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Kelm M, Widder A, Zwack C, Schöttker K, Reibetanz J, Meining A, Germer CT, Flemming S. Two-step versus three-step proctocolectomy for ulcerative colitis: a comparative study on nutritional status, immunosuppressive therapy, and long-term outcome. Tech Coloproctol 2024; 28:62. [PMID: 38824195 DOI: 10.1007/s10151-024-02931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/03/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Despite novel medical therapies, rates of surgery in ulcerative colitis remain relevant. While various surgical approaches for multistep proctocolectomy are available, overall evidence is low and robust recommendations are lacking for individual procedures especially in case of refractory inflammation and signs of malnutrition. METHODS All patients who received multistep proctocolectomy between 2010 and 2021 for ulcerative colitis were evaluated and divided into two groups (two-step/2-IPAA [ileal pouch-anal anastomosis] versus three-step/3-IPAA proctocolectomy). Patient characteristics as well as short- and long-outcomes were individually analyzed. RESULTS Surgical techniques were explained in detail. Fifty patients were included in the study with 27 patients receiving 2-IPAA and 23 patients 3-IPAA. Rates of postoperative complications were comparable for both groups. While patients receiving 2-IPAA were more often suffering from malignancy, 3-IPAA resulted in a significant increase of hemoglobin and albumin levels as well as a reduction of immunosuppressive medication. Rates of stoma reversal trended to be reduced for 3-IPAA compared to 2-IPAA (52.2% vs. 77.8%, p = 0.06). CONCLUSION Three-step proctocolectomy with creation of sigmoidostomy is a safe procedure and reasonable surgical approach in patients with preoperatively high dosages of immunosuppressive medication or risk factors such as persistent active inflammation and anemia.
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Affiliation(s)
- M Kelm
- Department for General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6, 97080, Würzburg, Germany
| | - A Widder
- Department for General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6, 97080, Würzburg, Germany
| | - C Zwack
- Department for General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6, 97080, Würzburg, Germany
| | - K Schöttker
- Department of Internal Medicine, Division of Gastroenterology, University Hospital of Wuerzburg, Würzburg, Germany
| | - J Reibetanz
- Department for General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6, 97080, Würzburg, Germany
| | - A Meining
- Department of Internal Medicine, Division of Gastroenterology, University Hospital of Wuerzburg, Würzburg, Germany
| | - C-T Germer
- Department for General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6, 97080, Würzburg, Germany
| | - S Flemming
- Department for General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Str. 6, 97080, Würzburg, Germany.
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de Bock E, Herman ES, Meij V, Burghgraef TA, Oldenburg B, Verheijen PM, Pronk A, Filipe MD, Vriens MR, Richir MC. Postoperative outcomes of surgical delay in inflammatory bowel disease patients: a multicenter cohort study. Updates Surg 2024:10.1007/s13304-024-01893-5. [PMID: 38805172 DOI: 10.1007/s13304-024-01893-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 05/18/2024] [Indexed: 05/29/2024]
Abstract
Postponement of surgical inflammatory bowel disease (IBD) care may lead to disease progression. This study aims to determine the influence of delayed surgical IBD procedures on clinical outcomes. This multicenter retrospective cohort study included IBD patients who underwent a surgical procedure during the Coronavirus disease 2019 (COVID-19) pandemic from March 16, 2020, to December 31, 2020, and were compared to a pre-COVID-19 cohort. The primary endpoint was determining the number of (major) postoperative complications. Secondary endpoints were the time interval between surgical indication and performance of the surgical procedure and the risk factors of postoperative complications using multivariate analysis. Eighty-one IBD patients who underwent a surgical procedure were included. The median time interval between surgical indication and performance of the surgical procedure did not differ between the COVID-19 and pre-COVID-19 cohorts (34 vs. 33.5 days, p = 0.867). Multivariate analysis revealed a longer time interval between surgical indication and surgical procedure significantly correlated with the risk of developing postoperative complications [odds ratio (OR) 1.03, p = 0.034]. Moreover, previous surgery was identified as an independent predictor (OR 4.25, p = 0.018) for an increased risk of developing major postoperative complications. There was no significant surgical delay for patients with IBD in the COVID-19 pandemic cohort compared to the pre-pandemic cohort. However, a longer time interval between surgical indication and surgical procedure significantly correlated with the risk of developing postoperative complications. In the event of future scarcity in healthcare, efforts should be made to continue surgical procedures in IBD patients.
