Quality of life in patients with ileal pouch for ulcerative colitis / Qualidade de vida em portadores de reservatório ileal por retocolite ulcerativa

INTRODUCTION: proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard surgical procedure for the treatment of ulcerative colitis (UC) and is associated with the prospect of cure. Experience gained over the years has demonstrated the occurrence of a high number of complications as well as bowel disorders that can compromise quality of life (QoL). OBJECTIVE: evaluate QoL in patients with IPAA for ulcerative colitis. PATIENTS AND METHODS: the Inflammatory Bowel Disease Questionnaire (IBDQ) was used to assess QoL in patients with IPAA after its validation in Portuguese. RESULTS: thirty-one patients submitted to IPAA by the same group of professionals were evaluated. QoL was classified as regular in all domains evaluated (intestinal and systemic symptoms and emotional and social aspects). There were no differences in relation to gender, type of pouch or postoperative time. However, elderly patients showed a tendency toward lower scores. Having a professional activity was associated with higher scores in systemic symptoms and social aspects (p < 0.05). Patients with ileostomy showed lower values in the domains of systemic symptoms, emotional and social aspects (p <0.05). CONCLUSION: in all domains assessed, patients with IPAA for UC had QoL classified as regular. Ileostomy and lack of professional activity negatively influenced QoL. (AU)

OBJETIVO: Avaliar a qualidade de vida em portadores de RI por RCUI. PACIENTES E MÉTODOS: Foi empregado IBDQ, validado em português na avaliação da QoL em portadores de RI. RESULTADOS: Foram avaliados 31 pacientes submetidos a RI pelo mesmo grupo. QoL foi classificada como regular em todos os domínios avaliados (sintomas intestinais e sistêmicos e aspectos emocionais e sociais). Não houve diferenças em relação ao sexo, tipo de reservatório ou tempo de pós-operatório. Entretanto, pacientes idosos apresentaram uma tendência a escores mais baixos. Atividade profissional relacionou-se com escores mais altos em sintomas sistêmicos e aspectos sociais (p < 0,05). Portadores de ileostomia apresentaram valores mais baixos nos domínios sintomas sistêmicos, aspectos emocionais e sociais (p < 0,05). CONCLUSÃO: Em todos os domínios avaliados, portadores de RI por RCUI apresentaram QoL classificada como regular. Ileostomia e inatividade profissional influenciaram negativamente a QoL. (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. .

Quality of life from oncological patients with definitive and temporary colostomy

INTRODUCTION: Colorectal cancer is one of the most prevalent neoplasms in the western world. Colostomy, temporary or permanent, can be a serious limiting factor affecting the quality of life of oncological patients. OBJECTIVE: To compare the quality of life of oncological patients with definitive and temporary colostomy. METHODS: Descriptive cross-sectional study carried out at a public hospital in Brasilia, Federal District of Brazil. The study analyzed 39 patients with colorectal cancer, 76.9% males, sorted into two groups: definitive ostomy (n=26) and temporary ostomy (n=13). The World Health Organization Quality of Life (WHOQOL)-bref questionnaire was used to assess the quality of life. Data were analyzed using Excel 2007 and Statistical Package for Social Sciences 19.0. RESULTS: 50% of definitive and 76.9% of temporary ostomy patients reported that the physical pain did not interfere in the affairs. 38.5% of definitive and 46.2% of temporary ostomy accepted their physical appearance. 46.2% of definitive and 53.8% of temporary ostomy reported good quality of life. 84.6% of definitive and 46.2% of temporary ostomy did not enjoy their life. 50% of definitive and 53.8% of temporary ostomy were satisfied with their sleep. 57.7% of definitive and 53.8% of temporary ostomy considered the environments as healthy. Over 70% of definitive and over 50% of temporary ostomy had financial constraints and were dissatisfied with leisure opportunities, respectively. 69.2% of definitive and 46.2% of temporary ostomy presented lower libido. 88.5% of definitive and 61.5% of temporary ostomy attended the church. CONCLUSION: The results showed that temporary ostomy patients suffer the same afflictions as the patients with definitive ostomy, equally affecting the quality of life of these patients. (AU)

INTRODUÇÃO: O câncer colorretal é uma das neoplasias mais prevalentes no mundo ocidental. A colostomia, temporária ou definitiva, pode ser um sério limitador da qualidade de vida de pacientes oncológicos. OBJETIVO: Comparar a qualidade de vida de pacientes oncológicos colostomizados definitivos e temporários. MÉTODOS: Estudo transversal descritivo realizado em um hospital público do Distrito Federal. Amostra constituída por 39 pacientes com câncer colorretal, 76,9% homens, separados em dois grupos: colostomizados definitivos (n=26) e colostomizados temporários (n=13). Utilizou-se o questionário World Health Organization Quality of Life (WHOQOL)-bref para avaliar a qualidade de vida. Os dados foram analisados pelos programas Excel 2007 e Statistical Package for Social Sciences 19.0. RESULTADOS: 50% dos colostomizados definitivos e 76,9% dos temporários referiram que a dor física não interferia nos afazeres. 38,5% dos definitivos e 46,2% dos temporários aceitavam bem a aparência física. 46,2% dos definitivos e 53,8% dos temporários relataram boa qualidade de vida. 84,6% dos definitivos e 46,2% dos temporários aproveitavam pouco a vida. 50% dos definitivos e 53,8% dos temporários estavam satisfeitos com o sono. 57,7% dos definitivos e 53,8% dos temporários consideravam os ambientes salutares. Mais de 70% e mais de 50% dos definitivos e temporários tinham limitações financeiras e estavam insatisfeitos com as oportunidades de lazer, respectivamente. 69,2% dos definitivos e 46,2% dos temporários estavam insatisfeitos com a libido. 88,5% dos definitivos e 61,5% dos temporários frequentavam a igreja. CONCLUSÃO: Os resultados mostraram que os colostomizados temporários sofrem as mesmas angústias que os colostomizados definitivos, o que afeta igualmente a qualidade de vida dos mesmos. (AU)

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.

Anastomosis ileorrectal en el tratamiento quirúrgico de la colitis ulcerosa: resultados a largo plazo / Ileorectal anastomosis in the surgical treatment of ulcerative colitis: long-term results

Background: Total colectomy with ileorectal anastomosis (IRA) is an alternative to the ileoanal pouch for the surgical treatment of ulcerative colitis in a selected group of patients. This technique leaves rectal mucosa Hable to develop persistent proctitis, dysplasia and cancer Aim: To describe short and long-term results of IRA and to assess the presence of dysplasia. Material and methods: Descriptive study of patients treated with IRA. The data were obtained from the clinical records, and the present status was evaluated with an interview. A proctoscopy and biopsy was offered free of cost to the contacted patients. Results: Between 1978 and 2005, 26 patients were operated. One patient presented an anastomotic leakage that was treated with a loop ileostomy There was no operative mortality. Twenty-three patients were followed for a períod of 1 to 23 years. Three patients evolved as Crohn 's disease and two of them needed a proctectomy. Three patients died of non-related diseases. In the remaining 17, the average evacuation rate was 3.7/24 h and all were continent. None developed a rectal cancer Only two patients had their planned annual endoscopic surveillance. In 2 of the 11 patients who accepted endoscopy and biopsy, a low-grade dysplasia was found. Conclusions: IRA has low morbidity and acceptable functional results in this selected group of patients. No patient present high-grade dysplasia or cancer; however, the adherence to the endoscopic follow-up ispoor.

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 ...