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Ileoanal pouch

Devendra K Gupta, Kashish Khanna, Shilpa Sharma
Aim: This study aims to evaluate the need of Redo pull-through (Re PT) procedures for Hirschsprung's disease (HD) and suggest preventive strategies. Materials and Methods: Patients who underwent redo procedures for HD from 1980 to 2016 by a single surgeon were retrospectively reviewed. Results: Of 167 patients operated for HD, 32 underwent Re PT; 7 were previously operated by the same surgeon, while 25 were referred from outside. Indication for Re PT included residual disease including the rectal pouch following-Duhamel (12), false-negative biopsy (3), retraction of bowel (5), anorectal stricture (2), bowel twist (1), cuff inversion (2), postmyectomy continued symptoms after primary PT (1), fecal fistula (1), Re PT after surgery for adhesive intestinal obstruction (3), bleeding (1), and combination of causes, including scarred perineum (1)...
January 2019: Journal of Indian Association of Pediatric Surgeons
Jonathan P Segal, Matteo Rottoli, Richard K Felwick, Guy Ht Worley, Simon D McLaughlin, Carlo Vallicelli, Paul Bassett, Omar D Faiz, Ailsa L Hart, Susan K Clark
Aim: Prepouch ileitis (PPI) is inflammation of the ileum proximal to an ileoanal pouch, usually associated with pouchitis. The treatment of PPI as a specific entity has been poorly studied, but it is generally treated concurrently with pouchitis. This to our knowledge is the largest study to explore the efficacy of biologics for the specific treatment of PPI. Methods: This was a retrospective observational study reporting outcomes following biological treatment in patients with PPI across three centers...
2018: Clinical and Experimental Gastroenterology
Philip H Sossenheimer, Laura R Glick, Abraham Dachman, Kinga B Skowron, Michele Rubin, Konstantin Umanskiy, Radhika Smith, Lisa Cannon, Roger D Hurst, Russell D Cohen, Neil H Hyman, David T Rubin
BACKGROUND: Anastomotic complications after restorative total proctocolectomy with IPAA for ulcerative colitis alter functional outcomes and quality of life and may lead to pouch failure. Routine contrast enema of the pouch assesses anastomotic integrity before ileostomy reversal, but its clinical use is challenged. OBJECTIVE: The purpose of this research was to assess the relationship among preoperative clinical characteristics, abnormal pouchography, and long-term pouch complications...
November 28, 2018: Diseases of the Colon and Rectum
Angela J Khera, Janet W Chase, Michael Salzberg, Alexander J V Thompson, Michael A Kamm
Background: Patients with inflammatory bowel disease (IBD) often experience functional bowel symptoms despite achieving disease remission. Although behavioral treatment (bowel and pelvic floor muscle retraining) is effective for managing constipation or fecal incontinence in non-IBD patients, there is limited evidence for its efficacy in patients with quiescent inflammatory bowel disease. The aim of this study was to evaluate the outcome of gut-directed behavioral treatment, including pelvic floor muscle training, for symptoms of constipation or fecal incontinence in patients with IBD in disease remission...
November 19, 2018: Inflammatory Bowel Diseases
Jonathan P Segal, Lawrence Penez, Soad Mohsen Elkady, Guy H T Worley, Simon D McLaughlin, Benjamin H Mullish, Mohammed N Quraishi, Nik S Ding, Tamara Glyn, Kesavan Kandiah, Mark A Samaan, Peter M Irving, Omar D Faiz, Susan K Clark, Ailsa L Hart
BACKGROUND: Restorative proctocolectomy with ileal pouch-anal anastomosis is considered the procedure of choice in patients with ulcerative colitis refractory to medical therapy. Subsequent inflammation of the pouch is a common complication and in some cases, pouchitis fails to respond to antibiotics, the mainstay of treatment. In such cases, corticosteroids, immunomodulatory or biologic treatments are options. However, our understanding of the efficacy of anti-tumour necrosis factor medications in both chronic pouchitis and Crohn's-like inflammation is based on studies that include relatively small numbers of patients...
September 2018: Scandinavian Journal of Gastroenterology
Fahima Dossa, Arden M Morris, Amy R Wilson, Nancy N Baxter
BACKGROUND: Without prophylactic surgery, patients with familial adenomatous polyposis are at high risk for colorectal cancer development. Various surgical options for prophylaxis are available. Patient decision-making for preventative treatments is often influenced by the preferences of healthcare providers. OBJECTIVE: We determined surgeon preferences for the surgical options available to patients with familial adenomatous polyposis. DESIGN: We obtained preference estimates for postoperative health states from colorectal surgeons who had treated ≥10 patients with familial adenomatous polyposis...
