Colonic Pouches: Sacs or reservoirs created to function in place of the COLON and/or RECTUM in patients who have undergone restorative proctocolectomy (PROCTOCOLECTOMY, RESTORATIVE).Colon: The segment of LARGE INTESTINE between the CECUM and the RECTUM. It includes the ASCENDING COLON; the TRANSVERSE COLON; the DESCENDING COLON; and the SIGMOID COLON.Colonic Diseases: Pathological processes in the COLON region of the large intestine (INTESTINE, LARGE).Cheek: The part of the face that is below the eye and to the side of the nose and mouth.Colonic Neoplasms: Tumors or cancer of the COLON.Proctocolectomy, Restorative: A surgical procedure involving the excision of the COLON and RECTUM and the formation of an ILEOANAL RESERVOIR (pouch). In patients with intestinal diseases, such as ulcerative colitis, this procedure avoids the need for an OSTOMY by allowing for transanal defecation.Douglas' Pouch: A sac or recess formed by a fold of the peritoneum.Pouchitis: Acute INFLAMMATION in the INTESTINAL MUCOSA of the continent ileal reservoir (or pouch) in patients who have undergone ILEOSTOMY and restorative proctocolectomy (PROCTOCOLECTOMY, RESTORATIVE).Intestinal Mucosa: Lining of the INTESTINES, consisting of an inner EPITHELIUM, a middle LAMINA PROPRIA, and an outer MUSCULARIS MUCOSAE. In the SMALL INTESTINE, the mucosa is characterized by a series of folds and abundance of absorptive cells (ENTEROCYTES) with MICROVILLI.Colonic Polyps: Discrete tissue masses that protrude into the lumen of the COLON. These POLYPS are connected to the wall of the colon either by a stalk, pedunculus, or by a broad base.Colitis, Ulcerative: Inflammation of the COLON that is predominantly confined to the MUCOSA. Its major symptoms include DIARRHEA, rectal BLEEDING, the passage of MUCUS, and ABDOMINAL PAIN.Colitis: Inflammation of the COLON section of the large intestine (INTESTINE, LARGE), usually with symptoms such as DIARRHEA (often with blood and mucus), ABDOMINAL PAIN, and FEVER.Mesocricetus: A genus of the family Muridae having three species. The present domesticated strains were developed from individuals brought from Syria. They are widely used in biomedical research.Gastrointestinal Motility: The motor activity of the GASTROINTESTINAL TRACT.Macropodidae: A family of herbivorous leaping MAMMALS of Australia, New Guinea, and adjacent islands. Members include kangaroos, wallabies, quokkas, and wallaroos.Gastrointestinal Transit: Passage of food (sometimes in the form of a test meal) through the gastrointestinal tract as measured in minutes or hours. The rate of passage through the intestine is an indicator of small bowel function.Colonic Pseudo-Obstruction: Functional obstruction of the COLON leading to MEGACOLON in the absence of obvious COLONIC DISEASES or mechanical obstruction. When this condition is acquired, acute, and coexisting with another medical condition (trauma, surgery, serious injuries or illness, or medication), it is called Ogilvie's syndrome.Ileostomy: Surgical creation of an external opening into the ILEUM for fecal diversion or drainage. This replacement for the RECTUM is usually created in patients with severe INFLAMMATORY BOWEL DISEASES. Loop (continent) or tube (incontinent) procedures are most often employed.Diverticulosis, Colonic: A pathological condition characterized by the presence of a number of COLONIC DIVERTICULA in the COLON. Its pathogenesis is multifactorial, including colon aging, motor dysfunction, increases in intraluminal pressure, and lack of dietary fibers.Defecation: The normal process of elimination of fecal material from the RECTUM.Anal Canal: The terminal segment of the LARGE INTESTINE, beginning from the ampulla of the RECTUM and ending at the anus.Anastomosis, Surgical: Surgical union or shunt between ducts, tubes or vessels. It may be end-to-end, end-to-side, side-to-end, or side-to-side.Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease.Rectal Neoplasms: Tumors or cancer of the RECTUM.Digestive System Surgical Procedures: Surgery performed on the digestive system or its parts.Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus.Rectum: The distal segment of the LARGE INTESTINE, between the SIGMOID COLON and the ANAL CANAL.Reconstructive Surgical Procedures: Procedures used to reconstruct, restore, or improve defective, damaged, or missing structures.Ileitis: Inflammation of any segment of the ILEUM and the ILEOCECAL VALVE.Adenomatous Polyposis Coli: A polyposis syndrome due to an autosomal dominant mutation of the APC genes (GENES, APC) on CHROMOSOME 5. The syndrome is characterized by the development of hundreds of ADENOMATOUS POLYPS in the COLON and RECTUM of affected individuals by early adulthood.Colostomy: The surgical construction of an opening between the colon and the surface of the body.Crohn Disease: A chronic transmural inflammation that may involve any part of the DIGESTIVE TRACT from MOUTH to ANUS, mostly found in the ILEUM, the CECUM, and the COLON. In Crohn disease, the inflammation, extending through the intestinal wall from the MUCOSA to the serosa, is characteristically asymmetric and segmental. Epithelioid GRANULOMAS may be seen in some patients.Double-Blind Method: A method of studying a drug or procedure in which both the subjects and investigators are kept unaware of who is actually getting which specific treatment.Remission Induction: Therapeutic act or process that initiates a response to a complete or partial remission level.Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.Duodenoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the duodenum.Gastrointestinal Agents: Drugs used for their effects on the gastrointestinal system, as to control gastric acidity, regulate gastrointestinal motility and water flow, and improve digestion.Antirheumatic Agents: Drugs that are used to treat RHEUMATOID ARTHRITIS.Anti-Inflammatory Agents: Substances that reduce or suppress INFLAMMATION.Recovery of Function: A partial or complete return to the normal or proper physiologic activity of an organ or part following disease or trauma.Jervell-Lange Nielsen Syndrome: A form of long QT syndrome that is associated with congenital deafness. It is characterized by abnormal cardioelectrophysiology involving the VOLTAGE-GATED POTASSIUM CHANNEL. It results from mutation of KCNQ1 gene (Subtype 1 or JLN1) or the KCNE1 gene (Subtype 2 or JLN2).Peer Review: An organized procedure carried out by a select committee of professionals in evaluating the performance of other professionals in meeting the standards of their specialty. Review by peers is used by editors in the evaluation of articles and other papers submitted for publication. Peer review is used also in the evaluation of grant applications. It is applied also in evaluating the quality of health care provided to patients.Retrospective Moral Judgment: The application of current standards of morality to past actions, institutions, or persons.Complicity: Association with or participation in an act that is, or is perceived to be, criminal or immoral. One is complicitous when one promotes or unduly benefits from practices or institutions that are morally or legally suspect.HistoryPeer Review, Health Care: The concurrent or retrospective review by practicing physicians or other health professionals of the quality and efficiency of patient care practices or services ordered or performed by other physicians or other health professionals (From The Facts On File Dictionary of Health Care Management, 1988).Peer Review, Research: The evaluation by experts of the quality and pertinence of research or research proposals of other experts in the same field. Peer review is used by editors in deciding which submissions warrant publication, by granting agencies to determine which proposals should be funded, and by academic institutions in tenure decisions.PubMed: A bibliographic database that includes MEDLINE as its primary subset. It is produced by the National Center for Biotechnology Information (NCBI), part of the NATIONAL LIBRARY OF MEDICINE. PubMed, which is searchable through NLM's Web site, also includes access to additional citations to selected life sciences journals not in MEDLINE, and links to other resources such as the full-text of articles at participating publishers' Web sites, NCBI's molecular biology databases, and PubMed Central.Periodicals as Topic: A publication issued at stated, more or less regular, intervals.BooksPublishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing.MEDLINE: The premier bibliographic database of the NATIONAL LIBRARY OF MEDICINE. MEDLINE® (MEDLARS Online) is the primary subset of PUBMED and can be searched on NLM's Web site in PubMed or the NLM Gateway. MEDLINE references are indexed with MEDICAL SUBJECT HEADINGS (MeSH).Serial Publications: Publications in any medium issued in successive parts bearing numerical or chronological designations and intended to be continued indefinitely. (ALA Glossary of Library and Information Science, 1983, p203)Biological Science Disciplines: All of the divisions of the natural sciences dealing with the various aspects of the phenomena of life and vital processes. The concept includes anatomy and physiology, biochemistry and biophysics, and the biology of animals, plants, and microorganisms. It should be differentiated from BIOLOGY, one of its subdivisions, concerned specifically with the origin and life processes of living organisms.