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Affiliation(s)
- Ellen de Bock
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Eline S Herman
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vincent Meij
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thijs A Burghgraef
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bas Oldenburg
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul M Verheijen
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - Mando D Filipe
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Menno R Vriens
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Milan C Richir
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Hanna QEB, Tripp DA, Geirc M, Gnat L, Moayyedi P, Beyak M. Psychosocial factors associated with j-pouch surgery for patients with IBD: a scoping review. Qual Life Res 2023; 32:3309-3326. [PMID: 37347396 DOI: 10.1007/s11136-023-03454-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Ulcerative colitis and Crohn's disease are subtypes of inflammatory bowel disease: a chronic condition of unclear etiology characterized by inflammation of the small and large intestine. Inflammatory bowel disease is managed with diet, medications, and surgeries, with the most common surgery, recommended to ulcerative colitis patients being j-pouch surgery. PURPOSE To assess the current literature concerning psychosocial factors associated with j-pouch surgery for patients with inflammatory bowel disease. METHODS A systematic scoping review of the empirical and grey literature was conducted for original research on j-pouch surgery and psychosocial variables. Eight databases were searched: Medline, PsychInfo, CINAHL, EBM Reviews, ProQuest Dissertations and Theses Global, ResearchGate, Prospero, and PrePubMed. RESULTS Thirty-nine articles were identified. Many studies (n = 18) adopted a case-series design, and none examined psychosocial interventions. The most popular psychosocial variables assessed were quality of life (n = 34) and those associated with sexual health and functioning (n = 9). CONCLUSIONS Despite being an established surgical procedure, little research has examined the psychosocial implications of j-pouch surgery. As such, clinicians lack a robust understanding of how this procedure affects patients' psychiatric and social status and adaptive abilities. There is a need for high-quality research utilizing validated measures and rigorous design methodologies with control populations.
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Affiliation(s)
- Quincy E B Hanna
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Dean A Tripp
- Department's of Psychology, Anesthesiology & Urology, Queen's University, Kingston, ON, Canada.
| | - Madelaine Geirc
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Lauren Gnat
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Paul Moayyedi
- Department Gastroenterology, McMaster University, Hamilton, ON, Canada
| | - Michael Beyak
- Division of Gastroenterology, Department of Medicine, Queen's University, Kingston, ON, Canada
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4
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de Bock E, Filipe MD, Meij V, Oldenburg B, van Schaik FDM, Bastian OW, Fidder HF, Vriens MR, Richir MC. Quality of life in patients with IBD during the COVID-19 pandemic in the Netherlands. BMJ Open Gastroenterol 2021; 8:e000670. [PMID: 34215570 PMCID: PMC8257293 DOI: 10.1136/bmjgast-2021-000670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/07/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE COVID-19 has put a strain on regular healthcare worldwide. For inflammatory bowel disease (IBD), gastrointestinal surgeries were postponed and changes in treatment and diagnostic procedures were made. As abrupt changes in treatment regimens may result in an increased morbidity and consequent well-being of patients with IBD, the aim of this study was to determine the effect of the COVID-19 pandemic on health-related quality of life (HRQoL) in patients with IBD. DESIGN All patients with IBD who completed both Inflammatory Bowel Disease Questionnaire (IBDQ) and 36-Item Short Form Health Survey (SF-36) questionnaire between 31 August and 13 September 2020 were included in our cohort study. The primary end point was to determine the HRQoL in patients with IBD, measured by the IBDQ and SF-36 questionnaire. The secondary end point was determining which factors influence the HRQoL in patients with IBD. RESULTS 582 patients with IBD filled in the IBDQ and SF-36 questionnaire. The HRQoL in our study population was low according to the questionnaires on both physical and mental subscales. In addition, multivariate analysis showed that increased age, female sex and patients who underwent surgery had a significantly lower HRQoL, most frequently on the physical domains in both questionnaires. CONCLUSION Patients with IBD had an overall low HRQoL during the COVID-19 pandemic. Furthermore, older patients, women and patients who underwent surgical procedures had the lowest physical HRQoL.
