>Year 2000, Issue 2
García-Osogobio S, Takahashi MT, Mass W, Arch-Ferrer J, Remes-Troche JM, Cárdenas S
Sphincter preserving surgery in patients with unspecific chronic ulcerative colitis
Cir Gen 2000; 22 (2)
PDF: 4. Kb.
Antecedents: Total proctocolectomy and ileo-anal anastomosis (PCTAIA) is the procedure of choice for patients with Unspecific Chronic Ulcerative Colitis (UCUC) requiring surgery. Frequency of this disease is low in Mexico; hence, the experience with this procedure is scarce.
Objective: To analyze the surgical morbidity and mortality and the long-term functional results in a series of patients subjected to this type of surgery in a reference hospital of Mexico City.
Setting: Third level health care hospital.
Design: Clinical retrospective and observational study.
Patients and methods: We reviewed the clinical records of patients subjected to surgery due to inespecific chronic ulcerative colitis, at the National Institute of Nutrition (from the Ministry of Health) from January 1987 to June 1997. We analyzed demographic data, surgical indication, surgical morbidity and mortality, long term morbidity and mortality, as well as the functional state on their last medical examination. All were operated directly by, or under the supervision of two surgeons. The technique used was the same in all patients and consisted of total resection of the colon and rectum, resection of the mucous and submucous layers of the anal transition zone, creation of a J-shaped ileal reservoir and manual endo-anal anastomosis.
Results: Average age was of 37 ± 14 years. There were 13 (50%) women and 13 (50%) of men. Total morbidity was of 46% without mortality. Average follow-up was of 24 months, average diurnal evacuations were 4.8%, nocturnal discharge was 20%, none presented incontinence. Three patients presented inflammation of the reservoir that responded favorably to antibiotics. Two patients presented long-term fistulas of the ileal reservoir, but none needed resection. No deaths occurred.
Conclusion: PCTAIA is a feasible surgery in our conditions, accompanied by acceptable rates of morbidity and mortality, and satisfactory functional results.
||Rectal disease, ulcerative colitis, morbidity, recurrence, mortality.
Dozois RR. Surgical treatment of chronic ulcerative colitis. Hepatogastroenterology 1989; 36: 227-34.
Tjandra JJ, Fazio VW, Church JM, Oakley JR, Milsom JM, Lavery IC. Similar functional results after restorative proctocolectomy in patients with familial adenomatous polyposis and mucosal ulcerative colitis. Am J Surg 1993; 165: 322-5.
Klopp AL. Body image and self-concept among individuals with stomas. J Enterostomal Ther 1990; 17: 98-105.
Kelman G, Minkler P. An investigation of quality of life and self-esteem among individuals with ostomies. J Enterostomal Ther 1989; 16: 4-11.
Church J, Fazio VW. The continent ileostomy: indications, techniques for construction, and management of complications. Sem Colon Rectal Surg 1991; 2: 102-10.
Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 1978; 2: 85-8.
Kelly KA, Pemberton JH, Wolff BG, Dozois RR. Ileal pouch-anal anastomosis. Curr Prob Surg 1992; 29: 59-131.
Takahashi T, Arch J, Gómez-Méndez T, Cardenas S. Alternativas quirúrgicas para el tratamiento de la colitis ulcerativa crónica inespecífica. Rev Gastroenterol Mex 1996; 61: 134-8.
Decanini-Teran C, Cardona Pérez MA, Moreno-Guzmán A. Salazar-Bañuelos A, Mendoza-Hernandez S. Colectomía abdominal y proctectomía mucosa con anastomosis ileo-anal y reservorio ileal en pacientes con poliposis familiar y colitis ulcerativa crónica inespecífica. Rev Sanid Milit Mex 1988; 42: 167-70.
Luna-Pérez P, Rodríguez-Coria DF, Sánchez-Maldonado W, González-Macouzet J. Proctocolectomía con ileoanastomosis: morbilidad y resultados funcionales en pacientes con y sin cáncer colorectal. Rev Gastroenterol Mex 1996; 61: 184-92.
Cohen Z, McLeod RS, Stephen W, Stern HS, O’Connor B, Reznick R. Continuing evolution of the pelvic pouch procedure. Ann Surg 1992; 216: 506-11; discussion 511-2.
Moreno EF, Domínquez JM, Sagar PM, Pemberton JH. Update on ileal pouch-anal anastomosis. Rev Gastroenterol Mex 1996; 61: 387-93.
McIntyre PB, Pemberton JH, Beart RW Jr, Devine RM, Nivatvongs S. Double-stapled vs. handsewn ileal pouch-anal anastomosis in patients with chronic ulcerative colitis. Dis Colon Rectum 1994; 37: 430-3.
Farouk R, Dozois R, Pemberton J, Larson D. Incidence and subsequent impact of pelvic abscess after ileal pouch-anal anastomosis for chronic ulcerative colitis. Dis Colon Rectum 1998; 41: 1239-43.
>Year 2000, Issue 2