Similar outcome after colonic pouch and side-to-end anastomosis in low anterior resection for rectal cancer: a prospective randomized trial. (1/75)

OBJECTIVES: To compare a colonic J-pouch or a side-to-end anastomosis after low-anterior resection for rectal cancer with regard to functional and surgical outcome. SUMMARY BACKGROUND DATA: A complication after restorative rectal surgery with a straight anastomosis is low-anterior resection syndrome with a postoperatively deteriorated anorectal function. The colonic J-reservoir is sometimes used with the purpose of reducing these symptoms. An alternative method is to use a simple side-to-end anastomosis. METHODS: One-hundred patients with rectal cancer undergoing total mesorectal excision and colo-anal anastomosis were randomized to receive either a colonic pouch or a side-to-end anastomosis using the descending colon. Surgical results and complications were recorded. Patients were followed with a functional evaluation at 6 and 12 months postoperatively. RESULTS: Fifty patients were randomized to each group. Patient characteristics in both groups were very similar regarding age, gender, tumor level, and Dukes' stages. A large proportion of the patients received short-term preoperative radiotherapy (78%). There was no significant difference in surgical outcome between the 2 techniques with respect to anastomotic height (4 cm), perioperative blood loss (500 ml), hospital stay (11 days), postoperative complications, reoperations or pelvic sepsis rates. Comparing functional results in the 2 study groups, only the ability to evacuate the bowel in <15 minutes at 6 months reached a significant difference in favor of the pouch procedure. CONCLUSIONS: The data from this study show that either a colonic J-pouch or a side-to-end anastomosis performed on the descending colon in low-anterior resection with total mesorectal excision are methods that can be used with similar expected functional and surgical results.  (+info)

Long-term functional results after ileal pouch anal restorative proctocolectomy for ulcerative colitis: a prospective observational study. (2/75)

OBJECTIVE: To document functional results in patients treated with an ileal pouch anal anastomosis (IPAA). SUMMARY BACKGROUND DATA: The restorative proctocolectomy with IPAA has become the procedure of choice for patients with ulcerative colitis, yet the long-term functional results are not well known. METHODS: We performed this prospective observational study in 391 consecutive patients (56% male; mean age, 33.7 +/- 10.8 years; range, 12-66 years) who underwent an IPAA between 1987 and 2002 (mean follow-up, 33.6 months; range, 0 to 180 months). RESULTS: The majority of patients underwent the procedure under elective circumstances with a hand-sewn ileal pouch anal anastomosis and a protective ileostomy. In 25 patients (6.4%), the procedure was performed under urgent conditions; in 137 patients (35%), the temporary ileostomy was omitted; in 117 patients (29.9%), the ileal pouch anal anastomosis was stapled. There was 1 hospital mortality (0.25%) and 1 30-day mortality. Mean length of stay was 9.2 +/- 5.6 days (3-68 days; median, 8 days) and was increased by the occurrence of septic complications (8.9 versus 13.6 days; P < 0.02) and by the omission of a temporary ileostomy (8.3 versus 10.4 days; P = 0.005). Complications included pelvic abscess (1.3%), anastomotic dehiscence (6.4%), bowel obstruction (11.7%), and anastomotic stenosis in need of mechanical dilatation (10.7%). Patients were asked to record their functional results on a questionnaire for 1 week at 3, 6, 9, 12, 18, and 24 months after the IPAA and yearly thereafter. Our data to 10 years show that median number of bowel movements (bms) was 6 bm/24 hours at all time intervals. The average number of bms increased by 0.3 bm/decade of life (P < 0.001). Throughout the entire follow-up, more than 75% of patients had at least 1 bm most nights, although fewer than 40% found it necessary to alter the time of their meals to avoid bms at inappropriate times. Depending on the time interval, between 57% and 78% of patients were always able to postpone a bm until convenient, and this ability was similar in patients with a stapled or hand-sewn ileoanal anastomosis; only up to 18% were able to always distinguish between flatus and stools, and this ability was similar in patients with a stapled or hand-sewn ileoanal anastomosis. Complete daytime and nighttime continence was achieved by 53-76% of patients depending on the time interval. The percentage of fully continent patients was higher following the stapled rather than the hand-sewn technique (P < 0.001), and this difference persisted over time. When patients experienced incontinence, its occurrence ameliorated over time (P < 0.001), and the occurrence of perianal rash and itching as well as the use of protective pads decreased over time (P < 0.008). At 5 years, patients judged quality of life as much better or better in 81.4% and overall satisfaction and overall adjustment as excellent or good in 96.3% and 97.5%, respectively. CONCLUSIONS: We conclude that the IPAA confers a good quality of life. The majority of patients are fully continent, have 6 bms/d on average, and can defer a bm until convenient. When present, incontinence improves over time.  (+info)

Training in trauma surgery: quantitative and qualitative aspects of a new paradigm for fellowship. (3/75)

OBJECTIVE: To describe outcomes from a clinical trauma surgical education program that places the board-eligible/board-certified fellow in the role of the attending surgeon (fellow-in-exception [FIE]) during the latter half of a 2-year trauma/surgical critical care fellowship. SUMMARY BACKGROUND DATA: National discussions have begun to explore the question of optimal methods for postresidency training in surgery. Few objective studies are available to evaluate current training models. METHODS: We analyzed provider-specific data from both our trauma registry and performance improvement (PI) databases. In addition, we performed TRISS analysis when all data were available. Registry and PI data were analyzed as 2 groups (faculty trauma surgeons and FIEs) to determine experience, safety, and trends in errors. We also surveyed graduate fellows using a questionnaire that evaluated perceptions of training and experience on a 6-point Likert scale. RESULTS: During a 4-year period 7,769 trauma patients were evaluated, of which 46.3% met criteria to be submitted to the PA Trauma Outcome Study (PTOS, ie, more severe injury). The faculty group saw 5,885 patients (2,720 PTOS); the FIE group saw 1,884 patients (879 PTOS). The groups were similar in respect to mechanism of injury (74% blunt; 26% penetrating both groups) and injury severity (mean ISS faculty 10.0; FIEs 9.5). When indexed to patient contacts, FIEs did more operations than the faculty group (28.4% versus 25.6%; P < 0.05). Death rates were similar between groups (faculty 10.5%; FIEs 10.0%). Analysis of deaths using PI and TRISS data failed to demonstrate differences between the groups. Analysis of provider-specific errors demonstrated a slightly higher rate for FIEs when compared with faculty when indexed to PTOS cases (4.1% versus 2.1%; P < 0.01). For both groups, errors in management were more common than errors in technique. Twenty-one (91%) of twenty-three surveys were returned. Fellows' feelings of preparedness to manage complex trauma patients improved during the fellowship (mean 3.2 prior to fellowship versus 4.5 after first year versus 5.8 after FIE year; P < 0.05 by ANOVA). Eighty percent rated the FIE educational experience "great -5" or "exceptional- 6." Eighty-five percent consider the current structure of the fellowship (with FIE year) as ideal. Ninety percent would repeat the fellowship. CONCLUSION: The educational experience and training improvement offered by the inclusion of a FIE period during a trauma fellowship is exceptional. Patient outcomes are unchanged. The potential for an increased error rate is present during this period of clinical autonomy and must be addressed when designing the methods of supervision of care to assure concurrent senior staff review.  (+info)

Quantification of risk for pouch failure after ileal pouch anal anastomosis surgery. (4/75)

OBJECTIVE: To identify risk factors associated with ileal pouch failure and to develop a multifactorial model for quantifying the risk of failure in individual patients. SUMMARY BACKGROUND DATA Ileal pouch anal anastomosis (IPAA) has become the treatment choice for most patients with ulcerative colitis and familial adenomatous polyposis who require surgery. At present, there are no published studies that investigate collectively the interrelation of factors related to ileal pouch failure, nor are there any predictive indices for risk stratification of patients undergoing IPAA surgery. METHODS: Data from 23 preoperative, 7 intraoperative, and 10 postoperative risk factors were recorded from 1,965 patients undergoing restorative proctocolectomy in a single center between 1983 and 2001. Primary end point was ileal pouch failure during the follow-up period of up to 19 years. The "CCF ileal pouch failure" model was developed using a parametric survival analysis and a 70%:30% split-sample validation technique for model training and testing. RESULTS: The median patient follow-up was 4.1 year (range, 0-19 years). Five-year ileal pouch survival was 95.6% (95% CI, 94.4-96.7). The following risk factors were found to be independent predictors of pouch survival and were used in the final multivariate model: patient diagnosis, prior anal pathology, abnormal anal manometry, patient comorbidity, pouch-perineal or pouch-vaginal fistulae, pelvic sepsis, anastomotic stricture and separation. The model accurately predicted the risk of ileal pouch failure with adequate calibration statistics (Hosmer Lemeshow chi2 = 3.001; P = 0.557) and an area under the receiver operating characteristics curve of 82.0%. CONCLUSIONS: The CCF ileal pouch failure model is a simple and accurate way of predicting the risk of ileal pouch failure in clinical practice on a longitudinal basis. It may play an important role in providing risk estimates for patients wishing to make informed choices on the type of treatment offered to them.  (+info)

Short- and long-term outcomes of ileal pouch-anal anastomosis for ulcerative colitis. (5/75)

