Successful endoscopic treatment of fecalith blocking sinus in a patient with ileal pouch-anal anastomosis / Tratamento endoscópico bem-sucedido de fecálito bloqueando seio em paciente com anastomose bolsa ileal-anal

Background: Ulcerative colitis patients who underwent restorative proctocolectomy with ileal pouch-anal anastomosis can develop various mechanical complications. Among them is presacral sinus resulting from chronic anastomotic leak. Methods: We present a symptomatic patient with a large fecalith blocking the sinus which was successfully treated with Doppler ultrasound guided endoscopic needle knife sinusotomy along with fecalith extraction. Results: A 67-year-old female presented with a 4-month history of perianal pain and urgency. Pouchocopy showed a 3-cm deep wide-mouthed anastomotic sinus, the orifice of which was blocked by a large hard fecalith. Removal of the fecalith using RothNet, Tripod, or Basket were made but failed. Then needle knife was applied to cut the orifice to enlarge the opening of the sinus. One month later, the patient returned and the fecalith was successfully removed with two Baskets and two Rothnets. Six months after fecalith extraction, pouchoscopy showed a compartalized distal pouch sinus with two cavities, which was treated by two sessions of Doppler ultrasound guided endoscopic needle knife sinusotomy. Six months following the treatment, the sinus was completed healed. The patient tolerated all procedures well without any complication. Conclusion: Fecalith blocking pouch anastomotic sinus is a rare complication in patients with restorative proctocolectomy. In our case, this surgical complication was successfully treated with a carefully planned, stepwise endoscopy approach. (AU)

Experiênria: Pacientes com colite ulcerativa tratados por proctocolectomia restauradora com anastomose bolsa ileal-anal podem ser acometidos por diversas complicações mecânicas. Entre elas, cita-se o seio pré-sacral resultante de vazamento crônico pela anastomose. Métodos: Apresentamos uma paciente sintomática com um grande fecálito bloqueando o seio, com tratamento bem-sucedido com sinusotomia por bisturi-agulha guiado por ultrassom, juntamente com a extração do fecálito. Resultados: Mulher, 67 anos, apresentou-se com história de 4 meses de dor perianal e urgência. A avaliação endoscópica da bolsa ileal revelou um seio anastomótico com grande abertura situada a 3 cm de profundidade, cujo orifício estava bloqueado por um grande fecálito endurecido. Foi tentada sem sucesso a remoção do fecálito com a ajuda de Roth-Net, Tripod, ou cestos recuperadores. Depois dessas tentativas, aplicamos um bisturi-agulha com o objetivo de seccionar o orifício com vistas à ampliação da abertura do seio. Um mês depois, a paciente retornou, e o fecálito foi removido com sucesso com dois cestos recuperadores e dois RothNets. Transcorridos seis meses após a remoção do fecálito, uma avaliação endoscópica da bolsa ileal revelou um seio distal compartimentado com duas cavidades, tratado por duas sessões de sinusotomia endoscópica por bisturi-agulha guiado por ultrassom. Seis meses depois do tratamento, o seio estava completamente curado. A paciente tolerou satisfatoriamente todos os procedimentos, sem qualquer complicação. Conclusão: A presença de um fecálito bloqueando o seio anastomótico de bolsa ileal é complicação rara em pacientes submetidos a uma proctocolectomia restauradora. Em nosso caso, essa complicação cirúrgica foi tratada com sucesso com uma abordagem endoscópica em etapas, cuidadosamente planejada. (AU)

Closure of leak at the tip of the "J" after ileal pouch-anal anastomosis using a novel over-the-scope clipping system / Fechamento de vazamento na extremidade de bolsa ileal em J após anastomose bolsa ileal-anal usando um novo sistema "over-the-scope" clip (OTSC)

