Update of complications and functional outcome of the ileo-pouch anal anastomosis: overview of evidence and meta-analysis of 96 observational studies.

OBJECTIVE: The objective of this study is to provide a comprehensive update of the outcome of the ileo-pouch anal anastomosis (IPAA). DATA SOURCES: An extensive search in PubMed, EMBASE, and The Cochrane Library was conducted. STUDY SELECTION AND DATA EXTRACTION: All studies published after 2000 reporting on complications or functional outcome after a primary open IPAA procedure for UC or FAP were selected. Study characteristics, functional outcome, and complications were extracted. DATA SYNTHESIS: A review with similar methodology conducted 10 years earlier was used to evaluate developments in outcome over time. Pooled estimates were compared using a random-effects logistic meta-analyzing technique. Analyses focusing on the effect of time of study conductance, centralization, and variation in surgical techniques were performed. RESULTS: Fifty-three studies including 14,966 patients were included. Pooled rates of pouch failure and pelvic sepsis were 4.3% (95% CI, 3.5-6.3) and 7.5% (95% CI 6.1-9.1), respectively. Compared to studies published before 2000, a reduction of 2.5% was observed in the pouch failure rate (p = 0.0038). Analysis on the effect of the time of study conductance confirmed a decline in pouch failure. Functional outcome remained stable over time, with a 24-h defecation frequency of 5.9 (95% CI, 5.0-6.9). Technical surgery aspects did not have an important effect on outcome. CONCLUSION: This review provides up to date outcome estimates of the IPAA procedure that can be useful as reference values for practice and research. It is also shows a reduction in pouch failure over time.

Ileal pouch anal anastomosis with close rectal dissection using automated vessel sealers for ulcerative colitis: a promising alternative.

BACKGROUND: Despite decennia of experience, ileal pouch anal anastomosis for ulcerative colitis is still associated with high complication rates. The development of automatic vessel sealers has resulted in the revival of a promising surgical alternative to the conventional procedure: close rectal dissection. By preserving the mesorectal layer it is hypothesized that nerve-related and other postoperative complications can be reduced. METHODS: All patients with ulcerative colitis with indication for restorative proctocolectomy at our institution during the pilot study underwent the close rectal pouch procedure with temporary diverting ileostomy. Standardized clinical history, anorectal physiology measurements, and endoscopic and histological examination were carried out before and after surgery. RESULTS: The procedure was technically successful in all 10 patients, with a median age of 41 years and a median postoperative follow-up period of 16 months. There were no cases of pelvic sepsis and bladder or sexual dysfunction. The median daytime defecation frequency was 6.0. Endoscopic and histological examination showed no abnormalities. The anorectal physiology supported the good functional results. CONCLUSION: The preliminary results of the close rectal pouch procedure are promising, with good functional results and a low complication rate after 1 year.

Spontaneous regression of a cystic retroperitoneal tumour in young women postpartum. Report of two cases.

Retroperitoneal cystic tumours are rarely found, and of these, the most common lesion is a cystic lymphangioma. We present two postpartum patients with a cystic retroperitoneal tumour which showed spontaneous regression and a review of the literature.

[Second operation more frequent following breast-conserving treatment for invasive lobular than for invasive non-lobular carcinoma]. / Vaker tweede operatie na borstsparende behandeling wegens invasief lobulair dan wegens invasief niet-lobulair carcinoom.

OBJECTIVE: To establish the frequency of re-excision or mastectomy in women who had breast-conserving treatment for invasive lobular mammary carcinoma. DESIGN: Retrospective. METHOD: Data on the number of patients with invasive carcinoma from 1998-2006 were obtained from the national pathology database (PALGA) and the Dutch Comprehensive Cancer Centre East. The following data on patients who had undergone breast-conserving treatment for invasive lobular carcinoma were collected from the electronic patient records: age, localization procedure with wire-localisation and tumour size. RESULTS: The frequency of re-excision or mastectomy following initial breast-conserving surgery in 123 patients with invasive lobular carcinoma was 46.3 % versus 31.5 % in 877 patients with other types of invasive carcinoma. The number of re-excisions was higher in the group with invasive non-lobular carcinoma (4.9% versus 9.2%), and the number of conversions to mastectomy was higher in the group with invasive lobular carcinoma (41.5% versus 20.1%). The age of the patient, the localisation procedure and tumour size were not significant predictors of a tumour-free surgical margin or for the necessity of re-excision. CONCLUSION: The frequency of re-excision in patients with invasive lobular carcinoma was higher than in patients with other types of breast cancer. There was no statistically significant predictor for obtaining a tumour-free surgical margin.