Ileal pouch-anal anastomosis was an important advancement in the treatment of ulcerative colitis. The aim of this study was to determine whether early complications of ileal pouch-anal anastomosis in patients with ulcerative colitis are associated with poor late functional results. PATIENTS AND METHODS: Eighty patients were operated on from 1986 to 2000, 62 patients with ileostomy and 18 without. The early and late complications were recorded. Specific emphasis has been placed on the incidence of pouchitis with prolonged follow-up. RESULTS: The ileostomy was closed an average of 9.2 months after the first operation. Fourteen patients were excluded from the long-term evaluation; 6 patients were lost to regular follow-up, 4 died, and 4 patients still have the ileostomy. Of the 4 patients that died, 1 died from surgical complications. Early complications after operation (41) occurred in 34 patients (42.5%). Late complications (29) occurred in 25 patients as follows: 16 had pouchitis, 3 associated with stenosis and 1 with sexual dysfunction; 5 had stenosis; and there was 1 case each of incisional hernia, ileoanal fistula, hepatic cancer, and endometriosis. Pouchitis occurred in 6 patients (9.8%) 1 year after ileal pouch-anal anastomosis, 9 (14.8%) after 3 years, 13 (21.3%) after 5 years, and 16 (26.2%) after more than 6 years. The mean daily stool frequency was 12 before and 5.8 after operation. One pouch was removed because of fistulas that appeared 2 years later. CONCLUSIONS: Ileal pouch-anal anastomosis is associated with a considerable number of early complications. There was no correlation between pouchitis and severe disease, operation with or without ileostomy, or early postoperative complications. The incidence of pouchitis was directly proportional to duration of time of follow-up.  (+info)

Could laparoscopic colon and rectal surgery become the standard of care? A review and experience with 750 procedures. (6/75)

INTRODUCTION: The benefits of the laparoscopic approach to colon and rectal surgery do not seem as great as for other laparoscopic procedures. To study this further we decided to review the current literature and the 10-year experience of a surgical group from university teaching hospitals in Montreal, Quebec and Toronto in performing laparoscopic colon and rectal surgery. METHODS: The prospectively designed case series comprised all patients having laparoscopic colon and rectal surgery. The procedures were carried out by a group of 4 surgeons between April 1991 and November 2001. We noted intraoperative complications, any conversions to open surgery, operating time, postoperative complications and postoperative length of hospital stay. RESULTS: The group attempted 750 laparoscopic colon and rectal procedures of which 669 were completed laparoscopically. Malignant disease was the indication for surgery in 49.6% of cases. Right hemicolectomy and sigmoid colectomy accounted for 54.5% of procedures performed. Intraoperative complications occurred in 8.3%, with 29.0% of these resulting in conversion to open surgery. The overall rate of conversion to open surgery was 10.8%, most commonly for oncologic concerns. Median operating time was 175 minutes for all procedures. Postoperative complications occurred in 27.5% of procedures completed laparoscopically but were mostly minor wound complications. Pulmonary complications occurred in only 1.0%. The anastomotic leak rate was 2.5%. The early reoperation rate was 2.4%. Postoperative mortality was 2.2%. No port site metastases have yet been detected. The median postoperative length of stay was 5 days. CONCLUSIONS: The clinical outcomes of laparoscopic colon and rectal surgery in this 10-year experience are consistent with numerous cohort studies and randomized clinical trials. Laparoscopic colon and rectal surgery in the hands of well-trained surgeons can be performed safely with short hospital stay, low analgesic requirements and acceptable complication rates compared with historical controls and other reports in the literature. Evidence from published randomized clinical trials is emerging that under these conditions laparoscopic resection represents the better treatment option for most benign conditions, but concerns regarding its appropriateness for malignant disease are still to be resolved.  (+info)

Continent diversions: the new gold standards of ileoanal reservoir and neobladder. (7/75)

In recent decades, surgical treatment of familial adenomatous polyposis, chronic ulcerative colitis, and muscle-invasive bladder cancer has undergone a revolution. Specifically, ileoanal reservoir and neobladder have become the new "gold standard" of definitive surgical therapy for these disorders. This article discusses issues in surgical construction, indications, contraindications, perioperative care concepts, and nursing and health professional implications related to these two procedures. These interventions include screening candidates for ileoanal reservoir or neobladder to rule out Crohn's disease or metastatic cancer and educating candidates for continent diversions about the proposed procedure(s) and associated events, potential complications, postoperative exercise, sexual health and function issues, and the benefits of support group participation so they can gain a realistic understanding of ultimate functional outcomes. Questions for future research are addressed.  (+info)

The effect of ageing on function and quality of life in ileal pouch patients: a single cohort experience of 409 patients with chronic ulcerative colitis. (8/75)

OBJECTIVE: To evaluate in what manner ageing affects functional outcome and quality of life (QoL) in patients with chronic ulcerative colitis (CUC) after ileal pouch-anal anastomosis (IPAA). SUMMARY BACKGROUND DATA: Short-term function and QoL after IPAA is good. However, patients are usually young, and little is known about the influence of time and ageing on long-term outcomes after IPAA. METHODS: Using a standardized questionnaire, functional outcome, QoL, and complications were assessed prospectively in a cohort of 409 patients followed annually for 15 years after IPAA. RESULTS: Follow-up was complete in the single cohort of 409 patients and functional and QoL outcomes summarized at 5, 10, and 15 years. Daytime stool frequency changed little (mean 6), while nighttime frequency increased from 1 stool to 2 stools. Incontinence for gas and stool increased from 1% to 10% during the day and from 2% to 24% at night over 15 years. The cumulative probability of pouchitis increased from 28% at 5 years to 38% at 10 years and to 47% at 15 years. Bowel obstruction and stricture were other principal long-term complications. At 15 years, 91% of patients had kept the same job. Work was not affected by the surgery in 83%, while social activities, sports, traveling, and sexual life all improved after surgery and did not deteriorate over time. CONCLUSIONS: These long-term results in a single cohort of 409 IPAA patients are unique and are likely a more accurate reflection of long-term outcome than has been previously reported. These data support the conclusion that IPAA is a durable operation for patients requiring proctocolectomy for CUC; functional and QoL outcomes are good, predictable, and stable for 15 years after operation.  (+info)