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Affiliation(s)
| | | | | | - Bas Oldenburg
- Gastroenterology and Hepatology, UMC Utrecht, Utrecht, The Netherlands
| | | | | | - Herma F Fidder
- Gastroenterology and Hepatology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Milan C Richir
- Surgery, UMC Utrecht, Utrecht, The Netherlands
- Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, Locatie VUmc, Amsterdam, The Netherlands
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Rijcken E, Senninger N, Mennigen R. [Restorative proctocolectomy for ulcerative colitis : Long-term functional results and quality of life]. Chirurg 2017; 88:566-573. [PMID: 28500611 DOI: 10.1007/s00104-017-0441-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Restorative proctocolectomy with ileo-pouch-anal anastomosis is the standard procedure for ulcerative colitis. It provides complete removal of the diseased colorectum, avoids permanent ileostomy and allows the preservation of continence. Functional results and quality of life after restorative proctocolectomy are of great importance. Patients usually have 5-6 bowel movements per day, and continence is satisfactory in more than 90% of patients. A good pouch function strongly correlates with high quality of life. Postoperative septic complications are the main risk factor for bad pouch function and pouch failure; therefore nowadays most procedures are performed with a covering ileostomy. Quality of life is usually impaired by active ulcerative colitis, and restorative proctocolectomy improves the quality of life up to the level of a healthy reference population. Taken together, restorative proctocolectomy provides excellent results concerning function and quality of life.
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Affiliation(s)
- E Rijcken
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Münster (UKM), Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland.
| | - N Senninger
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Münster (UKM), Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland
| | - R Mennigen
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Münster (UKM), Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland
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Orchard T. UK guidance opens new therapeutic avenues for patients with moderate-severe ulcerative colitis. Expert Rev Gastroenterol Hepatol 2016; 10:281-2. [PMID: 26651595 DOI: 10.1586/17474124.2016.1130622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tim Orchard
- a GI Unit , St Mary's Hospital, Imperial College Healthcare NHS Trust, Imperial College London , London , UK
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7
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Abstract
The position of surgery in the treatment of ulcerative colitis (UC) has changed in the era of biologics. Several important questions arise in determining the optimal positioning of surgery in the treatment of UC, which has long been a challenge facing gastroenterologists and surgeons. Surgery is life-saving in some patients and leads to better bowel function and better quality of life in most patients. The benefits of surgery, however, must be weighed against the potential surgical morbidity and compromised functioning that clearly can occur. The introduction of biologic therapy has added further complexity to decisions about medical management, surgery, and the relative timing of these choices. Appropriate medical management of UC may induce and maintain remission and may prevent surgery. However, medical management also carries risks of adverse effects, and recent data suggest that delay of surgery during ineffective medical therapy can increase the chances of negative surgical outcomes. To make individualized timely treatment decisions, early collaboration between gastroenterologists and surgeons is important and more data on predictors of treatment response and positive outcomes are needed. Early identification of patients who would benefit from biologic therapy or surgery is challenging.
