Proximal diversion at the time of ileal pouch-anal anastomosis for ulcerative colitis: current practices of North American colorectal surgeons.
نویسندگان
چکیده
PURPOSE Pelvic sepsis is a serious complication after ileal pouch-anal anastomosis for ulcerative colitis that may lead to pouch failure or poor function. Although a temporary loop ileostomy may be created at the time of ileal pouch-anal anastomosis to prevent or minimize the consequences of an anastomotic leak, research has suggested that an ileostomy can be safely omitted in selected patients. The purpose of this study was to examine the use of proximal diversion by colorectal surgeons at the time of ileal pouch-anal anastomosis for ulcerative colitis. METHODS A questionnaire was mailed to all practicing fellows of The American Society of Colon and Rectal Surgeons in North America. Surgeons were asked to describe their typical practice for a number of clinical scenarios. RESULTS Questionnaires were mailed to 913 American Society of Colon and Rectal Surgeons fellows, and 63 percent responded. For a patient who has had a prior colectomy and is not taking steroids, 27 percent of surgeons would perform ileal pouch-anal anastomosis alone, and 73 percent would perform ileal pouch-anal anastomosis with a loop ileostomy. For a patient who has not had previous surgery and is taking prednisone 40 mg/day, 16 percent of surgeons would perform a subtotal colectomy with an end ileostomy, 82 percent would perform a total proctocolectomy and ileal pouch-anal anastomosis with a loop ileostomy, and 2 percent would perform a total proctocolectomy and ileal pouch-anal anastomosis without an ileostomy. There was no relationship between practice setting, annual ileal pouch-anal anastomosis volume, or years in practice and surgeon response for either scenario. CONCLUSIONS The majority of surgeons create a temporary loop ileostomy at the time of ileal pouch-anal anastomosis for ulcerative colitis.
منابع مشابه
Results of Endorectal Heal J Pouch with Ulcerative Colitis
This study evaluates the results of endorectal Ileal J Pouch Anal Anastomosis (IJPAA) in 13 patients with Ulcerative colitis and 7 patients with familial adenomatous polyposis in 6 years in Emam Hosein Hospital. In the last, for this patients permanent Ileostomy was performed, but with (IJPAA) operation permanent Ileostomy is abandoned. Two patients, total colectomy rectal mocosectomy and ilea...
متن کاملFunctional outcomes and complications after restorative proctocolectomy and ileal pouch anal anastomosis in the pediatric population.
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متن کاملA reappraisal of the ileo-rectal anastomosis in ulcerative colitis.
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ورودعنوان ژورنال:
- Diseases of the colon and rectum
دوره 52 6 شماره
صفحات -
تاریخ انتشار 2009