INTRODUCTION:. Ileal pouch anal anastomosis (IPAA) is the standard procedure for reconstruction after colectomy for ulcerative colitis (UC). However, ileorectal anastomosis (IRA) as an alternative has, recently experienced a revival. This study from a single center compares the clinical outcomes of these procedures.. METHODS:. From 1992 to 2006, 253 patients consecutively underwent either IRA (n=105) or IPAA (n=148). Selection to either procedure was determined on the basis of rectal inflammation, presence of dysplasia/cancer or patient preferences. Patient-records were retrospectively evaluated. Mean follow-up time was 5.4 and 6.3 years respectively.. RESULTS:. Major postoperative complications occurred in 12.4% of patients after IRA and in 12.8% after IPAA (ns). Complications of any kind after IRA or IPAA, even including subsequent stoma-closure, occurred in 23.8% and 39.9% respectively (p,0.01). Estimated cumulative failure rates after 5 and 10 years were 10.1% and 24.1% for IRA and 6.1% and ...
ASA 2018 Abstracts: Better Function With A Colonic J-pouch Or A Side-to-end Anastomosis? A Randomized Controlled Trial To Compare The Complications, Functional Outcome And Quality Of Life In Patients With Low Rectal Cancer After A J-pouch Or A Side-to- End Anastomosis
Pouch salvage surgeries can avoid RPC/IPAA surgery failure. Pouch salvage operations are divided to two groups: Trans perineal and trans abdominal approaches (8). In the trans abdominal approach, the surgeon mobilizes the pouch, and depending on the pouch condition and small bowel mesentery length, the pouch will be removed or left in place. Then mucosectomy of rectal mucosa down to dentate line will be performed and at the end, hand sewn pouch anal anastomosis will complete the operation. Diverting ileostomy will be performed in most cases. Trans perineal approaches include fistulotomy for very low fistulas, advancement flap or muscle transposition for high fistulas and pouch-vaginal fistulas, or rectal mucosectomy plus pouch mobilization with pouch anal anastomosis for remained rectal mucosa or stricture at pouch anal anastomosis site. Four major complications resulting in pouch surgery failure were observed with sepsis being the most common factor. Sepsis could occur early, immediately after ...
Colonic J-pouch is a type of neorectum, performed during surgery for rectal cancer. This may improve the quality of life of patients over a straight end-to-end anastomosis by forming a reservoir for faeces with patients experiencing less urgency ...
The ileoanal pouch anastomosis is the procedure of choice for ulcerative colitis and familial adenomatosis polyposis, but can be complicated by anastomotic leak. We discuss the presentation, management, and outcome of 141 leaks after the ileoanal pouch anastomosis procedure in 1424 patients, and propose a management algorithm. Using a combination of nonoperative and operative means and tailoring the management to the presentation of the leak, we were able to achieve an 84% success rate in treating pouches complicated by leaks ...
I agree that you will feel so much better, even if you have the bag. Youll get used to it quickly, and its so much better than being sick! I was so sick before I had surgery, and while Im really happy with my j-pouch, I was fine with the bag too. I feel so much better. Best wishes!
hi Mary O. Thanks for your reply. No. I have not done, nor considered, PT for my abdomen. Why did you do PT? Were you having stomach pain similar to what I described?
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Tube Construction Carry-All Pouch by Rob Hans. Our pouches are great. Theyre availabe in sizes from 6 x 5 up to 12.5 x 8.5. Each pouch is printed on both sides (same image).
Bleeding with j-pouch Drinking water is healthy. I try to drink as much as I can. Liquid isnt the worst, at least its easy to pass and its quick. It takes 2 seconds. The worst is when you have to wipe a lot. Id take.... ...
AccessGUDID - Instrument pouch (05051223004264)- The Instrument Pouch is used for securing instruments in a convenient housing close to the surgical site, minimising hand to hand transfer.
Both the developed and the emerging economies are showing a great demand for packed food products. This has provided a momentum to the retort pouch market growth.
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Introduction. Restorative surgery for ulcerative colitis with ileal pouch anal anastomosis (IPAA) is frequently accompanied by complications. Volvulus of the ileal pouch is one of the most rarely reported late complications and to our knowledge no report exists on reoperative surgery for this condition. Case Report. A 58-year-old woman who previously had undergone restorative proctocolectomy due to ulcerative colitis with an IPAA presented with volvulus of the pouch. She was operated with a single row pouchopexy to the presacral fascia. Two months later she returned with a recurrent volvulus. At reoperation, the pouch was found to have become completely detached from the fascia. A new pexy was made by firmly anchoring the pouch with two rows of sutures to the presacral fascia as well as with sutures to the lateral pelvic walls. At follow-up after five months she was free of symptoms. Conclusion. This first report ever on reoperative surgery for volvulus of a pelvic pouch indicates that a single ...
Procedure that combines complete removal of the colon and creation of a new rectum using the ileum. This procedure may also be referred to as ileal reservoir reconstruction, ileal pouch-anal anastomosis, restorative proctocolectomy, or W-, S-, or J-pouch reconstruction.
Mays issue of Colorectal Disease reviews the quality of life, health-related quality of life and health status in patients having restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis.. ...
Though uncommon, ileoanal pouch-vaginal fistulas after restorative proctocolectomy present quite a challenge. Multiple salvage procedures, including endoanal, transabdominal, and transvaginal, have been used. Because of high recurrence rates, multiple operations are not uncommon, and ultimate pouch failure rates have been reported as high as 45 per cent. The Permacolâ„¢ Collagen Implant is a surgical implant that has been used successfully in a variety of operations ranging from urological to maxillofacial. Its properties allow fibroblast infiltration and revascularization so that it gradually becomes permanently incorporated into the surrounding tissue, providing strength and inhibiting scarring and contraction. We report the first documented case of Permacolâ„¢ use in repair of ileoanal pouch-vaginal fistula and we feel that it warrants further investigation as an option in the treatment of these fistulas ...
A flexible pouch includes a flexible compartment with a bottom. A rim is formed around the bottom of the compartment and is spaced from and extends outwardly from this compartment bottom. At least three coplanar feet are provided on the rim for stabilizing the pouch when the pouch is resting on the rim. These coplanar feet can be generally flush with the rim when the pouch is in a flat, empty position. However, when the compartment of the pouch is filled, the coplanar feet will be formed as the lowermost portions of the rim. The pouch will rest on these coplanar feet when on a support to be stably held in position. This pouch design will avoid wobbling or tipping over of the pouch and therefore minimize or eliminate product spillage. Also, a method for making this pouch includes the steps of forming the pouch with the compartment, providing a rim around the bottom of the compartment, and spacing the rim from the bottom of the compartment. A portion of this rim is then removed at the outer edge to form
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PURPOSE: Disconnection of an ileal pouch-anal anastomosis with repeat ileal pouch-anal anastomosis has been proposed for treatment of ileal pouch-anal anastomosis failure caused by septic or functional complications. We report our experience with repeat ileal pouch-anal anastomosis, and document functional outcome and quality of life.. METHODS: Of 101 patients undergoing laparotomy, ileoanal disconnection, and repeat ileal pouch-anal anastomosis, 80 were referred from other institutions. Indications included: chronic anastomotic leak (n=27), perineal or pouch-vaginal fistula (n=47), anastomotic stricture (n=22), dysfunction/long efferent limb of S-pouch (n=36), and previous ileal pouch-anal anastomosis excision or exclusion (n=6). In 64 cases a "septic" indication was observed. Pathologic features of Crohns disease were present in 4 patients preoperatively and 15 more after repeat ileal pouch-anal anastomosis. Four patients had clinical features of Crohns disease.. RESULTS: Three patients had ...
PURPOSE: Pathophysiology of pouchitis after ileal pouch-anal anastomosis is controversial because of the potential for development of carcinoma. Cyclooxygenase-2-derived prostaglandins may be involved in the inflammatory process and play a role in the pathogenesis of colon cancer. Vascular endothelial growth factor plays a major role in neoangiogenesis and is overexpressed in a number of gastrointestinal malignancies. The goal of this study was to evaluate the expression of cyclooxygenase-2 and vascular endothelial growth factor and to assess neoangiogenesis and epithelial cell proliferation in patients with ileal pouch-anal anastomosis. METHODS: Endoscopic biopsies were obtained from 15 patients with ileal pouch-anal anastomosis without pouchitis (10 biopsies from the ileal pouch and 10 from ileal nonpouch mucosa) and from 15 subjects with irritable bowel syndrome (10 biopsies from normal-appearing ileum and rectum). Cyclooxygenase-1, cyclooxygenase-2, and vascular endothelial growth factor ...
There is no quality evidence of the benefit of defunctioning ileostomy (DI) in ileal pouch-anal anastomoses (IPAAs) performed for inflammatory bowel disease (IBD), but most surgical teams currently resort to DI. In the case of a staged procedure with subtotal colectomy first, completion proctectomy with IPAA is performed for healthy patients, namely, after nutritional support, inflammation reduction and immunosuppressive agent weaning. Therefore, the aim of this trial is to assess the need for systematic DI after completion proctectomy and IPAA for IBD. This is a multicenter randomized open trial comparing completion proctectomy and IPAA without (experimental) or with (control) DI in patients presenting with ulcerative colitis or indeterminate colitis. Crohns disease patients will not be included. The design is a superiority trial. The main objective is to compare the 6-month global postoperative morbidity, encompassing both surgical and medical complications, between the two groups. The morbidity of