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8
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Agarwal S, Stucchi AF, Dendrinos K, Cerda S, O'Brien MJ, Becker JM, Heeren T, Farraye FA. Is pyloric gland metaplasia in ileal pouch biopsies a marker for Crohn's disease? Dig Dis Sci 2013; 58:2918-25. [PMID: 23543088 DOI: 10.1007/s10620-013-2655-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 03/19/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Approximately 5-10 % of ulcerative colitis (UC) patients who undergo ileal pouch-anal anastomosis (IPAA) will develop postoperative complications such as refractory pouchitis or a change in diagnosis to Crohn's disease (CD). Serological markers and histologic aspects of the pouch such as pyloric gland metaplasia (PGM) have been associated with a risk for these complications. METHODS Twenty-eight IPAA patients with either CD of the pouch or chronic pouchitis (cases) and 36 IPAA controls who experienced a normal postoperative course were originally consented. Of these 64 subjects, 22 cases and 17 controls had histopathologic and serologic data available and were subsequently enrolled. Demographic and clinical data were entered into a database, blood analyzed for serological markers (Prometheus Labs, San Diego, CA) and biopsies of the pouch and the afferent limb reviewed by two GI pathologists. RESULTS Of the cases, 55 % (12/22) had evidence of PGM in their pouch and/or small bowel biopsies, as compared to 12 % (2/17) of the controls (p = 0.006). Of 13 subjects with CD, 77 % (10/13) were found to have PGM versus subjects with chronic pouchitis in which 22 % (2/9) were found to have PGM (p = 0.03). There was a trend of ASCA positivity (both IgG and IgA, p = 0.20) and of higher ASCA titer levels (p = 0.07) with postoperative complications. CONCLUSION This study suggests that the presence of ileal pouch PGM is associated with postoperative complications and favors a diagnosis of CD over UC with chronic pouchitis.
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Affiliation(s)
- Shuchi Agarwal
- Section of Gastroenterology, Boston University School of Medicine, 85 East Concord St. 7th Floor, Boston, MA, 02118, USA,
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9
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Salehimarzijarani B, Jalaly NY, Dadvar Z, Hemmasi G, Ashrafi M, Zali M. Long-term quality of life after ileal pouch anal restorative proctocolectomy for ulcerative colitis. Indian J Gastroenterol 2013; 32:49-53. [PMID: 23238689 DOI: 10.1007/s12664-012-0284-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 11/13/2012] [Indexed: 02/04/2023]
Abstract
Restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) has evolved as the surgical procedure of choice for ulcerative colitis (UC). The aim of our study was to evaluate the quality of life (QOL) of UC patients who underwent this procedure over 5 years ago. Thirty-nine UC patients who underwent restorative proctocolectomy with IPAA were interviewed by the validated inflammatory bowel disease questionnaire (IBDQ). Each patient was assigned a score, ranging from 32 to 224, in which the highest score indicates the best QOL. QOL for postoperative patients was good in 15 (38.5 %), regular in 23 (59 %), and bad in 1 (2.6 %) patient. QOL was not significantly influenced by age or gender of the patient. The emotional aspect received the highest score in the IBDQ and for each question that was analyzed separately; most of the patients were pleased and thankful with their lives and this question received the highest score. Long-term QOL was good in UC patients who underwent IPAA. This operation should be considered as the first choice since the patients were stable after long-term follow up.
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Affiliation(s)
- Babak Salehimarzijarani
- Research Center for Gastroenterology and Liver Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Biondi A, Zoccali M, Costa S, Troci A, Contessini-Avesani E, Fichera A. Surgical treatment of ulcerative colitis in the biologic therapy era. World J Gastroenterol 2012; 18:1861-70. [PMID: 22563165 PMCID: PMC3337560 DOI: 10.3748/wjg.v18.i16.1861] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 11/25/2011] [Accepted: 03/10/2012] [Indexed: 02/06/2023] Open
Abstract
Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis, biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conventional treatments and for patients with steroid dependent disease. The reduction in hospitalization and surgical intervention for patients affected by ulcerative colitis after the introduction of biologic treatment remains to be proven. Furthermore, these agents seem to be associated with increase in cost of treatment and risk for serious postoperative complications. Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in ulcerative colitis patients. Surgery is traditionally recommended as salvage therapy when medical management fails, and, despite advances in medical therapy, colectomy rates remain unchanged between 20% and 30%. To overcome the reported increase in postoperative complications in patients on biologic therapies, several surgical strategies have been developed to maintain long-term pouch failure rate around 10%, as previously reported. Surgical staging along with the development of minimally invasive surgery are among the most promising advances in this field.
