Document Detail


Delayed ileal pouch-anal anastomosis. Complications and functional results.
MedLine Citation:
PMID:  1914739     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In patients with chronic ulcerative colitis (CUC), ileal pouch-anal anastomosis (IPAA) can be performed either at the time of colectomy or as a delayed procedure after total abdominal colectomy and ileostomy. There has been debate as to whether delayed IPAA results in superior functional results, since patients are frequently steroid-free and have little evidence of active disease. To assess this, we analyzed 95 patients who had undergone total abdominal colectomy, either with ileostomy and Hartmann's procedure or with ileorectostomy, 2-183 months prior to IPAA. Postoperative complications and functional results were compared with those of 776 CUC patients who underwent IPAA at the time of abdominal colectomy. Indications for prior colectomy included toxic megacolon (40 percent), failed medical therapy (36 percent), other reasons (e.g., iatrogenic perforation, cancer) (6 percent), and reasons unclear (18 percent). Nineteen percent of delayed-IPAA patients were taking steroids at the time of pouch construction. Follow-ups were similar in the two groups. The incidence of septic and obstructive complications after delayed IPAA vs. IPAA at the time of colectomy were 10.5 percent vs. 5.4 percent and 6.5 percent vs. 14.5 percent, respectively. There were no significant differences in postoperative functional results between the two groups. Delayed IPAA confers no advantage over IPAA performed at the time of colectomy in terms of functional outcome. Delayed IPAA was associated with a significantly higher rate of septic complications but a lower incidence of postoperative obstruction.
Authors:
S Galandiuk; J H Pemberton; J Tsao; D M Ilstrup; B G Wolff
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  34     ISSN:  0012-3706     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  1991 Sep 
Date Detail:
Created Date:  1991-11-15     Completed Date:  1991-11-15     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  755-8     Citation Subset:  IM    
Affiliation:
Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Colectomy*
Colitis, Ulcerative / drug therapy,  surgery*
Defecation
Fecal Incontinence / epidemiology*,  physiopathology,  therapy
Female
Follow-Up Studies
Humans
Incidence
Incontinence Pads / utilization
Intestinal Obstruction / epidemiology*
Intestine, Small*
Male
Middle Aged
Peritonitis / epidemiology*
Postoperative Complications / epidemiology*
Proctocolectomy, Restorative / adverse effects,  methods,  standards*
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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