OBJECTIVE: leaks from the body or the tip of the J-pouch can occur after restorative proctocolecotmy. Although it may follow an indolent clinical course, it often requires surgical repair or pouch revision. Here we describe a novel endoscopic approach to close the leak at the tip of the J pouch. DESIGN: pouchoscopy was performed under sedation and endoscopic over-the-scope clipping system was used for the management of a leak from the tip of a J-pouch. RESULTS: under sedation, a pouchoscopy was performed and the deep tip of "J" leak was detected with a guidewire, along with water-contrasted pouchogram. The contained cavity from the leak was cleaned with hydrogen peroxide and 50% dextrose. Debridement of the epithelialized mouth of the leak was performed with an endoscopic cytology brush. Then endoscopic over-the-scope clipping system was used and the leak defect was completely closed. There was no bleeding or perforation. The entire procedure took 25 min. The patient continued to do well and reported resolution of the low back pain symptom. CONCLUSION: we reported the first case in the literature that a leak from the tip of a J-pouch was endoscopically occluded using a novel over-the-scope clipping system. (AU)

OBJETIVE: vazamentos do corpo da bolsa e da extremidade da bolsa ileal em J podem ocorrer após proctocolectomia restauradora. Embora possam apresentar um curso clínico indolente, muitas vezes requerem procedimentos abdominais. DESENHO: endoscopia da bolsa ileal foi realizada sob sedação e clipagem endoscópica usando o sistema "over-the-scope" foi utilizada para fechar um vazamento na extremidade da bolsa ileal em "J". RESULTADOS: sob sedação, uma endoscopia de bolsa ileal foi realizada e a extremidade profunda do vazamento da bolsa ileal em "J" foi detectada com um fio-guia. A cavidade que continha o vazamento foi limpa com peróxido de hidrogênio e 50% de dextrose. Desbridamento da borda epitelizada do vazamento foi realizada com uma escova de citologia endoscópica. Então o sistema endoscópico "over-the-scope" clip foi usado e o vazamento foi completamente fechado. Não houve sangramento ou perfuração. O processo todo levou 25 minutos. O paciente evoluiu bem e relatou a resolução do sintoma de dor lombar. CONCLUSÃO: relatamos o primeiro caso na literatura de vazamento na extremidade de bolsa ileal em J que foi fechado através de procedimento endoscópico usando um novo sistema "over-the-scope" clip (OTSC). (AU)

Management of ileal pouch prolapse with endoscopic hot snare / Tratamento de prolapso da bolsa ileal com alca diatermica endoscopica

Pouch prolapse is a complication following the creation of restorative proctocolectomy. There is a paucity of information in the literature pertaining to its management. An ileal J pouch patient with dyschezia presented to our Pouch Center. Under sedation, pouchoscopy was performed with a gastroscope. We detected an anterior distal pouch mucosal prolapse, 1.5 cm in diameter, blocking the anal canal. The prolapsed mucosa was excised with hot snare under a retroflex view. There was no bleeding or perforation. The entire procedure took 25 minutes. The patient tolerated the procedure well and was discharged home 30 minutes after post-procedural observation. The patient reported the resolution of the dyschezia symptom. The histopathological examination of excised specimen showed small bowel mucosa and sub-mucosa with changes compatible with mucosal prolapse. Endoscopic hot snare appears to be feasible in the management of pouch mucosal prolapse. (AU)

O prolapso da bolsa ileal é uma complicação que pode surgir após a criação da proctocolectomia restauradora. As informações na literatura são escassas quanto ao tratamento. Um paciente com bolsa ileal em "J" e apresentando disquezia deu entrada em nosso centro médico. Sob sedação, realizamos uma endoscopia da bolsa ileal. Detectamos uma bolsa distal anterior com prolapso da mucosa, com 1,5 cm de diâmetro, bloqueando o canal anal. O prolapso da mucosa foi retirado com alça diatérmica sob visão retroflexa. Não houve sangramento ou perfuração. A duração de todo o processo foi de 25 minutos. O paciente tolerou bem o procedimento e recebeu alta após 30 minutos de observação pós-procedimento. O paciente relatou a resolução do sintoma de disquezia. O exame histopatológico do espécime extirpado mostrou a mucosa e submucosa do intestino delgado com alterações compatíveis com o prolapso da mucosa. A alça diatérmica endoscópica parece ser viável no tratamento de prolapso da mucosa da bolsa ileal. (AU)