October 2018: Diseases of the Colon and Rectum
S M Oke, J Segal, S K Clark, A L Hart, S M Gabe
INTRODUCTION: Restorative proctocolectomy is a surgical treatment for patients with medically refractory ulcerative colitis and some cases of familial adenomatous polyposis. Intestinal failure, defined as an inability to maintain adequate hydration and micronutrient balances when on a conventionally accepted normal diet, is a rare complication of restorative proctocolectomy. We describe our experience of patients with restorative proctocolectomy who have developed intestinal failure requiring parenteral support...
August 16, 2018: Annals of the Royal College of Surgeons of England
Cristian Urla, Justus Lieber, Florian Obermayr, Andreas Busch, Roland Schweizer, Steven W Warmann, Hans-Joachim Kirschner, Jörg Fuchs
BACKGROUND: Total colonic aganglionosis (TCA) is a rare variant of Hirschsprung's disease occurring in 3-10% of the cases. Only few studies reported the long-term clinical and metabolic outcomes of patients with TCA. The aim of this study was to evaluate the functional and metabolic long-term outcomes of children undergoing surgical treatment for TCA. METHODS: A 15-year retrospective study was performed. Blood chemistry tests and stool analysis performed at the last follow-up visit were recorded...
August 15, 2018: BMC Surgery
G H T Worley, N S Fearnhead, S R Brown, A G Acheson, M J Lee, O D Faiz
AIM: The second Association of Coloproctology of Great Britain and Ireland (ACPGBI) Ileoanal Pouch Registry (IPR) report was released in July 2017 following a first report in 2012. This article provides a summary of data derived from the most recent IPR report (2017 Ileoanal Pouch Report. METHOD: The IPR is an electronic database of voluntarily submitted data including patient demographics, disease, intra-operative and postoperative factors submitted by consultant surgeons or delegates...
October 2018: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
G H T Worley, J P Segal, J Warusavitarne, S K Clark, O D Faiz
AIM: It is well established that ileo-anal pouch-related septic complications (PRSC) increase the risk of pouch failure. There are a number of publications that describe the management of early PRSC in ulcerative colitis (UC) in small series. This article aims to systematically review and summarize the relevant current data on this subject and provide an algorithm for the management of early PRSC. METHOD: A systematic review was undertaken in accordance with PRISMA guidelines...
August 2018: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Mathurin Fumery, Niraj S Patel, Brigid S Boland, Parambir S Dulai, Siddharth Singh, William J Sandborn
Background and aims: Colectomy with ileoanal pouch is the standard of care for most patients with ulcerative colitis (UC) who require surgery. However, 5%-38% of patients with ileoanal pouch develop pouch strictures that can severely impact the functional results. We retrospectively evaluated the efficacy and safety of endoscopic balloon dilation of ileoanal pouch strictures in patients with inflammatory bowel disease (IBD). Methods: All consecutive patients with IBD that underwent endoscopic balloon dilatation of a pouch stricture at our institution between January 1, 2011, and April 31, 2016, were included...
May 18, 2018: Inflammatory Bowel Diseases
C Simillis, T Afxentiou, G Pellino, C Kontovounisios, S Rasheed, O Faiz, P P Tekkis
AIM: There is no consensus as to which ileoanal pouch design provides better outcomes after restorative proctocolectomy. This study compares different pouch designs. METHOD: A systematic review of the literature was performed. A random effects meta-analytical model was used to compare adverse events and functional outcome. RESULTS: Thirty comparative studies comparing J, W, S and K pouch designs were included. No significant differences were identified between the different pouch designs with regard to anastomotic dehiscence, anastomotic stricture, pelvic sepsis, wound infection, pouch fistula, pouch ischaemia, perioperative haemorrhage, small bowel obstruction, pouchitis and sexual dysfunction...
August 2018: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Jonathan P Segal, Heyson Chan, Brigitte Collins, Omar D Faiz, Susan K Clark, Ailsa L Hart
OBJECTIVES: To report outcomes following biofeedback for functional problems associated with an ileoanal pouch. Incontinence and evacuatory disorders associated with the ileoanal pouch can be particularly problematic and difficult to treat using conventional therapies. Biofeedback therapy is a behavioural treatment that offers a non-surgical approach as an alternative or adjunct for patients. MATERIALS AND METHODS: This was a retrospective single centre study. We reviewed the notes of all patients attending for biofeedback at our institution between January 2012 and October 2017 and identified all those that did so for ileoanal pouch related problems...
