pouch & sewn or stapled to the anal muscles to restore the intestinal passage. |
| |
|
| |
| |
| |
(source: Southern Medical Journal).
More Information (source: Southern Medical Journal).
|
12/31/1969 03:59 PM
|
|
Current Status of Sphincter-Saving Operations for Chronic Ulcerative Colitis
|
When surgery is demanded by the course of a patient with ulcerative colitis, the sphincter mechanism can be spared. The straight ileoanal anastomosis without a reservoir has not been satisfactory for adults because of frequent diarrheal stools. The ileorectal anastomosis has the advantage of minimal morbidity, but the patient is not totally cured, because the diseased rectum is still in place. The pouch pull-through procedure has an increased morbidity, but the patient is cured of ulcerative colitis. The anastomotic stricture rate is 7% to 15% and the failure rate, 2% to 6%. Inflammation of the pouch or reservoir occurs in 5% to 19%. There have been no deaths in the reviewed series. As the details of the pouch pull-through procedure are refined, this operation will become the choice for treatment of ulcerative colitis.
(C) 1985 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
|
|
Restorative Proctocolectomy: Ochsner Clinic Experience
|
Background. Restorative proctocolectomy, a standard operation for ulcerative colitis and familial adenomatous polyposis has significant complications, even in experienced hands.
Methods. We studied surgical outcome by retrospectively reviewing cases of restorative proctocolectomy done at Ochsner Foundation Hospital from 1982 to 1995. Demographic and clinical data from two periods (1982 to 1989 and 1989 to 1995) were compared to determine factors associated with improved outcome.
Results. We performed 145 ileal pouch-anal procedures. In 56 patients, 104 complications occurred. The more recent group had a greater incidence of inflammatory bowel disease, steroid use, and staged operations; reduced operative times and hospital stays; more general but fewer pouch-related complications. Pouch failures were similar for both groups.
Conclusions. Perioperative outcome appeared to be associated with technical experience, improved perioperative care, exclusion of patients with Crohn's disease, judicious surgical reoperation for pouch complications, and use of a 3-stage procedure in malnourished patients or those with acute or toxic colitis.
(C) 2001 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
|
|
|
|
| |
|
|
|