Current trends regarding protective ileostomy after restorative proctocolectomy / Tendências atuais sobre ileostomia protetora após proctocolectomia restauradora

The decision to perform a protective ileostomy after ileoanal-pouch anastomosis is controversial, and most of the discussion is based on its advantages and disadvantages. Although a temporary intestinal diversion has been routinely indicated in most patients, this choice is also associated with complications. The present work aims to review the outcomes after restorative proctocolectomy with or without a protective ileostomy in the treatment of ulcerative colitis and polyposis syndromes. Most papers emphasize that diversion protects against anastomosis leaks; consequently, it may prevent pelvic sepsis and pouch failure. Otherwise, a defunctioning ileostomy may cause morbidity such as dehydration, electrolyte imbalance, psychological problems, skin irritation, anastomosis strictures and intestinal obstruction, among others. There are those who believe that the omission of an ileostomy after the confection of ileal pouches should be reserved for selected patients, with quite acceptable results. The selection criteria should include surgeon, patient and procedure features to ensure a good outcome. (AU)

A decisão de realizar ileostomia de proteção após anastomose da bolsa ileal ao canal anal é controversa, sendo a discussão baseada em suas vantagens e desvantagens. Embora a derivação intestinal temporária tenha sido indicada rotineiramente na maioria dos pacientes, essa escolha também está associada a complicações. O presente trabalho teve como objetivo rever os resultados após proctocolectomia restauradora com ou sem ileostomia de proteção no tratamento da colite ulcerativa e síndromes polipoides. Muitos trabalhos enfatizam que a derivação protege contra fístulas anastomóticas; consequentemente, ela pode prevenir sepse pélvica e perda da bolsa. Por outro lado, a derivação por ileostomia pode ser causa de morbidade como desidratação, distúrbios eletrolíticos, problemas psicológicos, lesões dérmicas, estenose de anastomose e obstrução intestinal, entre outras. Há aqueles que acreditam que a omissão de ileostomia após a confecção de bolsa ileal deve ser reservada a pacientes selecionados, obtendo-se resultados aceitáveis. Os critérios de seleção devem incluir características do cirurgião, do paciente e do procedimento na tentativa de se obter bons resultados. (AU)

Radical cystectomy with W-shaped orthotopic ileal neobladder constructed with non-absorbable titanium staples-long term follow-up

Purposes We retrospectively assessed our experience with the W-shaped orthotopic ileal pouch, which was constructed with non –absorbable titanium staples. For these purpose, we discuss the results of bladder capacity, urinary continence and early and long-term postoperative complications. Materials and Methods We included in the study 17 patients who underwent radical cystoprostatectomy followed by construction of an orthotopic W-shaped ileal pouch between October 2000 and November 2009. A 65-70 cm segment of ileum was isolated and prearranged into a W- configuration, leaving two 10 cm intact segments on both sides of the ileal fragment. In our technique we entirely anatomized all adjacent limbs in order to create a sphere-shaped pouch. The ureters were directly anastomized to both intact segments of the ileal division. All our patients underwent pouchscopy 6 months after operation and annually. Results Mean operative time for neobladder reconstruction and ureteral anastomoses was 87 ± 7.67 minutes. In one patient a leak from the ileo-ileal anastomosis was confirmed on the 3rd day after operation. In 2 cases unilateral stricture of the ureteral-neobladder anastomosis was documented. Staple lines were mostly covered with ileal mucosa after 6 months. The mean functional bladder capacity was 340 ± 27.6 mL and 375 ± 43.4 mL at 6 and 12 months, respectively. First-year daytime and nighttime continence was good and acceptable in 90% and 78% of patients, while it increased to 95% during the 2nd year. Conclusions The long term follow-up shows that non-absorbable titanium staples can be safely used for creation of an orthotopic ileal neobladder. However, these data should be further validated in a larger series of patients. .

