Document Detail


The ileo neo rectal anastomosis: long-term results of surgical innovation in patients after ulcerative colitis and familial adenomatous polyposis.
MedLine Citation:
PMID:  22885881     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Restorative proctocolectomy with ileo neo rectal anastomosis (INRA) combines cure of ulcerative colitis (UC) or familial adenomatous polyposis (FAP) with restoration of intestinal continuity. Evaluation of long-term results was needed to determine if there is a place for INRA in the armamentarium of a surgeon besides the ileal pouch anal anastomosis (IPAA).
METHODS: All patients with INRA were included in the analysis. Patient demographics and clinical and follow-up data (morbidity, dietary problems, defecation frequency, fecal continence, anal and neorectal physiology, and neorectal mucosa assessment) were registered prospectively.
RESULTS: Seventy-nine patients were enrolled, and in 58 patients (50 UC, 8 FAP), INRA was successful. In 21 patients, intraoperative conversion to IPAA was needed. In 49 patients with INRA, a functional reservoir was achieved. No pelvic sepsis or bladder or sexual dysfunction occurred. Thirteen patients experienced episodes of reservoir inflammation. Median bowel movements of six (5, 8) with a nocturnal defecation frequency of one were recorded with fecal continence or minor incontinence. Anal manometry and neorectal physiology showed a decrease in resting pressure and an increase in squeeze pressure and maximum tolerated volume. The median follow-up was 8.1 years (6.7, 10.1).
CONCLUSIONS: This is an example of a surgical innovation with a theoretical potential to be superior to the current technique. This potential was not confirmed in short- and long-term evaluations. Hence, IPAA is currently the best available alternative to a conventional ileostomy.
Authors:
Joost T Heikens; Hein G Gooszen; Johannes L J M Teepen; Willem E Hueting; Henk J Oostvogel; Theo J M V van Vroonhoven; J Han J M van Krieken; Cees J H M van Laarhoven
Publication Detail:
Type:  Clinical Trial; Journal Article     Date:  2012-08-12
Journal Detail:
Title:  International journal of colorectal disease     Volume:  28     ISSN:  1432-1262     ISO Abbreviation:  Int J Colorectal Dis     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-14     Completed Date:  2013-06-17     Revised Date:  2013-10-09    
Medline Journal Info:
Nlm Unique ID:  8607899     Medline TA:  Int J Colorectal Dis     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  111-8     Citation Subset:  IM    
Affiliation:
Department of Surgery, Radboud University Nijmegen Medical Centre, Route 690, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands. j.heikens@chir.umcn.nl
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MeSH Terms
Descriptor/Qualifier:
Adenomatous Polyposis Coli / surgery*
Adult
Anastomosis, Surgical
Colitis, Ulcerative / surgery*
Female
Follow-Up Studies
Humans
Ileum / surgery*
Male
Postoperative Complications / epidemiology
Proctocolectomy, Restorative / methods*
Prospective Studies
Rectum / surgery*
Treatment Outcome
Comments/Corrections
Comment In:
Int J Colorectal Dis. 2013 Sep;28(9):1313-4   [PMID:  23092985 ]

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


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