The detrimental effects of catabolism, insuline resistance and muscle wasting on surgical outcome is wellknown. This catabolism is especially pronounced in patients with acute or chronic inflammation (IBD, cancer) and for those undergoing major surgery. Patients with ulcerative colitis operated with an ileal pouch-anal anastomosis (j-pouch) fall well into both these categories.. To prevent this undesirable catabolism, we will investigate the effects of intravenous administration of predominantly anabolic amino acids (with an amino acid content equal to breast milk) on whole body metabolism, with special emphasis on muscle and fat metabolism and intracellular signalling pathways.. Twenty-four patients will be block-randomized by gender in this parallel-group, randomized, assessor-blinded, placebo-controlled trial to receive either Vaminolac® (Fresenius Kabi) or saline. Metabolism before and after the intervention will be assessed by palmitate- and amino acid kinetics of radioactively labelled ...
Objective: To evaluate the pregnancies, deliveries and functional results of patients who have undergone and ileal pouch-anal anastomosis. Design: A retrospective survey by questionnaire. Setting: The
MOKHELE, N N; THOMSON, S R and WATERMEYER, G A. Predictors of emergency colectomy in patients admitted with acute severe ulcerative colitis. S. Afr. j. surg. [online]. 2017, vol.55, n.3, pp.20-26. ISSN 2078-5151.. BACKGROUND: Acute Severe Ulcerative Colitis (ASUC) is a life-threatening condition which requires urgent and aggressive medical therapy to reduce mortality, morbidity and avoid surgery. To facilitate this process, it is essential to identify patients at high risk of poor outcomes and emergency colectomy. Numerous such risk factors have been described in Western literature, however there is no local data addressing this issue. As such it is unclear if these predictors are applicable in our setting. The aim of this study is thus to identify risk factors for emergency colectomy in patients admitted to Groote Schuur Hospital with ASUC. METHODS: A retrospective cohort study of 98 patients admitted with ASUC between January 2003 and January 2013 was performed. Clinical, demographic, ...
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Adenocarcinoma in an ileoanal pouch formed for ulcerative colitis in a patient with primary sclerosing cholangitis and a liver transplant: report of a case and
TY - JOUR. T1 - Safety, feasibility, and short-term outcomes of laparoscopic ileal-pouch-anal anastomosis. T2 - A single institutional case-matched experience. AU - Larson, David W.. AU - Cima, Robert R.. AU - Dozois, Eric J.. AU - Davies, Michael. AU - Piotrowicz, Karen. AU - Barnes, Sunni A.. AU - Wolff, Bruce. AU - Pemberton, John. PY - 2006/5/1. Y1 - 2006/5/1. N2 - OBJECTIVE: To compare safety and short-term outcomes of 100 laparoscopic ileal pouch-anal anastomosis (IPAA) versus 200 conventional open IPAA patients. SUMMARY BACKGROUND DATA: Outcomes of laparoscopic IPAA (LAP-IPAA) have been incompletely characterized. Previous reports are characterized by small numbers of patients and rarely include case-matched or randomized trial methodology. This report describes 100 LAP-IPAA patients case matched to 200 open IPAA patients. METHODS: Between 1998 and 2004, 100 consecutive LAP-IPAA patients (75 laparoscopic assisted, 25 hand assisted) were identified and case matched to 200 open IPAA control ...
The team estimated the cumulative risk of pouchitis using a Kaplan-Meier life table analysis.. The researchers reported joint symptoms during steroid tapering by 22% of the ulcerative colitis patients.. Each of these patients had involvement of the small joints of the hand.. The team found that the main symptoms were pain and stiffness, especially in the morning.. The cumulative risk for developing pouchitis after 10 years was found to be 20% in patients who experienced joint symptoms during steroid tapering.. The researchers found that the cumulative risk for pouchitis was 10% in those without those symptoms.. Dr Nakamuras team concluded, The presence of joint symptoms during steroid tapering is a significant risk factor for the development of pouchitis in patients who have undergone an ileal pouch-anal anastomosis forulcerative colitis. ...
INTRODUCTION: The resolution of pouchitis with metronidazole points to an anaerobic aetiology. Pouchitis is mainly seen in patients with ulcerative colitis pouches (UCP). We have recently found that sulphate reducing bacteria (SRB), a species of strict anaerobe, colonize UCP exclusively. Herein, we aimed to correlate levels of different bacterial species (including SRB) with mucosal inflammation and morphology. METHODS: Following ethical approval, fresh faecal samples and mucosal biopsies were taken from 9 patients with UCP and 5 patients with familial adenomatous polyposis pouches (FAPP). For the purposes of comparison, faecal samples and mucosal biopsies were also taken from the stomas of 7 of the 9 patients with UC (UCS). Colonization by four types of strict anaerobes (SRB, Clostridium perfringens, Bifidobacteria and Bacteroides) as well as by three types of facultative anaerobes (Enterococci, Coliforms and Lactobacilli) was evaluated. Inflammatory scores and mucosal morphology were assessed ...
Medeiros, Bruno Amaral et al. Proctocolectomy and ileal J-pouch anal anastomosis on the surgical treatment of familial adenomatous polyposis and ulcerative colitis: analysis of 49 cases. J. Coloproctol. (Rio J.), Sept 2012, vol.32, no.3, p.260-264. ISSN 2237- ...
Since I got home from the hospital, my stoma has been somewhat retracted. I have a loop ileostomy now, so I have two pieces of my intestine forming my stoma instead of one. The working part retracted quite a bit, but went to the point of near disappearance a couple of days ago. Because the […]. ...
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Synonyms for vesicogenital pouch in Free Thesaurus. Antonyms for vesicogenital pouch. 24 synonyms for pouch: bag, pocket, sack, container, purse, poke, bag, balloon, beetle, belly, bulge, jut, overhang, project, protrude, protuberate, stand out. What are synonyms for vesicogenital pouch?
I had UC for 8 years and got tired of being sick so Iwent and I said, take it out! My GI tried to talk me into a J-pouch but after doing alot of research on it, and talking to my surgeon I decided on the perm ileostomy. My surgeon said that was what he reccomended so that was one reason. A few of the other reasons I chose that were that the jpouch requires two surgeries, and some people, after the take down have to go to the bathroom like 30 timesa day at first! And it can sometimes take a year to get full control over your bowes and even then you can still expect to go 4-7 times a day, with some urgerncy, well that was part of what I was trying to get away from! Also, the jpocuh can develop pouchitis which is apparetnly icky. THere is something called a koch pouch, which I thought about doing, it is where they make a pouch out of your intestines in you stomach and you stick a catheter and drain it a few times a day. I thought that sounded like a good idea, however up research I found out only ...
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A strange name, but Oh what fun! Perhaps not the most PC toy if you also keep chipmunks but great otherwise.. These soft and snuggly plush toys feature a pouch to hold T-Nip catnip pouches. They contain top quality catnip and fit neatly into the pouch without the mess of loose catnip. When the catnip expires, just add a new pouch to the toy for another round of fun!. Each toy comes with two pouches, additional pouches are sold separately. The pouches can be frozen to keep the catnip fresh.. Toys are machine washable when the catnip pouch has been removed.. ...
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A specimen removal apparatus includes a pouch assembly fabricated from a flexible membrane, a pouch support, a drawstring having a knot and forming a noose disposed circumferentially around a mouth of the pouch assembly, an endoscopic tubular portion, and a drive rod. The pouch assembly includes a plurality of circumferentially disposed guide members advantageously circumferentially spaced apart to define gaps therebetween. The guide members are disposed in a circumferential pathway proximal to the mouth of the pouch assembly. When the drawstring is pulled, the knot is stopped at an end of a guide member and the noose is closed, thereby closing the mouth of the pouch assembly. The pouch assembly is detachable from the apparatus.
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The babies climb up the mothers fur and into her pouch where they find a teat. Some babies will not find their way to the pouch and will die. If they make it to the pouch, only babies who find one of the thirteen teats will survive. They will stay in the pouch and suckle for 55-60 days. Then they will move out of the pouch and spend another four to six weeks on their mothers back. In some parts of their range, females will have three litters a year ...
I did have a question though. I am pre-op and currently cook for myself, husband, and 1yr old daughter. I struggle to buy small enough quantities to feed my family as it is, and I worry about how much worse it is going to get post-op. Renting an aparment= teeny tiny freezer. So, to get to the question part: what do you do with all your leftovers? Do you have specific places/ shopping methods that help you purchase in small enough quantities for your pouch? It seems like you eat a lot of variety but maybe you are using a lot of the same core ingredients? Thanks for any insight you can provide. ...
sejak ada pouch ni ke mana jer kami berjalan mesti adik akan dok dalamnya.. senang gitu adikpun macam selesa.. kaalu batrisyia ku boleh masukkan sekali, aku kumasukkan juga supaya dia tak berlegar ke merata tempat ...
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AIMS--To investigate colonic metaplasia of goblet and columnar epithelial cells in ileal pouch mucosa; to correlate this with the degree of morphological and inflammatory change; and to assess whether such changes are related to the presence of faecal stasis. METHODS--Biopsy specimens of ileal pouch mucosa were taken from 31 patients (30 with ulcerative colitis, one with familial adenomatous polyposis) either before (eight patients) or after (23 patients) ileostomy closure. A simple morphological technique was used to assess changes in villous height. Inflammatory change was estimated using an established scoring system for pouchitis, and acquisition of colonic antigens was determined by immunohistochemistry using three monoclonal antibodies which recognise components of the two major epithelial cell types in the colorectum. The degree of staining with the monoclonal antibodies was graded and the grades correlated with an index of villous atrophy and with the inflammatory scores. RESULTS--Five ...