Histopathological evaluation and risk factors related to the development of pouchitis in patients with ileal pouches for ulcerative colitis

OBJECTIVE: Many changes in mucosal morphology are observed following ileal pouch construction, including colonic metaplasia and dysplasia. Additionally, one rare but potential complication is the development of adenocarcinoma of the reservoir. The aim of this study was to evaluate the most frequently observed histopathological changes in ileal pouches and to correlate these changes with potential risk factors for complications. METHODS: A total of 41 patients were enrolled in the study and divided into the following three groups: a non-pouchitis group (group 1) (n = 20; 8 males; mean age: 47.5 years) demonstrating optimal outcome; a pouchitis without antibiotics group (group 2) (n = 14; 4 males; mean age: 47 years), containing individuals with pouchitis who did not receive treatment with antibiotics; and a pouchitis plus antibiotics group (group 3) (n = 7; 3 males; mean age: 41 years), containing those patients with pouchitis who were administered antibiotics. Ileal pouch endoscopy was performed, and tissue biopsy samples were collected for histopathological analysis. RESULTS: Colonic metaplasia was found in 15 (36.6%) of the 41 patients evaluated; of these, five (25%) were from group 1, eight (57.1%) were from group 2, and two (28.6%) were from group 3. However, no correlation was established between the presence of metaplasia and pouchitis (p = 0.17). and no differences in mucosal atrophy or the degree of chronic or acute inflammation were observed between groups 1, 2, and 3 (p>0.45). Moreover, no dysplasia or neoplastic changes were detected. However, the degree of mucosal atrophy correlated well with the time of postoperative follow-up (p = 0.05). CONCLUSIONS: The degree of mucosal atrophy, the presence of colonic metaplasia, and the degree of acute or chronic inflammation do not appear to constitute risk factors for the development of pouchitis. Moreover, we observed that longer postoperative follow-up times were associated with greater degrees of mucosal atrophy.

Resultados da cirurgia de reservatórios ileais em pacientes com doença de Crohn / Long-term outcomes of ileal pouch after secondary diagnosis of Crohn's disease

RACIONAL: Retocolectomia total e reservatório ileal com anastomose ileoanal constitui o procedimento de escolha para doentes com retocolite ulcerativa inespecífica que requerem cirurgia. Entretanto, alguns doentes por ela acometidos podem desenvolver características compatíveis com doença de Crohn, com conseqüente falência do reservatório. OBJETIVO: Avaliar a evolução tardia dos doentes com reservatórios ileais cujo diagnóstico definitivo foi doença de Crohn. MÉTODOS: Entre fevereiro de 1983 a março de 2007, 151 doentes do Grupo de Coloproctologia do Hospital das Clínicas da Universidade Estadual de Campinas, SP, foram submetidos a retocolectomia total e reservatório ileal, sendo 76 por retocolite ulcerativa inespecífica. Destes, 11 (14,5 por cento) evoluíram como doença de Crohn, com diagnóstico histopatológico confirmado em 9: 1 no espécime da retocolectomia, 2 na proctectomia, 2 em segmentos de intestino delgado, 3 em reservatórios ileais, sendo 2 em biopsias e 1 no reservatório ressecado, e 1 em material de abscesso perianal. Oito doentes (72,7 por cento) eram mulheres e a média de idade foi de 30,6 (18-65) anos. RESULTADOS: Todos tinham diagnóstico pré-operatório de retocolite ulcerativa inespecífica e cinco foram operados inicialmente por megacólon tóxico. O tempo médio entre a confecção do reservatório ileal e a manifestação da doença de Crohn foi de 30,6 meses. Ileostomia de proteção não foi fechada apenas em um doente que apresentou fístula do reservatório no enema opaco e, posteriormente, abscesso perianal extenso e recidiva da doença de Crohn na alça aferente do reservatório. No seguimento tardio, três doentes evoluíram com fístulas perianais e perineais complexas, sendo associada à fístula reservatório-vaginal em uma delas. Todos necessitaram de nova derivação e o reservatório foi excisado em um deles devido à persistência da sepse pélvica. Uma outra apresentou fístula do reservatório para o intróito vaginal, corrigida com ...

