Surgical Treatment Of Ulcerative Colitis Research Articles

Restorative proctocolectomy for ulcerative colitis in children— Is the J-pouch better than straight pull-through?

Proctocolectomy and ileoanal anastomosis (IAA), with or without an ileal pouch, is the preferred method for the surgical treatment of ulcerative colitis (UC) in children. The authors compared the surgical complications and functional outcome for patients with UC who had proctocolectomy and straight IAA with those of patients who had proctocolectomy and IAA with a J-pouch. Twenty-two children (aged 7 to 15 years) with intractable UC had an IAA, 11 by straight ileoanal anastomosis (SIAA) and 11 with a J-pouch (JIAA). The median clinical and endoscopic follow-up period for SIAA patients was 4 years (range, 3.0 to 6.5 years); for JIAA patients it was 2 years (range, 1 to 3 years). The frequency of daytime and nighttime defecation was significantly higher ( P < .03) for patients with SIAA at 3, 6, and 12 months postoperatively. At the last follow-up visit, the mean frequency of defecation for patients with SIAA was 6.1 ± 2.5/d; that for patients with JIAA was 3.3 ± 0.5/d ( P < .03). Six of 10 patients with SIAA but none with JIAA had nighttime bowel evacuations. None of the patients had daytime soiling; 3 with SIAA and 2 with JIAA had slight soiling during sleep. There was no significant difference in the incidence of early (SIAA 27% v JIAA 45%) and late (SIAA 54% v JIAA 27%) surgical complications between the two groups. Endoscopically confirmed symptomatic pouchitis during the first post-operative year was found in 4 of the 11 (36%) patients with SIAA and in 2 of the 11 (18%) with JIAA (difference not significant). The early and long-term functional results of JIAA are superior to those of SIAA. There is no difference in the incidence of surgical complications and pouchitis between JIAA and SIAA patients.

Laparoscopic Techniques for Inflammatory Bowel Disease.

Very little has been written concerning the use of laparoscopic techniques in inflammatory bowel disease. Its most useful indications appear to be in Crohn's disease, especially for intestinal diversions when severe perineal/perianal sepsis occurs. In this instance, avoidance of a laparotomy is a major advantage, and the simplicity of a laparoscopic stoma formation makes this a procedure that most surgeons may perform, even with minimal laparoscopic experience. Laparoscopic techniques may also be used for the limited resections required in Crohn's ileal or ileocolonic disease and for diagnostic purposes when indicated. The laparoscopic approach to the surgical treatment of ulcerative colitis (total abdominal colectomy, possibly with proctectomy and ileoanal pouch formation) remains to be evaluated before it can be contemplated as an alternative to conventional procedures.

Laparoscopic Techniques for Inflammatory Bowel Disease

Very little has been written concerning the use of laparoscopic techniques in inflammatory bowel disease. Its most useful indications appear to be in Crohn's disease, especially for intestinal diversions when severe perineal/perianal sepsis occurs. In this instance, avoidance of a laparotomy is a major advantage, and the simplicity of a laparoscopic stoma formation makes this a procedure that most surgeons may perform, even with minimal laparoscopic experience. Laparoscopic techniques may also be used for the limited resections required in Crohn's ileal or ileocolonic disease and for diagnostic purposes when indicated. The laparoscopic approach to the surgical treatment of ulcerative colitis (total abdominal colectomy, possibly with proctectomy and ileoanal pouch formation) remains to be evaluated before it can be contemplated as an alternative to conventional procedures.

潰よう性大腸炎 潰よう性大腸炎に対する外科治療

潰瘍性大腸炎に対する外科治療は大腸全摘,回腸人工肛門,結腸全摘,回腸直腸吻合,大腸全摘,回腸嚢肛門吻合術などが行われているが,最近は大腸全摘回腸嚢肛門吻合術が一般化し,数多く行われている.この術式も肛門管を温存する変法もあり,これらの利点,欠点について要約した.