Objectives: To develop a prototype decision aid used to assist ulcerative colitis patients when deciding between ileal pouch-anal anastomosis (IPAA) and ileostomy. Methods: Three separate systematic reviews (quality of life studies, IPAA studies, ileostomy studies) were conducted to populate the decision aid with outcome probabilities. Meta-regression was used to select appropriate pooled outcomes. Results: Of 3920 studies reviewed, 9 studies reported on quality of life, 67 on outcomes following IPAA, and 11 following ileostomy. No difference in quality of life was found between procedures. Among IPAA patients, pooled pouch failure rate was 5.5%, with pouchitis being the most common complication (22%). Among ileostomy patients, the pooled rate of ileostomy revision was 17.1%. Conclusions: No surgical option is clearly superior and patients must weight specific risks and benefits in deciding between procedures. This newly developed decision aid may help patients decide which option is best for them.
This is what the digestive system looks like after j-pouch surgery. You can see that the entire colon has been removed and that only the small intestine is left. The end of the small intestine currently forms my ileostomy, during pouch surgery the surgeon constructs a pouch out of the small intestine by folding it up on itself and making it into a reservoir. This is then attached to the anal canal.. This is called pouch surgery or ileo-pouch anal anastomosis or IPAA… Also known as J pouch, Internal Pouch or ileo-anal pouch.. After this surgery I will no longer have my stoma or ileostomy bag, my waste will go through my system and then be stored in the pouch, because I still have control of the muscles in my bum Ill be able to hold waste and pass it normally into the toilet.. There are a few issues surrounding pouch surgery, one is that as the pouch is no where near as big as my large intestine was, Ill need to go to the toilet quite a few times a day. Most people after everything is settled ...
BACKGROUND: Restorative proctocolectomy is used as surgical treatment for ulcerative colitis. We have earlier documented adaptative changes in the terminal ileum after total colectomy, and straight ileo-anal anastomosis. AIM: To correlate the morphol
ECCO - European Crohn´s and Colitis Organisation. The European Crohn\s and Colitis Organisation is a highly active non-profit association focusing on Inflammatory Bowel Diseases (IBD).
Invalidating anorectal dysfunctions are common after restorative rectal surgery. Improvement of functional results by the technically more demanding J-pouch has been demonstrated in comparison with the straight coloanal anastomosis. In the present multicenter randomized trial we assessed whether the J-pouch is also superior to the side-to-end coloanal anastomosis ...
If you are one of the many individuals who have been offered or already have an ileo-anal pouch, then you will know what it feels like to take the decision to go ahead with the surgery - its daunting. Ileo-anal pouch surgery, (or restorative procto-colectomy to give it the surgical term) is increasingly being offered to patients who require surgery to remove their colon( Large Bowel) following certain chronic bowel disorders such as Ulcerative Colitis and FAP. There are various forms of pouch, the J pouch, the S pouch, the W pouch and the kock pouch, however, most surgeons opt for the J pouch due to its simple construction. Unfortunately, some patients are not eligible to be offered the surgery due to the risk of increased complications following the surgery, such as those with Crohns disease. For those patients, the only option is to have the affected part of the bowel removed with the possibility of having a permanent ileostomy if the colon is too badly damaged. ...
A surgical alternative to ileostomy is the ileal pouch-anal anastomosis, or ileoanal anastomosis. This procedure, used more frequently than permanent ileostomy in the treatment of ulcerative colitis, is similar to a continent ileostomy
Background: Pouchitis after total rectocolectomy is among the most common complications of patients with ulcerative colitis (UC). However, its frequency is quite rare in patients with familial adenomatous polyposis (FAP). We evaluated the inflammatory and pro-apoptotic activity in endoscopically normal mucosa of the ileal pouch in patients with UC and FAP. Methods: Twenty patients (10 with UC and 10 with FAP) with J pouch after total proctocolectomy were studied as were 10 normal controls. Biopsies were obtained from the mucosa of the pouch of UC and FAP patients and from the normal ileum of controls. The expression levels of TNF-α, IL-1β, IL-6, IL-8 and phospho-BAD were determined by immunoblotting. Activated NFκB was evaluated by immuno-precipitation and immunoblotting for IkappaB kinase beta. Results: Patients with UC had higher levels of IL-1β, IL-6, IL-8 and TNF-α than patients with FAP. The level of TNF-α was higher in patients with UC than in patients with FAP; both patient groups ...
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IA is a UK registered charity whose primary aim is to help people who have to undergo surgery which involves the removal of their colon (colectomy) and the creation of either an ileostomy or an ileo-anal pouch. On our information pages, we tell you about our association and how we can help you.
You neednt be a rocket scientist to understand that by taking the end of a piece of colon or small intestine and folding it back upon itself, will look like the letter "J" when viewed from the side. Furthermore, connecting the two, folded, separate pieces of bowel together in the middle of the "J", crates a pouch, or a new rectum (the neorectum). The neorectum is a pouch which recreates the capacity of the natural rectum.. In the case of the small bowel pouch, the end of the ileum is fashioned into the pouch, the so called IPAA, or ileopouch-anal anastomosis. In the case of the colon, the remaining end of the colon is folded back to form a colonic J pouch. Different pieces of intestine with the same idea; to hold the fecal material until it can be voluntary discharged.. ...
Time to put some of that psychology book-learnin to work! Coping is an area where Ive done some research (primarily in regards to coping with cancer) and is certainly something Ive thought about lots over the last few months. Ive gotten lots of comments regarding my lack of complaining and generally upbeat attitude through the […]. ...
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BACKGROUND: Few studies have evaluated the influence of colectomy on antineutrophil cytoplasmic antibody (ANCA) positivity in ulcerative colitis (UC). In small series of patients it has been suggested that ANCA positivity in UC might be predictive for development of pouchitis after colectomy. AIMS: To assess the prevalence of ANCA in UC patients treated by colectomy and a Brookes ileostomy (UC-BI) or ileal pouch anal anastomosis (UC-IPAA), and the relation between the presence of ANCA, the type of surgery, and the presence of pouchitis. SUBJECTS: 63 UC patients treated by colectomy (32 with UC-BI and 31 with UC-IPAA), 54 UC, and 24 controls. METHODS: Samples were obtained at least two years after colectomy. ANCA were detected by indirect immunofluorescent assay. RESULTS: There were no differences between patients with (36.3%) or without pouchitis (35.0%) and between patients with UC (55%), UC-BI (40.6%), and UC-IPAA (35.4%). However, ANCA prevalence significantly decreases in the whole group of ...
Background: Colectomy and ileorectal anastomosis (IRA) or restorative proctocolectomy are performed for prophylaxis in familial adenomatous polyposis (FAP). After IRA patients may require secondary proctectomy for worsening polyposis or rectal cancer. Outcomes after IRA were evaluated and risk factors predictive of progressive rectal disease identified. Methods: Parametric survival analysis was used to identify predictors of progressive rectal disease in all patients undergoing an IRA for FAP at a single centre. Hazard ratios (HRs) were calculated for phenotype, genotype, sex, age at surgery and presence of colonic cancer. Results: Of 427 patients who underwent IRA, 48 (11.2 per cent) developed rectal cancer and 77 (18.0 per cent) required proctectomy for worsening polyposis over a median follow-up of 15 (range 7-25) years. By the age of 60 years half of the patients retained their rectum. Rectal polyp count exceeding 20 (HR 30.99, 95 per cent confidence interval 9.57 to 100.32; P , 0.001), APC ...
"Clinical manifestations and diagnosis of colonic diverticular disease". Literature review.. *^ Stefánsson T, Ekbom A, Sparèn P ... Diverticulosis is the condition of having multiple pouches (diverticula) in the colon that are not inflamed. These are ... Most people with colonic diverticulosis are unaware of this structural change. When symptoms do appear in a person over 40 ... Diverticulosis is defined by the presence of multiple pouches (diverticula) in the colon.[18] In people without symptoms, these ...
... is when problems occur due to diverticulosis, a condition defined by the presence of pouches in the wall ... Colonic perforation due to diverticular disease may be classified using the Hinchey Classification. "Clinical manifestations ... and diagnosis of colonic diverticular disease". Literature review. "Diverticular Disease". www.niddk.nih.gov. September 2013. ...
... 5 has been related to the development of pouchitis in the ileal pouch following surgery for ulcerative colitis. The ... elevated number of IgG-producing cells in the colonic mucosa of ulcerative colitis patients is largely committed to producing ... "tropomyosin expression in the ileal pouch: a relationship with the development of pouchitis in ulcerative colitis". Am J ...
... colonic pouches MeSH E07.862.700 --- skeletal muscle ventricle MeSH E07.862.705 --- stomas MeSH E07.862.710 --- surgical flaps ...
... colonic pouches MeSH A10.850.700 --- skeletal muscle ventricle MeSH A10.850.705 --- stomas MeSH A10.850.710 --- surgical flaps ...
Chronic disease Diverticulitis and diverticulosis result from an out pouching of the colonic mucosa, or gut wall, leading to a ...
Depending on the type of surgery performed, the patient may still require periodic lower endoscopies to assess the pouch for ... Patients with toxic megacolon (colonic dilation > 6 cm and toxic appearing) who do not respond to steroid therapy within 72 ... destroying the hydroxyl and other radicals that may damage colonic epithelial barrier. 5-ASA may also be an inhibitor of TNF. ...
The pouch and flange (both one and two piece pouches) are usually changed every 2-5 days. Ostomy pouches fit close to the body ... and total colonic Hirschsprung's disease. An ileostomy may also be necessary in the treatment of colorectal cancer or ovarian ... Pouch leaks occurred in 11 patients, of these 7 have functioning pouches. Complications not related to the pouch itself ... and pouch fistulas (6.3%)); Of the 32 patients treated for valve slippage, 23 achieved a fully functioning pouch. Pouch or ...