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A fulminant colitis index greater or equal to 8 is not predictive of colectomy risk in infliximab-treated moderate-to-severe ulcerative colitis attacks. ACTA ACUST UNITED AC 2010; 34:612-7. [DOI: 10.1016/j.gcb.2010.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 07/13/2010] [Accepted: 07/13/2010] [Indexed: 01/02/2023]
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Szepes Z, Molnár T, Farkas K, Horváth G, Nagy F, Nyári T, Wittmann T. Better quality of life after surgery treatment in patients with colitis ulcerosa: what is the price? Orv Hetil 2010; 151:1264-9. [DOI: 10.1556/oh.2010.28908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A colitis ulcerosa (CU) krónikus lefolyása során jelentősen befolyásolja a betegek életminőségét. Kevés adat áll rendelkezésre arról, hogy a CU hatására kialakult rosszabb életminőséget a sebészeti beavatkozás milyen mértékben képes javítani.
Cél:
Mivel hazai adatok egyáltalán nem ismertek ezzel kapcsolatban, célul tűztük ki, hogy operált CU-s betegeink körében megvizsgáljuk a műtét kimenetelét és annak az életminőségre gyakorolt hatását.
Betegek és módszerek:
1998–2009 között 183 CU-s beteget [átlagéletkor a diagnózis idejében: 33,23 év (12–69 év); 95 nő, 88 férfi] hospitalizáltunk, akik legalább egy alkalommal parenteralis szteroidkezelésben részesültek. Annál a 46 betegnél [átlagéletkor a diagnózis idejében: 31 év (12–60 év); 29 nő, 17 férfi), akiknél colectomia történt ez idő alatt, feldolgoztuk a sebészi beavatkozások kimenetelét, szövődményeit, a rokkantsági besorolásban, a keresetben, a gyógyszerszedésben, valamint az orvosi ellátások számában történt változásokat a műtétet követően, ezenkívül minden beteg kitöltött egy általunk kidolgozott kérdőívet a műtét előtti és utáni életminőségük összehasonlítására. Az utánkövetés átlagidőtartama: 3,3 év (0–10 év) volt. Statisztikai analízisként kétmintás T-próbát és egy szempontos varianciaanalízist alkalmaztunk, a p<0,05 értéket fogadtuk el szignifikánsnak.
Eredmények:
A betegek 74%-a ileum-pouch anális anastomosis (IPAA) műtéten esett át, 11 betegnél végleges ileostoma és 1 betegnél ileorectalis anastomosis került kialakításra. Huszonnégy betegnél igazolódott korai, 23 esetben késői posztoperatív szövődmény (13 esetben a pouch gyulladása). A fekvőbeteg-ellátás igénye és az alkalmazott gyógyszeres kezelések száma szignifikánsan csökkent, a betegek életminősége pedig jelentősen javult a colectomia után a műtét előtti állapothoz képest. A betegek 32%-ának nem változott a rokkantsági besorolása; 64,5%-uknak nem okozott keresetbeli kiesést a colectomia.
Megbeszélés:
Adataink azt mutatják, hogy egy jól elvégzett műtétsorozat jelentős életminőség-javulást eredményez a betegek többségénél, azonban a késői posztoperatív szövődmények miatt további belgyógyászati kezelésre lehet szükség.
