Document Detail


Interposition of a gastric pouch between ileum and anus after proctocolectomy: long-term results in 3 patients.
MedLine Citation:
PMID:  19375617     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: After proctocolectomy, ileal pouch-anal anastomosis may not be feasible, especially in the case of desmoid tumor or after failed ileal pouch-anal anastomosis requiring excision of the pouch. We designed a gastric pouch interposed between the terminal ileum and the anus to avoid a permanent ileostomy for these patients. Long-term results and quality of life with this technique remain unknown. METHODS: After proctocolectomy, ileal pouch-anal anastomosis was not feasible or had failed in 3 patients (2 with familial adenomatous polyposis and 1 with ulcerative colitis; 40, 49, and 50 years of age, respectively). Of these patients, 2 had undergone end ileostomy 7 and 8 years previously. A pouch was created using the left half of the gastric fundus, supplied through the right gastroepiploic vessels; the pouch was anastomosed proximally to the terminal ileum and distally to the anus. Diverting ileostomy was performed in all patients. RESULTS: After a mean follow-up of 6 years, all 3 patients were highly satisfied with the operation and described their quality of life as good. The median stool frequency during the day and night were 6 and 1, respectively. No patient reported incontinence or urgency. Of the 3 patients, 2 had minimal soiling with gastric juice; 1 patient had anastomotic ulcers with bleeding requiring resection with reanastomosis. All of the patients needed long-term proton pump inhibitor therapy and topical perianal treatment to prevent skin burning. CONCLUSION: Inter-ileoanal gastroplasty is a surgical salvage technique that can avoid a permanent ileostomy. The procedure provides a good quality of life for patients with unfeasible or failed ileal pouch.
Authors:
Pablo Ortega-Deballon; Nicolas Cheynel; Giovanni Di-Giacomo; Rezkallah Hareth; Olivier Facy; Patrick Rat
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Surgery     Volume:  145     ISSN:  1532-7361     ISO Abbreviation:  Surgery     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-20     Completed Date:  2009-05-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  568-72     Citation Subset:  AIM; IM    
Affiliation:
Department of Digestive Surgery, University Hospital, Dijon, France. pablo.ortega-deballon@chu-dijon.fr
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MeSH Terms
Descriptor/Qualifier:
Adenomatous Polyposis Coli / surgery*
Adult
Colitis, Ulcerative / surgery*
Colonic Pouches*
Female
Follow-Up Studies
Gastroplasty / methods*
Humans
Male
Middle Aged
Proctocolectomy, Restorative / methods*
Quality of Life
Treatment Outcome

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


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