June 2018: Scandinavian Journal of Gastroenterology
Amin Makni, Houcine Magherbi, Yassine Ben Safta, Amine Sebai, Sofiene Ayadi, Zoubeir Ben Safta
No abstract text is available yet for this article.
March 2017: La Tunisie Médicale
Dejan Micic, Andres Yarur, Alex Gonsalves, Vijaya L Rao, Susan Broadaway, Russell Cohen, Sushila Dalal, John N Gaetano, Laura R Glick, Ayal Hirsch, Joel Pekow, Atsushi Sakuraba, Seth T Walk, David T Rubin
INTRODUCTION: Clostridium difficile is the most commonly isolated stool pathogen in inflammatory bowel disease (IBD). Traditional risk factors for C. difficile may not exist in patients with IBD, and no prior studies have assessed the risk factors for the isolation of C. difficile in both symptomatic and asymptomatic IBD outpatients. METHODS: We prospectively recruited consecutive IBD patients presenting to our outpatient clinic between April 2015 and February 2016...
April 2018: Digestive Diseases and Sciences
N S Fearnhead, M J Lee, A G Acheson, G Worley, O D Faiz, S R Brown
AIM: Increasing scrutiny on both individual and unit outcomes after surgical procedures is now expected. In the field of inflammatory bowel disease, this is particularly pertinent for outcomes after ileoanal pouch surgery. METHOD: The Surgical Workload and Outcomes Research Database (SWORD) relies on administrative data derived from Hospital Episode Statistics collected in England. The platform was interrogated for pouch procedures undertaken in England between April 2009 and December 2016 to assess national caseload and, between April 2012 and December 2016, to assess variation in caseload and outcomes after pouch surgery...
July 2018: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Aoibhlinn O'Toole, Punyanganie S de Silva, Linda G Marc, Christine A Ulysse, Marcia A Testa, Amanda Ting, Alan Moss, Josh Korzenik, Sonia Friedman
Background: Men with inflammatory bowel disease (IBD) may have increased sexual dysfunction. To measure the prevalence of sexual dysfunction in our male patients, we aimed to develop a new IBD-specific Male Sexual Dysfunction Scale (the IBD-MSDS). Methods: We used a cross-sectional survey and enrolled male patients (N = 175) ≥18 years old who attended IBD clinics at 2 Boston hospitals. We collected information on sexual functioning via a 15-item scale. General male sexual functioning was measured using the International Index of Erectile Dysfunction (IIEF); the Patient Health Questionnaire (PHQ-9) measured depressive symptoms...
January 18, 2018: Inflammatory Bowel Diseases
Alexander T Hawkins, Jun W Um, Amosy E M'Koma
Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for ulcerative colitis (UC). Emergency colectomies are performed for fulminant colitis (ie, toxic megacolon, profuse bleeding, perforation, or sepsis). The RPC and IPAA involve manipulation of the proximal ileum, which may influence the essential physiological function of gut-associated lymphoid tissues. Circulating plasma immunoglobulin G (p-IgG) deficiency is observed in patients with fulminant UC...
2017: Clinical Medicine Insights. Gastroenterology
J P Segal, S Oke, G L Hold, S K Clark, O D Faiz, A L Hart
BACKGROUND: The resident gut microbiota is essential for physiological processes; the disturbance of its balance is linked to intestinal inflammation. The ileoanal pouch is a model for the study of intestinal inflammation, as inflammation of the pouch is common and mostly develops within 12 months following ileostomy closure. This allows the longitudinal study of the microbiota, giving insight into the microbiota changes during transition from a normal to an inflamed pouch. AIM: To explore the literature on the microbiota of the ileoanal pouch in health and disease...
February 2018: Alimentary Pharmacology & Therapeutics
Rajan Chaudhry
Sixteen patients of ulcerative colitis and two of familial adenomatous polyposis were subjected to anorectal manometry, a minimal of three months after Pouch Ileo-Anal Anastomosis and closure of ileostomy. Using a perfusion catheter the parameters measured were resting anal pressure (RAP), maximum squeeze pressure (MSP), pouch volume and compliance at maximum tolerated volume. Subjective evaluation included anal continence and frequency of stools. The subjective functional results after surgery were then correlated with the objective findings of manometry...
April 1998: Medical Journal, Armed Forces India
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