BACKGROUND: Total rectocolectomy and ileal pouch-anal anastomosis is the choice surgical procedure for patients with ulcerative colitis. In cases of Crohn's disease post-operative diagnosis, it can be followed by pouch failure. AIM: To evaluate ileal pouch-anal anastomosis long-term outcome in patients with Crohn's disease. METHODS: Between February 1983 and March 2007, 151 patients were submitted to ileal pouch-anal anastomosis by Campinas State University Colorectal Unit, Campinas, SP, Brazil, 76 had pre-operative ulcerative colitis diagnosis and 11 had post-operative Crohn's disease diagnosis. Crohn's disease diagnosis was made by histopathological biopsies in nine cases, being one in surgical specimen, two cases in rectal stump, small bowel in two cases, ileal pouch in three and in perianal abscess in one of them. The median age was 30.6 years and eight (72.7 percent) were female. RESULTS: All patients had previous ulcerative colitis diagnosis and in five cases emergency colectomy was done by toxic megacolon. The mean time until of Crohn's disease diagnosis was 30.6 (6-80) months after ileal pouch-anal anastomosis. Ileostomy closure was possible in 10 cases except in one that had ileal pouch fistula, perianal disease and small bowel involvement. In the long-term follow-up, three patients had perineal fistulas and one had also a pouch-vaginal fistula. All of them were submitted to a new ileostomy and one had the pouch excised. Another patient presented pouch-vaginal fistula which was successfully treated by mucosal flap. Three patients had small bowel involvement and three others, pouch involvement. All improved with medical treatment. Presently, the mean follow-up is 76.5 months and all patients are in clinical remission, and four have fecal diversion. The remaining patients have good functional results with 6-10 bowel movements/day. CONCLUSION: Crohn's disease diagnosis after ileal pouch-anal anastomosis for ulcerative colitis may ...

Complicações imediatas e tardias após cirurgia de reservatório ileal na polipose adenomatosa familiar / Short-term and long-term postoperative complications after ileal pouch-anal anastomosis in familial adenomatous polyposis

RACIONAL: A retocolectomia total com confecção de reservatório ileal é cirurgia ideal para o tratamento do cólon e reto dos doentes com polipose adenomatosa familiar, no entanto pode estar associada a complicações no pós-operatório imediato e tardio. OBJETIVO: Estudar as complicações pós-operatórias da cirurgia do reservatório ileal na polipose adenomatosa familiar. MÉTODOS: Estudo retrospectivo de 69 doentes com polipose adenomatosa familiar submetidos a cirurgia de reservatório ileal no período de 1984 a 2006, pelo Grupo de Coloproctologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas, SP. O seguimento médio pós-operatório foi de 82 (2-280) meses. Dados de interesse: ocorrência de complicações no pós-operatório. RESULTADOS: A morbidade e mortalidade foram de 63,8 por cento e 2,9 por cento, respectivamente. As complicações mais freqüentes foram obstrução intestinal (17,4 por cento), estenose da anastomose (15,9 por cento) e sepse pélvica (10,1 por cento). Outras complicações foram isquemia aguda do reservatório ileal (4,3 por cento), ileíte do reservatório (" pouchitis" ) (2,9 por cento) e fístulas relacionadas ao reservatório (2,9 por cento). CONCLUSÕES: A morbimortalidade foi semelhante à da literatura e aceitável para uma cirurgia complexa como é a do reservatório ileal, realizada em dois tempos operatórios. A obstrução intestinal foi a complicação mais freqüente. Entretanto, isquemia do reservatório, " pouchitis" e sepse pélvica constituíram importantes complicações relacionadas à perda do reservatório ileal.