Update on the Surgical Management of Ulcerative Colitis and Ulcerative Proctitis: Current Controversies and Problems

: The surgical management of ulcerative colitis has been revolutionized in recent years by the development of the ileal pouch-anal procedure. Although it is now the operation of choice for most patients, there remain several controversies. A variety of designs of ileal pouch are available each with advantages and disadvantages. The technique used to anastomose the pouch to the anal canal is also open to debate with some surgeons favoring distal mucosectomy with eradication of all disease and others choosing to perform a stapled anastomosis to achieve better functional results. The main concern for gastroenterologists, however, is the risk of development of pouchitis. The etiology, diagnosis, and treatment of this condition will also be discussed in this review as well as the more classical options for the surgical treatment of ulcerative colitis.

Transanal mucosectomy

Restorative proctocolectomy has gained increasing popularity in the surgical treatment of ulcerative colitis. However, symptomatic proctitis in an excessively long anorectal stump or high-grade dysplasia within the retained anorectal mucosa can pose challenging problems. A corrective operation for these problems is described. A sphincter-preserving perineal approach to mobilize the pouch was described. It allows excision of the inflamed or dysplastic-retained anorectal mucosa, followed by pouch advancement and a neoileoanal anastomosis. The technique was successfully performed in two patients, one with symptomatic "proctitis" and another with high-grade dysplasia in the anorectal mucosa after a previously stapled ileoanal (distal rectal) anastomosis. This report illustrates the relative ease and safety of delayed mucosectomy via a perineal approach, provided that the initially stapled anastomosis is within 3 cm to 4 cm of the dentate line. This technique also obviates the need for complex abdominopelvic surgery after previous restorative proctocolectomy.

Efficasy of Preoperative Endoscopic Ultrasonography in Surgical Treatment of Ulcerative Colitis

Efficasy of Preoperative Endoscopic Ultrasonography in Surgical Treatment of Ulcerative Colitis

Progress of Surgical Treatment for Ulcerative Colitis

Progress of Surgical Treatment for Ulcerative Colitis

Carriage of adhesive Escherichia coli after restorative proctocolectomy and pouch anal anastomosis: relation with functional outcome and inflammation.

Restorative proctocolectomy with pelvic ileal reservoir is a well accepted option for the surgical treatment of ulcerative colitis. Acute pouchitis is a common complication and resembles acute ulcerative colitis. Patients with ulcerative colitis carry Escherichia coli that adhere to epithelial cells and thus this study examined whether acute pouchitis is associated with the carriage of adhesive E coli. E coli isolated from stool samples from 24 patients (median age 34 years, range 16-64; 13 men, 11 women) who had had restorative proctocolectomy with pelvic ileal reservoir were examined by means of the buccal epithelial cell adhesion assay. Patients were studied at a median of 12 months (range 7-21) after operation. Eight of 24 patients had acute pouchitis at the time of study. Adhesive E coli were detected in nine of 24 patients with a pelvic ileal reservoir compared with none of 12 controls (p < 0.05). The buccal epithelial cell adhesion index was inversely related to the degree of acute pouchitis (rs = 0.46, p = 0.024) and to the functional outcome (rs = -0.49, p = 0.022). Carriage of adhesive E coli was not related to the design of the reservoir. By contrast with ulcerative colitis, acute pouchitis is not associated with the carriage of adhesive E coli.

Surgical treatment of ulcerative colitis in Stockholm County, 1955 to 1984.

Time trends in surgical treatment of ulcerative colitis in Stockholm County over the 30-year period 1955 to 1984 were investigated. Four hundred eighty-six patients (263 men and 223 women) were submitted to colectomy with or without proctectomy. In elective cases, proctocolectomy was the procedure of choice until the 1980s, when subtotal colectomy became more common. In acute cases subtotal colectomy was the procedure of choice during the entire period. Major complications developed in 162 patients (33 percent) and 103 (21 percent) underwent another operation. The frequency of major complications increased, with the urgency of intervention being 25 percent in elective cases and 46 percent in acute cases (P less than .001). The postoperative mortality was 1.7 percent in 301 elective cases and 9.2 percent in 185 acute cases (P less than .001). The overall postoperative mortality was 4.5 percent and fell from 13 percent during 1960 to 1964 to 2.0 percent during 1980 to 1984 (P less than .01). In acute cases, the mortality during the same two periods fell from 36 to 3.0 percent (P less than .001). The postoperative mortality for proctocolectomy (2.7 percent) was significantly lower (P less than .01) than for subtotal colectomy (9.0 percent). Seventy-four percent of the patients treated by subtotal colectomy were acute cases, however, with a mortality of 11 percent and only 30 percent of the proctocolectomy cases were acute cases, with a mortality of 6.5 percent.