Diverticulosis occurs when pouches form on the intestinal wall. Once the pouches become inflamed it is known as diverticulitis ... Colonic Transit Study Technique and Interpretation: Can These Be Uniform Globally in Different Populations With Non-uniform ... In birds this is found as a pouch alongside the esophagus. Other animals including amphibians, birds, reptiles, and egg-laying ... ISBN 0-323-01639-1. Sarna, S.K. (2010). "Introduction". Colonic Motility: From Bench Side to Bedside. San Rafael, California: ...
The haustra (singular haustrum) of the colon are the small pouches caused by sacculation (sac formation), which give the colon ... 1] Gore, R. (1992). "Colonic contour changes in chronic ulcerative colitis: Reappraisal of some old concepts". AJR. American ...
The pouches (diverticula) occur where there is a gap between or weakness within the muscle fibres of the bowel wall, ... in 1978 classifies a colonic perforation due to diverticular disease. The classification is I-IV: Hinchey I - localised abscess ... With age, all people develop 'out-pouching' of the bowel wall as pressure from the inside of the bowel pushes the mucosa ... para-colonic) Hinchey II - pelvic abscess Hinchey III - purulent peritonitis (the presence of pus in the abdominal cavity) ...
The thymus appears in the form of two flask-shape diverticula, which arise from the third branchial pouch (pharyngeal pouch) of ... Cardiac diverticulum: A very rare congenital malformation of the heart that is usually benign Colonic diverticula: These can ... Play media Guttural pouch: A large (300-500 ml), paired, air-filled ventral diverticulum of the auditory tube found in horses ...
As estimated from the image in panel A, there are about 100 colonic crypts per square millimeter of the colonic epithelium. ... Additionally, surgeons have lately been using the term pouchoscopy to refer to a colonoscopy of the ileo-anal pouch. The large ... Colonic crypts deficient for CCOI in women reaches, on average, 18% in women and 23% in men by 80-84 years of age. Crypts of ... measuring the number of cells in a small number of crypts reported a range of 1500 to 4900 cells per colonic crypt. Cells are ...
Signs seen on colonoscopy include: colonic mucosal erythema (redness of the inner surface of the colon), ulcers, and bleeding.[ ... Jul 2009). "Do preoperative factors predict subsequent diagnosis of Crohn's disease after ileal pouch-anal anastomosis for ... Microscopic colitis - a colitis is diagnosed by microscopic examination of colonic tissue; macroscopically it is normal ...
In the next step of the surgery, an internal pouch is made of the patient's own small bowel, and this pouch is then hooked back ... Human colonic mucosa is maintained by the colonic epithelial barrier and immune cells in the lamina propria (see intestinal ... causing impaired colonic motility and leading to toxic megacolon. If the serous membrane is involved, a colonic perforation may ... in: Colonic diseases. By Timothy R. Koch. 2003. ISBN 978-0-89603-961-2 Podolsky DK (2002). "Inflammatory bowel disease". The ...
It is also known as the colonic fluke, as it infects the colon of pigs, rhesus monkeys, orang-utans, fish, field rats, and Napu ... The incomplete alimentary canal consists of a pair of lateral pouches arising from the oral sucker and a slightly tortuous ...
Diverticula are actually micro-hernias of the colonic mucosa and submucosa through the colonic muscular layer where blood ... Having pouches in the large intestine that are not inflamed is known as diverticulosis. Inflammation occurs in between 10% and ... Diverticulitis is a gastrointestinal disease due to abnormal pouches, which have developed in the wall of the large intestine, ... Diverticulitis is also known by the more complete term colonic diverticulitis since other organs, such as the bladder, can ...
Alternatively, a pouch can be created from the small intestine; this serves as the rectum and prevents the need for a permanent ... Animal proteins have greater amounts of sulphur containing amino acids such as methionine, which the colonic microflora accrues ... A small percentage of patients with ileo-anal pouches do have to manage occasional or chronic pouchitis. Surgery cannot cure ...
Diverticulosis occurs when pouches form on the intestinal wall. Once the pouches become inflamed it is known as diverticulitis ... Sarna, S.K. (2010). "Introduction". Colonic Motility: From Bench Side to Bedside. San Rafael, California: Morgan & Claypool ... In birds this is found as a pouch alongside the esophagus. Other animals including amphibians, birds, reptiles, and egg-laying ... "Commensal microbe-derived butyrate induces the differentiation of colonic regulatory T cells". Nature. 504 (7480): 446-450. doi ...
... but biopsy specimens must be examined under a microscope to determine whether cells are gastric or colonic in nature. Colonic ... "a pouch of stomach … drawn up by scar tissue into the mediastinum" ... representing an example of a "congenital short esophagus ...
Imperforate anus is an anus that ends in a blind pouch and does not connect to the rest of the person's intestines. Small left ... "Assessing colonic anatomy normal values based on air contrast enemas in children younger than 6 years". Pediatric Radiology. 47 ...
In such cases, a digital rectal examination elicits tenderness in the rectovesical pouch. Coughing causes point tenderness in ... Elderly: diverticulitis, intestinal obstruction, colonic carcinoma, mesenteric ischemia, leaking aortic aneurysm. The term " ... fecal retention in colonic reservoirs: a case control study". Surgical Infections. 8 (1): 55-62. doi:10.1089/sur.2005.04250. ...
En papillote - The food is put into a pouch and then baked, allowing its own moisture to steam the food. Smoking Smoking is the ... 1995). "Colonic protein fermentation and promotion of colon carcinogenesis by thermolyzed casein". Nutr Cancer. 23 (3): 271-81 ... Corpet DE, Stamp D, Medline A, Minkin S, Archer MC, Bruce WR (November 1990). "Promotion of colonic microadenoma growth in mice ...
The patient may require an ileostomy (permanent stoma where stool goes into a bag on the abdomen) or have an ileo-anal pouch ... the resulting colonic polyps and cancers are confined to the colon wall and removal can greatly reduce the spread of cancer. ...
F. Mahjoub u. a.: Invading plant material appearing as a colonic tumoural mass in a four-year-old girl. In: Trop Doct 39, 2009 ... a tobacco pouch and a magazine at the same time plastic tooth brush case Not all objects are solid. In 1987, a case was ... R. J. Roberge u. a.: Popcorn primary colonic phytobezoar. In: Ann Emerg Med 17, 1988, S. 77-79. PMID 3337421 A. Eitan u. a.: ... PMID 18666334 R. M. Richter and L. M. Littman: Endoscopic extraction of an unusual colonic foreign body. In: Gastrointest ...
The patient may require an ileostomy (permanent stoma where stool goes into a bag on the abdomen) or have an ileo-anal pouch ... "Likely underdiagnosed, given the lower number of colonic polyps and lower risk for colorectal cancer compared to classic FAP". ... "Colectomy may be necessary, but in approximately one third of individuals the colonic polyps are limited enough in number that ... Most partial and whole APC deletions are associated with 100-2000 colonic adenomas, although attenuated FAP has been seen. ...
A colonic diverticulum is a saclike pouch of colonic mucosa and submucosa that protrudes through the muscular layer of the ... Colonic Diverticulosis By Joel A. Baum, MD, Assistant Clinical Professor of Medicine, Icahn School of Medicine at Mount Sinai ; ... Colonic diverticulosis is the presence of one or more diverticula in the colon. Most diverticula are asymptomatic, but some ... Complications of colonic diverticular disease are more common in people who smoke, are obese, or use NSAIDs. Complications ...
... including those with an ileal J-pouch reservoir. The rest consisted in protection of the anastomosis in the context of a ... A study of the safety and clinical efficacy of flexible sigmoidoscopy and colonoscopy after recent colonic surgery in 52 ... one case of pancolitis in an ulcerative colitis with haemodynamic involvement and 2 colonic perforations secondary to ...
Colon outpouching: Diverticulosis is an outpouching of the wall of the colon due to a weakness in the colonic wall. ... Diverticular disease is a condition where pouches protrude outward from weakened areas in the colon and result in abdominal ...
Computer-assisted assessment of colonic polyp histopathology using probe-based confocal laser endomicroscopy. ... Although pouch failure occurs more frequently than after primary ileal pouch-anal anastomosis, patient satisfaction and quality ... Two were rediverted and 13 had the pouch excised. Five-year pouch survival was 74 percent, higher for ulcerative colitis (79 ... PURPOSE: Disconnection of an ileal pouch-anal anastomosis with repeat ileal pouch-anal anastomosis has been proposed for ...
Colonic J-pouch is a type of neorectum, performed during surgery for rectal cancer. This may improve the quality of life of ... Colonic J-pouch is a type of neorectum, performed during surgery for rectal cancer. This may improve the quality of life of ... Comparison of Colonic J-pouch and Straight Coloanal anastomosis after Low Anterior Resection. Iran Red Crescent Med J. 2013;15 ...
A 5-cm colonic J pouch colo-anal reconstruction following anterior resection for low rectal cancer results in acceptable ... The aim of this study was to assess evacuation and continence in patients with a colon pouch, and to examine the impact of ... In 1998, all 102 surviving patients with a colon pouch, whose stoma had been closed for more than one year, were sent a postal ... A colon pouch has early functional benefits, although long-term function, especially evacuation, might mitigate against its ...
AIMS--To investigate colonic metaplasia of goblet and columnar epithelial cells in ileal pouch mucosa; to correlate this with ... Expression of colonic antigens by goblet and columnar epithelial cells in ileal pouch mucosa: their association with ... Expression of colonic antigens by goblet and columnar epithelial cells in ileal pouch mucosa: their association with ... One of eight (12%) pre-closure and 15 of 23 (65%) post-closure biopsy specimens stained with an antibody for colonic mucin. ...
Surveillance of the blind pouch is not currently recommended. Malignant infiltration of the colonic wall should be included in ... We present a case of a 68-year-old man with EWDA arising in the bypassed stomach that presented as a colonic pseudo-obstruction ... At autopsy the primary tumor was identified in the blind pouch of the bypassed stomach. A literature review on gastric EWDA and ... Pathologic examination showed metastatic EWDA in the colonic wall. Post-operative complications led to the patients demise. ...