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Affiliation(s)
- Zoltán Szepes
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Szeged Korányi fasor 8–10. 6720
| | - Tamás Molnár
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Szeged Korányi fasor 8–10. 6720
| | - Klaudia Farkas
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Szeged Korányi fasor 8–10. 6720
| | - Gábor Horváth
- 2 Miskolci Semmelweis Ignác Egészségügyi Központ és Egyetemi Oktatókórház Miskolc
| | - Ferenc Nagy
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Szeged Korányi fasor 8–10. 6720
| | - Tibor Nyári
- 3 Szegedi Tudományegyetem, Általános Orvostudományi Kar Orvosi Informatika Intézet Szeged
| | - Tibor Wittmann
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Szeged Korányi fasor 8–10. 6720
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Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 2010; 105:501-23; quiz 524. [PMID: 20068560 DOI: 10.1038/ajg.2009.727] [Citation(s) in RCA: 891] [Impact Index Per Article: 63.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Guidelines for clinical practice are aimed to indicate preferred approaches to medical problems as established by scientifically valid research. Double-blind placebo controlled studies are preferable, but compassionate-use reports and expert review articles are used in a thorough review of the literature conducted through Medline with the National Library of Medicine. When only data that will not withstand objective scrutiny are available, a recommendation is identified as a consensus of experts. Guidelines are applicable to all physicians who address the subject regardless of specialty training or interests and are aimed to indicate the preferable but not necessarily the only acceptable approach to a specific problem. Guidelines are intended to be flexible and must be distinguished from standards of care, which are inflexible and rarely violated. Given the wide range of specifics in any health-care problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the board of trustees. Each has been intensely reviewed and revised by the Committee, other experts in the field, physicians who will use them, and specialists in the science of decision analysis. The recommendations of each guideline are therefore considered valid at the time of composition based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at a time established and indicated at publication to assure continued validity. The recommendations made are based on the level of evidence found. Grade A recommendations imply that there is consistent level 1 evidence (randomized controlled trials), grade B indicates that the evidence would be level 2 or 3, which are cohort studies or case-control studies. Grade C recommendations are based on level 4 studies, meaning case series or poor-quality cohort studies, and grade D recommendations are based on level 5 evidence, meaning expert opinion.
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Affiliation(s)
- Asher Kornbluth
- Samuel Bronfman Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA.
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Stornes T, Skreden K, Sollie A, Bjerkeseth T. Bekkenreservoarkirurgi. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:1150-2. [DOI: 10.4045/tidsskr.09.0808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Long-term outcome 10 years or more after restorative proctocolectomy and ileal pouch-anal anastomosis in patients with ulcerative colitis. Langenbecks Arch Surg 2009; 395:49-56. [PMID: 19280217 DOI: 10.1007/s00423-009-0479-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 02/24/2009] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study was to assess quality of life (QOL) in a long-term follow-up of patients with ulcerative colitis (UC) 10 years and more after ileal pouch-anal anastomosis (IPAA) to correlate these results with pouch function and to assess the long-term pouch failure rate. METHODS In a unicentric study, 294 consecutive patients after IPAA between 1988 and 1996 were identified from a prospective database. QOL was evaluated according to the validated Gastrointestinal Quality of Life Index (GIQLI). RESULTS Overall median follow-up was 11.5 years. Thirty-seven patients experienced pouch failure (12.6%). The rates of ileal pouch success after 5, 10 and 15 years were 92.3%, 88.7% and 84.5%. According to the GIQLI, patients with a functioning pouch achieved a mean score of 107.8, reflecting a decrease of QOL of 10.8% compared to a healthy population. There were significant negative correlations between QOL and an age of >50 years (p < 0.05), pouchitis, perianal inflammation and increased stool frequency (p < 0.0001). CONCLUSIONS QOL and functional results of patients with UC 10 years or more after IPAA were acceptable; however, those were reduced when compared to a healthy population. Pouch failure rate still increases up to 15.5% 15 years after IPAA. This result represents an important issue in providing patients with comprehensive preoperative information.