BACKGROUND: Restorative proctocolectomy is the procedure of choice to treat familial adenomatous polyposis, however it can be associated to short-term and long-term postoperative complications. AIM: To evaluate the occurrence of complications related to the surgical treatment of familial adenomatous polyposis with ileal pouch technique. METHODS: Retrospective study of 69 patients with familial adenomatous polyposis after rectocolectomy with ileal reservoir between 1984 and 2006, operated on Coloproctology Group, Medical Sciences Faculty, State University of Campinas, Campinas, SP, Brazil. The median follow-up period was 82 (2-280) months. Data obtained were surgical techniques and postoperative complications. RESULTS: The morbidity and mortality were 63.8 percent and 2.9 percent, respectively. The most frequent complications were small-bowel obstruction (17.4 percent), anastomotic stricture (15.9 percent) and pelvic sepsis (10.1 percent). Acute ischemia of the ileal pouch (4.3 percent), pouchitis (2.9 percent) and ileal pouch-related fistula (2.9 percent) had poorer frequency than others. CONCLUSIONS: The morbid-mortality was similar to the literature’s data and it is acceptable for a complex surgery in two terms like the ileal reservoir-anal anastomosis. The small-bowel obstruction was the most frequent complication. However, ischemia of the reservoir, pouchitis and pelvic sepsis were important complications and was related to the failure of the ileal reservoir.

Reservorio ileal con anastomosis reservorio anal por colitis ulcerosa: Complicaciones y resultados funcionales a largo plazo / Ileal pouch-anal anastomosis for ulcerative colitis: Complications and long term functional results

Background: The ileo anal-pouch-anastomosis (IPAA) is the treatment of choice for patients with ulcerative colitis (UC). Aim To analyze the surgical outcomes, long term evolution and functional results of IPAA. Material and methods: All patients subjected to an IPAA, from 1984 to 2006 were identified from a prospectively constructed inflammatory bowel disease database. Surgical variables, postoperative complications and functional evaluation, using Oresland score were analyzed. Chi square, Fischer exact test, T Student, Mann Whitney and binary logistic regression were included in the statistical analysis. Results: In the study period 107 patients, aged 14 to 62 years (61 females), subjected to an IPAA, were identified in this period. All patients, except 4, had a J pouch. All were protected with a loop ileostomy Thirteen patients (12.1 percent) had specific postoperative complications: pelvic collections in five (4.6 percent), wound infection in four (3.7 percent), fistula of the anastomosis in two (1.8 percent), hemoperitoneum and pouch necrosis in one each. Three (2.7 percent) patients were reoperated. There was no post-operative (30 days) mortality. A complete follow-up was obtained in 106 of 107 patients: four evolved as Crohn disease; four lost their pouch and two died for other causes. One patient required an ileostomy due to a vaginal fistula. Seventy two patients were followed more than 36 months after ileostomy closure and 92 percent have a satisfactory intestinal function. In the univariate analysis, poorest intestinal function was related to age of diagnosis of UC and presence of chronic pouchitis. In the multivariate analyses age of diagnosis was associated with poor function. Conclusions: IPAA has a low rate of complications. The long term intestinal function is satisfactory in most patients. A poorer intestinal function was observed in older patients and those with chronic pouchitis).

Resultados funcionales a largo plazo luego de la coloproctectomía con reservorio ileal en pacientes con y sin complicaciones postoperatorias / Long term functional outcomes after ileoanal pouch in patients with and without postoperative complications