New approach to surgical treatment of ulcerative colitis and polyposis coli without pelvic pouch

A new method for the surgical treatment of ulcerative colitis and polyposis coli is described. Instead of preparing a pelvic pouch, the natural rectal pouch stripped of the diseased mucosa was used experimentally in dogs. The undisturbed muscular cuff of the rectum (12 cm from the anal verge) was covered by healthy vascularized mucosa of small bowel in such a manner that the dog could use its rectum as usual before surgery. The results are encouraging. The rectal reservoir is spared, with its sensitivity, continence and motor activity covered by healthy mucosa. The dogs thrived.

Surgical Treatment of Ulcerative Colitis in Japan

An epidemiological survey was conducted on 4, 484 patients diagnosed as having ulcerative colitis in nationwide hospitals up to June 1981. Among these patients, 640 who underwent surgery were investigated. The ages of the patients who had surgery ranged from 3 to i9years, and the average ages were 33.8 years for males and 38.0 years for females. Mast of the patients were in their twenties, followed by those in their thirties. The duration of the disease was one year or less in 40.0%, longer than one year in 59.1% and longer than 5 years in 14.5%. According to the pathological classification, many of the patients who underwent surgery were of colitis type, in the active stage, severe and of the relapsing-remitting type. One third of the surgical procedures were emergency operations and the remaindes were elective. The indications for emergency patients were major hemorrhage, perforation, peritonitis, toxic megacolon, etc. The indications for the elective patients included repeated recurrence, and limitations of medical treatment. The mortality was 6.0% for the elective operations and 35.4% for the emergency operations, The mortality was high in patients with perforation, peritonitis and toxic megacolon as complications.

Long term follow-up of surgical treatment for ulcerative colitis--with special reference to recurrence and the quality of life.

From 1961 to 1984, fifty-one patients with ulcerative colitis were surgically treated at Tohoku University Hospital. The results of various types of surgical treatments for ulcerative colitis were analysed and discussed with special reference to recurrence and the quality of life at the time of follow-up. Total colitis and left-sided colitis were observed in 42 and 9 patients, respectively. There were five operative deaths. Thirteen patients received total proctocolectomy and 38 patients received various types of conservative operations at the first operation. In seven patients there was a recurrence of the disease in the retained colon or rectum and proctocolectomy with ileostomy was carried out. Forty-six patients were followed. Four died of other diseases and two were lost to follow-up. The periods of follow-up after the final operation ranged from 3-29 years. The types of operative procedures were ileostomy in 19, ascendicostomy in 14, ileoproctostomy in 6 and ascendicoproctostomy in 1 patient. Following treatment of recurrence of the disease, in most patients who had undergone various surgical treatments, favorable results of quality of life were attained, even in those with ileostomy. These results indicate that it is important to select the most proper types of operative procedures for surgical treatment of ulcerative colitis by individualizing each case.

Personality traits that can affect adaptation after colectomy. A study of 10 patients treated for ulcerative colitis either with proctocolectomy and ileostomy or with colectomy, proctomucosectomy, ileal pouch and ileoanal anastomosis.

