Document Detail


The Ideal Ileal-Pouch Design: A Long-Term Randomized Control Trial of J- vs W-Pouch Construction.
MedLine Citation:
PMID:  23135583     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: : The IPAA has become established as the preferred technique for restoring intestinal continuity postproctocolectomy. The ideal pouch design has not been established. W-pouches may give better functional results owing to increased volume, whereas the J-pouch's advantage is its straightforward construction. We report short- and long-term results of an randomized control trial designed to establish the ideal pouch.
DESIGN: : Ninety-four patients were randomly assigned to J- and W-pouches (49:45) and assessed at 1 and 8.7 years postoperatively. Assessment was questionnaire based and designed to assess pouch function and patient quality of life.
RESULTS: : Eighty-five percent of patients were followed up at 1 year, and 68% were followed up at 8.7 years. At 1 year, there was a significant difference in 24-hour bowel movement frequency J- vs W-pouches 7 vs 5(p < 0.001) and in daytime frequency J- vs W-pouches 6 vs 4 (p < 0.001), with no difference in nocturnal function. At 9-year follow-up, function had equilibrated between the 2 groups: 24-hour bowel movement frequency J- vs W-pouches 6.5 vs 6 (p = 0.36), daytime frequency 5.5 vs 5 (p = 0.233), and nocturnal function 1 vs 1 (p = 0.987). Mean operating time of J- and W-pouches was 195 and 215 minutes (p < 0.05). All other parameters, pad usage, urgency, incontinence, and quality of life, did not differ significantly between groups.
CONCLUSION: : These data demonstrate that the theoretical functional advantage conferred on the W-pouch by its greater volume exists only in the short term and is of little consequence to patients' long-term quality of life. This advantage is attenuated as the pouches mature, resulting in no disparity in pouch function. This, combined with the more consistent, efficient, and easily taught construction of the J-pouch, should conclusively establish it as the optimum ileal-pouch design.
Authors:
P H McCormick; G D Guest; A J Clark; D Petersen; D A Clark; A R Stevenson; J W Lumley; R W Stitz
Related Documents :
10402893 - Management and short-term outcome of persistent hyperinsulinaemic hypoglycaemia of infa...
10556123 - Burkholderia cepacia in cystic fibrosis. variable disease course.
10468683 - Comparison of ranitidine bismuth citrate plus clarithromycin with omeprazole plus clari...
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  55     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-08     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1251-7     Citation Subset:  IM    
Affiliation:
1 Department of Colorectal Surgery, Royal Brisbane and Womens Hospital, Brisbane, Queensland, Australia 2 Australian Colorectal Endosurgery, Wesley Medical Centre, Auchenflower, Queensland, Australia 3 Holy Spirit Northside, Chermside, Queensland, Australia.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

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


Previous Document:  Anal Cancer Screening in HIV-Infected Patients: Is It Time to Screen Them All?
Next Document:  Drivers of cost after surgical and medical therapy for chronic ulcerative colitis: a nested case-coh...