1,721,499 research outputs found
Immunosuppression may exert a hypoxia-mediated carcinogenetic effect in long-standing fistulizing Crohn's disease
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Effects of age at disease onset and at treatment on serology in inflammatory bowel diseases
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Preoperative exposure to biologics and surgeons' attitude toward the surgical approach in ulcerative colitis
Full text linkOutcomes of salvage surgery for ileal pouch complications and dysfunctions. the experience of a referral centre and review of literature
No full textBACKGROUND AND AIMS:
Failure rates of restorative proctocolectomy with ileo pouch-anal anastomosis (IPAA) range between 3.5 and 15%. Salvage surgery aims to preserve the pouch and transanal evacuation. We report our experience with salvage, review the outcomes of revisional pouch surgery, and propose a classification of pouch dysfunction.
METHODS:
We collected data on patients undergoing pouch salvage surgery between 1987 and 2014 at our hospital. Pre- and post-salvage functional data were assessed. Function at the 3-year follow-up was compared with that of matched IPAA controls (study patients:controls, 1:3).
RESULTS:
Considering only patients who underwent primary IPAA at our centre (n = 31), 5-year failure was higher after salvage compared with primary IPAA (28.8 vs 5.7% log rank test, p = 0.005). Overall, we included 39 patients, with eight additional patients who received primary IPAA elsewhere, undergoing 46 procedures. Most patients had a J-pouch (74.4%) and needed salvage for septic complications. A transperineal approach was used in 22 patients, whereas 17 underwent abdominal salvage, with 77.3 and 64.7% success rates, respectively. Minor surgery was effective but required repeated procedures. Overall failure was 28.2% at a median follow-up of 42 (1-153) months. A significant decrease in bowel frequency (p = 0.021) and rate of urgency (p = 0.009) was observed at the 3-year follow-up after salvage in 25 patients available for comparison. Functional results after major salvage procedures were poorer compared with healthy IPAA controls (p = 0.003).
CONCLUSIONS:
Salvage surgery is effective and safe in experienced teams, but the 5-year failure rate is higher after salvage than after successful primary pouch surgery. Sepsis brings about a higher risk of failure compared with mechanical causes of dysfunction
Education and imaging. Gastrointestinal: Symmetric lymphangitis of lower limbs originating from a perianal abscess.
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Slaughtering sacred cows: Long-term surveillance after ileal pouch-anal anastomosis for ulcerative colitis and choice of anastomosis
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