The purpose of the present study was to examine how specific personality traits and/or conflicts could serve to predict nonadaptability after surgical treatment for ulcerative colitis. In order to define the scope of the study and to establish more specific hypotheses, retrospective studies were conducted by in depth interviews with 10 patients. Five of the patients had undergone colectomy with proctomucosectomy and ileal pouch ad modum Parks, and 5 had had a proctocolectomy with ileostomy ad modum Brooke. The interviews were recorded on tape and analyzed by the interviewer as well as by an independent evaluator. In addition, the operating surgeon provided an independent evaluation of the patients' post-operative adaptation. There was good consensus between both sets of assessments based on interviews as well as between the interview diagnoses and the surgeon's evaluation. There was no observed correlation between prevailing psychiatric diagnostic categories and postoperative adaptation. Psychological factors, such as a discrepancy between body image and body ideal, alexithymic characteristics, abnormal aggression patterns, extensive physical exercise and muscular training, showed varying degrees of negative correlation with postoperative adaptation.

Alternatives to conventional ileostomy in the surgical treatment of ulcerative colitis.

Alternatives to conventional ileostomy in the surgical treatment of ulcerative colitis.

Surgical Treatment of Ulcerative Colitis in Children

Surgical Treatment of Ulcerative Colitis in Children

Surgical treatment of ulcerative colitis in children: R. L. Telander, S. L. Smith, H. M. Marcinek, et al. Surgery 90:787–794, (October), 1981

Surgical treatment of ulcerative colitis in children: R. L. Telander, S. L. Smith, H. M. Marcinek, et al. Surgery 90:787–794, (October), 1981

I. Epidemiological Study on the Surgical Treatment of Ulcerative Colitis in Japan

We did statistical survey of 1905 caces with ulcerative colitis which had occurred or recurred until December 1974 and been treated at medical institutions all over the country. Among those 1905 cases, 333 cases who had received surgical therapy, were examined. The results were as follows;1) Seventeen per cent of 1905 cases had surgical operation.2) In the study by regional groups, the rate of operation was higher in the districts where the amount of snowfall is greater. In the study by age groups, most of patients had received sugical procedures in 20 to 49 years of age.3) The post operative mortality was increasing till 1971 and thereafter, it is gradually decreasing. It is about 8 % after 1974.4) The mortality was higher in the cases who had not been diagnosed exactly at operation or had received emergency operation. Especially in the perforated or peritonitis cases, it was higher.5) Twenty nine of all cases died with ulcerative colitis did not receive surgical operation. The operation should be decided at earlier stage.

I. Treatment of Ulcerative Colitis

Physicians are reminded the following three facts on treating the patients with ulcerative colitis ; 1) The disorder is a chronic inflammation and the affected colon is much irritated. 2) Immunological process is playing a role in the pathogenesis. 3) Approximately 20% of the patients will be ultimately treated surgically.General measures of treatment are the colonic, physical and emotional rest, maintenance of nutrition and of fluid and electrolytes balance, and other managements for improvement of general status.As chemotherapeutic measures, in patients with mild or moderate colitis Salazopyrine is the drag of first choice and steroid enema is the second. Oral administration of steroid is given to patient with refractory and severe colitis. In acute fulminant colitis no oral intake is allowed, and all medications and nutritions are given parenterally. If no definite improvement is seen within a week surgical treatment is urgent. Indication of surgical treatment for ulcerative colitis is not definite, but the cases which do not respond to medical treatment for some weeks are generally indicated. Since the prognosis for patients with severe colitis on medical management is not good, earlier surgery has been recommended.For maintenance of remission, administration of Salazopyrine may be used for more than 6 months.

Operative treatment of ulcerative colitis, Crohn's disease and diverticulitis (author's transl)

Operations and follow-up examinations were conducted on 106 patient with ulcerative colitis, 33 with colitis Crohn, and 163 with diverticulitis, at the University Clinics of Cologne and Munich. Overall mortality rates were 24.5% (n=26), 6.1% (n=2) and 16% (n=26), respectively. In the surgical treatment of ulcerative colitis the possibility of malignant degeneration and, in the case of Crohn's disease, prevention of recurrences must be taken into consideration. Whether Crohn's disease is a precancerous condition remains to be clarified. Choosing the optimal time for operative intervention is as important in diverticulitis as in ulcerative colitis. Because of the possibility of complications and the high risk of operation, early intervention is recommended for diverticulitis.