Introducción: La coloproctectomía con reservorio ileal es la opción quirúrgica de elección en pacientes con colitis ulcerosa (CU). Las complicaciones postoperatorias on frecuentes pero los resultados definitivos son considerados, en general, buenos. Objetivo: nuestro objetivo fue evaluar los resultados funcionales a largo plazo de una serie consecutiva de pacientes con pouch ileal (PI) y establecer su relación con las complicaciones postoperatorias. Pacientes y métodos: incluimos 144 pacientes categorizados en 2 grupos: I- pacientes sin complicaciones postoperatorias (n: 71); y II- pacientes con complicaciones postoperatorias (n: 73). Los pacientes fueron seguidos por un tiempo medio de 3,8 años (rango 1-15 años). Evaluamos: número de deposiciones, capacidad de discriminación entre gases y materiafecal, inhibición voluntaria de la defecación, requerimiento de medicación antidiarreica y grado de incontinencia. Resultados: los resultados funcionales fueron similares entre los dos grupos con respecto al número de deposiciones, a la necesidad de tomar antidiarreicos, a la discriminación anal y a la inhibición voluntaria de la defecación por más de 5 hs. Se observó una mayor tendencia a presentar escapes en los pacientes con complicaciones (34%) respecto de aquellos sin ellas (20%; p<0.08 NS). Comparado con el grupo II, los escapes en el grupo I estaban significativamente relacionados con el incumplimiento de la dieta (p<0.01). La infección pélvica fue la complicación más frecuente en los pacientes con incontinencia (56%). Conclusiones: nuestro estudio demostró que la mayoría de los parámetros funcionales a largo plazo no son influenciados por la ocurrencia de complicaciones postoperatorias, con excepción de una tendencia a la incontinencia, más frecuentemente asociada con la infección pélvica.

Background: the proctocolectomy with ileal pouch (IP) has become the gold standard for surgical treatment for ulcerative colitis (UC). The postoperative complications are frequent but the definitive outcome is acceptable. Aim: our aim was to evaluate the long term functional outcome in a series of consecutive patients with IP and o establish its relation with postoperative complications. Patients and methods: we included 144 patients categorized in two groups: I- patients without postoperative complications (n: 71); II- patients with postoperative complications (n: 73). Patients were followed for a median time of 3.8 years (range 1-15). We evaluated: stool frequency, anal discrimination between gas and stool, voluntary evacuation inhibition, requirement of antidiarrheal medications and presence of incontinence. Results: the functional outcome was similar between the two groups in terms of stool frequency, medication use, anal discrimination and the voluntary inhibition of evacuation for more than 5 hours. A trend to present seepage was seen in patients with complications (34%) more than in those without them (20%; p<0.08 NS). Compared with group II, seepage in group I was significantly related with dietary lapses (p<0.01). The most frequent complication in incontinent patients was pelvic sepsis (56%). Conclusions: our study showed that most of long-term functional parameters are not influenced by the presence of postoperative complications. However, a trend for incontinence seems to be related to postoperative complications, more frequently with pelvic sepsis.

Short- and long-term outcomes of ileal pouch-anal anastomosis for ulcerative colitis

Ileal pouch-anal anastomosis was an important advancement in the treatment of ulcerative colitis. The aim of this study was to determine whether early complications of ileal pouch-anal anastomosis in patients with ulcerative colitis are associated with poor late functional results. PATIENTS AND METHODS: Eighty patients were operated on from 1986 to 2000, 62 patients with ileostomy and 18 without. The early and late complications were recorded. Specific emphasis has been placed on the incidence of pouchitis with prolonged follow-up. RESULTS: The ileostomy was closed an average of 9.2 months after the first operation. Fourteen patients were excluded from the long-term evaluation; 6 patients were lost to regular follow-up, 4 died, and 4 patients still have the ileostomy. Of the 4 patients that died, 1 died from surgical complications. Early complications after operation (41) occurred in 34 patients (42.5 percent). Late complications (29) occurred in 25 patients as follows: 16 had pouchitis, 3 associated with stenosis and 1 with sexual dysfunction; 5 had stenosis; and there was 1 case each of incisional hernia, ileoanal fistula, hepatic cancer, and endometriosis. Pouchitis occurred in 6 patients (9.8 percent) 1 year after ileal pouch-anal anastomosis, 9 (14.8 percent) after 3 years, 13 (21.3 percent) after 5 years, and 16 (26.2 percent) after more than 6 years. The mean daily stool frequency was 12 before and 5.8 after operation. One pouch was removed because of fistulas that appeared 2 years later. CONCLUSIONS: Ileal pouch-anal anastomosis is associated with a considerable number of early complications. There was no correlation between pouchitis and severe disease, operation with or without ileostomy, or early postoperative complications. The incidence of pouchitis was directly proportional to duration of time of follow-up