Colonic J-Pouch-Anal Anastomosis for Rectal Cancer. Dehni, Nidal; Parc, Rolland; Church, James M. ...
To describe, in the J-pouch reconstruction group, the feasibility of the colonic J-pouch. ... Percentage of the colonic J-pouch reconstruction performed with respect to the total number of patients selected for the J- ... Colonic J-Pouch Reconstruction Versus Straight Colorectal Anastomosis After Low Anterior Resection for Rectal Cancer: Impact on ... J-Pouch Colorectal Anastomosis or Straight Colorectal Anastomosis in Treating Patients With Rectal Cancer Who Have Undergone ...
Colonic Diseases. Intestinal Diseases. Pathologic Processes. Inflammatory Bowel Diseases. Amino-acid, glucose, and electrolyte ... Patients with ulcerative colitis operated with an ileal pouch-anal anastomosis (j-pouch) fall well into both these categories. ... Amino Acids in Ileal Pouch-anal Anastomosis for Ulcerative Colitis (AMINOPOUCH). This study is ongoing, but not recruiting ... With this study we hope to find evidence for anabolic effects of intravenous amino acids in j-pouch surgery for ulcerative ...
Diverticular disease is a group of conditions that affect your large intestine (colon). It involves small pouches or sacs, ...
A medical history of colonic resection. *Anorectal surgery or chemo- radiotherapy. *Pre-existing fecal incontinence grade III ... j-pouch coloanal anastomosis although a j-pouch coloanal anastomosis is a common type of anastomosis, a comparison with the ... Procedure: j-pouch coloanal anastomosis side-to-end coloanal anastomosis in the Netherlands, the side-to-end anastomosis is the ... The objective of this study was to compare the functional and surgical results of the J-pouch with those of the side-to-end ...
Morbidity Following Coloanal Anastomosis: A Comparison of Colonic J-Pouch vs Straight Anastomosis. Brown, Shaun; Margolin, ...
Colonic Pouches*. Female. Humans. Ileum / surgery*. Male. Middle Aged. Pressure. Proctocolectomy, Restorative*. Quality of Life ... 9102269 - Is colonic electrical activity a similar phenomena to small-bowel electrical activity?. 8769279 - Effects of ... In 26 patients (54.17 percent of the cases), 10 males and 16 females, ileal pouch-anal anastomosis was performed after a ... Patients quality of life was improved for those undergoing the modified ileal pouch-anal anastomosis.. ...
Extensive colonic resection, subtotal or total colectomy. *Presence of ileostomies, colostomies or rectal pouches ... Diagnosis of Crohns disease for more than 4 months with small bowel and/or colonic involvement ... History of evidence of adenomatous colonic polyps that have not been removed. ...
Extensive colonic resection, subtotal or total colectomy. *Presence of ileostomies, colostomies or rectal pouches ... History of evidence of colonic mucosal dysplasia. *Current evidence of, or has been treated for a malignancy within the past ... Diagnosis of Crohns disease for greater than 4 months duration with small bowel and/or colonic involvement ... History or evidence of adenomatous colonic polyps that have not been removed ...
Functional Outcome And Quality Of Life In Patients With Low Rectal Cancer After A J-pouch Or A Side-to- End Anastomosis ... Better Function With A Colonic J-pouch Or A Side-to-end Anastomosis? A Randomized Controlled Trial To Compare The Complications ... Better Function With A Colonic J-pouch Or A Side-to-end Anastomosis? A Randomized Controlled Trial To Compare The Complications ... Pouch necrosis was noted in 2(JP). QOL: QOL scores using either instrument were similar at 12 and 24 months(p,0.05) in both ...
Enlargement of colonic pouch after proctectomy and colonanal anastomosis: Potential cause for evacuation difficulty. Hida, Jin- ... Colonic manifestations of multiple endocrine neoplasia type 2B: Report of four cases. Grobmyer, Stephen R.; Guillem, Jose G.; ...
To investigate changes in morbidity and mortality associated with ileal J-pouch surgery performed during the first 3 years of a ... Colonic Diseases / epidemiology, surgery*. Colonic Pouches / standards*. Education, Medical, Continuing / standards*. ... OBJECTIVE: To investigate changes in morbidity and mortality associated with ileal J-pouch surgery performed during the first 3 ... The results suggest that fellowship training and board certification conferred reasonable proficiency in J-pouch surgery before ...
The mucosa of the ileal pouch after restorative proctocolectomy develops relevant adaptative changes but the real mechanisms ... Colonic Pouches / pathology*. Female. Follow-Up Studies. Humans. Inflammation / pathology. Intestinal Mucosa / pathology*. Male ... with functioning pouch. We compared the histology of the upper pouch mucosa with the lower one. Then we divided the 46 patients ... BACKGROUND/AIMS: The mucosa of the ileal pouch after restorative proctocolectomy develops relevant adaptative changes but the ...
Colonic J-pouch-anal anastomosis. Ileocecal reservoir. Sigmoid colon onlay patch (Bricker-Johnston) ...
Comparison between straight and colonic J-pouch anastomosis.. Hallböök O, Adrian TE, Permert J, Staab P. ... Enhancing release of peptide YY after near-total proctocolectomy: jejunal pouch vs. ileal pouch-distal rectal anastomosis. ... Morphological and immunohistochemical changes in intestinal mucosa and PYY release following total colectomy with ileal pouch- ...
Rapid Incorporation of ω-3 Fatty Acids Into Colonic Tissue After Oral Supplementation in Patients With Colorectal Cancer: A ... Risk of postoperative morbidity in patients having bowel resection for colonic Crohns disease. Iesalnieks, I., Spinelli, A., ...
Laparoscopic ultralow anterior resection with colonic J-pouch-anal anastomosis.. Selvindos PB, Ho YH. ...
  • A plain abdominal x ray shows a colonic diameter of 7 cm. (brainscape.com)
  • The classification is I-IV: Hinchey I - localised abscess (para-colonic) Hinchey II - pelvic abscess Hinchey III - purulent peritonitis (the presence of pus in the abdominal cavity) Hinchey IV - feculent peritonitis. (wikipedia.org)
  • Compared with small pouches, a large pouch design does not lead to better neorectal compliance in the pig model, whereas pouch evacuation seems to be considerably compromised. (springer.com)
  • The haustra (singular haustrum) of the colon are the small pouches caused by sacculation (sac formation), which give the colon its segmented appearance. (wikipedia.org)
  • Expression of colonic antigens by goblet and columnar epithelial cells in ileal pouch mucosa: their association with inflammatory change and faecal stasis. (bmj.com)
  • The mucosa associated colonic microflora of 57 patients with active inflammatory bowel disease and 46 controls was investigated using 16S rDNA based single strand conformation polymorphism (SSCP) fingerprint, cloning experiments, and real time polymerase chain reaction (PCR). (bmj.com)
  • There is no quality evidence of the benefit of defunctioning ileostomy (DI) in ileal pouch-anal anastomoses (IPAAs) performed for inflammatory bowel disease (IBD), but most surgical teams currently resort to DI. (biomedcentral.com)
  • The free radical induction theory, discussed below, proposes that 5-ASA is serving not just as an anti-inflammatory agent, but also as a free radical trap, destroying the hydroxyl and other radicals that may damage colonic epithelial barrier. (wikipedia.org)
  • The perspective is a potential for primary prophylaxis of surgical complications, reduction in the length of hospitalization, and subsequently optimized long-term functional outcome of the pouch. (clinicaltrials.gov)
  • Temporary ileostomies are also often made as the first stage in surgical construction of an ileo-anal pouch, so fecal material doesn't enter the newly made pouch until it heals and has been tested for leaks-usually requiring a period of eight to ten weeks. (wikipedia.org)
  • The stomal- or colorectal-nurse does this initially for a patient and advises them on the exact size required for the bag (pouch)'s opening. (wikipedia.org)
  • Several studies have suggested a correlation with environmental factors (eg, a diet low in fiber or high in red meat), heritable factors, and alterations in the colonic wall structure and motility. (merckmanuals.com)
  • Bazzocchi G, Ellis J, Villanueva-Meyer J et al (1991) Effect of eating on colonic motility and transit in patients with functional diarrhea. (springer.com)
  • Bassotti G, Germani U, Morelli A (1995) Human colonic motility: physiological aspects. (springer.com)
  • CUSUM analysis of J-pouch surgery reflects no learning curve after board certification. (biomedsearch.com)
  • OBJECTIVE: To investigate changes in morbidity and mortality associated with ileal J-pouch surgery performed during the first 3 years of a single surgeon's practice to determine the presence or absence of a learning curve after fellowship training. (biomedsearch.com)
  • The results suggest that fellowship training and board certification conferred reasonable proficiency in J-pouch surgery before the onset of practice. (biomedsearch.com)
  • Primary anastomosis can be performed at the time of emergency surgery if colonic lavage is carried out. (brainscape.com)
  • Several differential diagnoses were considered such as CSD, colonic duplication, and congenital pouch colon with high ARM and the patient was scheduled for surgery due to increasing intolerance of food. (hindawi.com)
  • The definition of toxic megacolon is non-obstructive, total or segmental colonic dilatation of 6 cm or more, associated with systemic toxicity. (brainscape.com)
  • The decreased contractile function of the smooth muscle further helps acceleration of propulsion by decreasing segmental contractions and allowing forward movement of the colonic contents without impediments. (springer.com)
  • So far, only ten cases of neonatal colonic segmental dilatation have been described in the literature [ 1 ]. (hindawi.com)
  • All the morphological changes showed a trend of greater severity in the group A patients, in particular villous atrophy (p = 0.005) and colonic-like mucins secretion (p = 0.006). (biomedsearch.com)
  • BACKGROUND: This study reports the outcome from the addition of a continent colonic conduit (CCC) to an electrically stimulated gracilis neoanal sphincter in patients with severe evacuatory disorder following formation of a neosphincter for end-stage faecal incontinence. (biomedsearch.com)
  • Methods: Nine patients with UC had colonic biopsy specimens taken during a symptomatic flare that coincided with positive C difficile (C difficile+) tests. (ebscohost.com)
  • Understanding New Concepts: Clostridium difficile Infection in Pouch Patients. (ebscohost.com)
  • We present a case of a 68-year-old man with EWDA arising in the bypassed stomach that presented as a colonic pseudo-obstruction (CPO). (openarchives.gr)