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Becker JM, Stucchi AF. Treatment of choice for acute severe steroid-refractory ulcerative colitis is colectomy. Inflamm Bowel Dis 2009; 15:146-9. [PMID: 19009603 DOI: 10.1002/ibd.20780] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- James M Becker
- Department of Surgery, Boston University Medical Center, Boston, Massachusetts 02118, USA. interscience.wiley.com
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Chessin DB, Gorfine SR, Bub DS, Royston A, Wong D, Bauer JJ. Septic complications after restorative proctocolectomy do not impair functional outcome: long-term follow-up from a specialty center. Dis Colon Rectum 2008; 51:1312-7. [PMID: 18584247 DOI: 10.1007/s10350-008-9413-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 05/07/2008] [Accepted: 05/11/2008] [Indexed: 02/08/2023]
Abstract
PURPOSE After restorative proctocolectomy, 7 to 8 percent of patients may have a pouch leak. Concern exists that pouch leak may be associated with impaired functional outcome. We evaluated patients who underwent restorative proctocolectomy to determine whether pouch leak adversely affected long-term functional outcome and quality of life. METHODS We queried our prospectively maintained database of patients who underwent restorative proctocolectomy for demographic and clinical data. We sent a long-term outcome questionnaire to patients, including the validated Fecal Incontinence Severity Index and Cleveland Global Quality of Life scores. Pouch leak was identified by clinical or radiographic evidence of leak. Patients with leak were compared with those without to determine the impact on long-term functional outcome or quality of life. RESULTS A total of 817 patients were available for follow-up and 374 patients (46 percent) completed questionnaires. The group with (n = 60; 16 percent) and without (n = 314; 84 percent) leak had similar demographics. The median Fecal Incontinence Severity Index score (15.3 vs. 14.7, P = 0.77), Cleveland Global Quality of Life score (0.79 vs. 0.81, P = 0.48), and bowel movements per 24 hours (7.92 vs. 7.88, P = 0.92) were similar. The pouch loss/permanent ileostomy rate was higher in those who leaked (13.3 vs. 0.9 percent, P < 0.001). CONCLUSIONS Anastomotic leak after restorative proctocolectomy does not adversely affect long-term quality of life or functional outcome. However, pouch loss/permanent ileostomy is significantly more likely in patients who have had an anastomotic leak.
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Affiliation(s)
- David B Chessin
- Department of Surgery, Division of Colorectal Surgery, Mount Sinai Medical Center, New York, New York, USA.
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Baudet A, Rahmi G, Bretagne AL, Gloro R, Justum AM, Reimund JM. Severe ulcerative colitis: present medical treatment strategies. Expert Opin Pharmacother 2008; 9:447-57. [PMID: 18220494 DOI: 10.1517/14656566.9.3.447] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A total of 15-19% of ulcerative colitis patients have a severe attack at some time during their illness. As a consequence of its high associated mortality and morbidity rates, a close collaboration between gastroenterologists and surgeons in their management is mandatory, in order to define, as best as possible, the timing of surgery (i.e., colectomy) when patients fail to respond to medical treatment or worsen despite optimal medical treatment. The first step in medical treatment consists of using intravenous corticosteroids as they have been demonstrated to reduce drastically the mortality rates. However, at 1 year approximately 25% of patients become corticosteroid dependent and 30% require colectomy, which can consistently affect their quality of life. Therefore, intravenous ciclosporin has been proposed as a rescue therapy, with a further improvement of short-term efficacy and reduction of surgery requirement. Nevertheless, its use is associated with a risk of toxicity and intravenous ciclosporin is not easy to use in non-specialised centres. In addition, long-term studies suggest that colectomy is often only delayed and relapse frequent. Consequently, some authors evaluate the potential use of infliximab. Available data are encouraging, reporting a significant short-term reduction in colectomy rate. Nevertheless, additional trials are required to better define the more effective and safe treatment option(s), for both the short- and long-term, in this patient setting; a question addressed in ongoing trials.
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Affiliation(s)
- Agnès Baudet
- Service d'Hépato-Gastro-Entérologie et Nutrition, Centre Hospitalier Universitaire de Caen, Hôpital Côte de Nacre, Avenue Côte de Nacre, 14033 Caen Cedex, France
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