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1

Inulin supplementation in rat model of pouchitis

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Drzymała-Czyż S., Banasiewicz T., Tubacka M., Majewski P., Biczysko M., Kościński T., Drews M., Walkowiak J.

Acta Biochimica Polonica

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2011

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vol. 58

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issue 3

381-384

EN

Available data indicates potential effectiveness of prebiotic therapy in alleviating inflammation and prolonging the remission in inflammatory bowel disease. Documented successes of such therapies were the basis for this study. So far, there is no data related to the effectiveness of inulin application in symptomatic or severe pouchitis in humans or in animal model. The aim of the study was to determine the effect of inulin supplementation on the expression of intestinal inflammation and feeding efficiency in rats with induced pouchitis. Twenty-four Wistar rats were operated. After induction of pouchitis animals were randomly divided into control and supplementation groups receiving, respectively, semi-synthetic diet with or without inulin (in a lower (LD) or higher (HD) dose: 2.5 % or 5 % of total dietary content of mass) for a period of 6 weeks. Selected nutritional parameters were assessed throughout the study. Histopathological and immunohistochemical analysis of pouch mucosa specimens was also performed. The energy intake, weight gain, feeding efficiency, quality of stools were comparable in all studied groups. The intensity of inflammation (Moskovitz scale) and adaptive changes (Laumonier scale) did not differ between compared groups. The tissue expression of pro- and anti-inflammatory interleukins (IL-1α, IL-6, IL-10 and IL-12) was not different either. Inulin supplementation does not improve the quality of stools or the expression of intestinal inflammation in rats with induced pouchitis. It has no impact on the intensity of pouch adaptation or on feeding efficiency.

2

Ileal pouch anal anastomosis leak after restorative proctocolectomy without protective stoma successfully treated with endoscopic vacuum therapy

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Borejsza-Wysocki M., Bobkiewicz A., Kościński T., Banasiewicz T., Krokowicz Ł.

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vol. 92(4)

58-62

EN

Aim An ileal pouch anal anastomosis (IPAA) leak is one of the most severe complication after restorative proctocoletomy (RPC). We present a rare case of a successful management of IPAA leak after RPC without defunctionig stoma with the utility of endoscopic vacuum therapy. Methods A 57-year-old male with a ileal pouch anal anastomosis leak after RPC due to ulcerative colitis with presacral abscess was qualified for endoscopic vacuum therapy (EVT). The abscess of the left buttock was drained and secured with suction drain (redon drain). Due to the lack of defunctioning stoma, a system for contain and divert fecal matter was placed within afferent limb of the J-pouch and EVT was placed directly within IPAA dehiscence. EVT was changed every third day. Results The patient underwent a total of five EVT sessions. Improvement of patient’s general condition characterized with lack of pelvic pain, fever and reduction of inflammatory markers was achieved. Locally, anastomosis dehiscence was healed with prominent reduction in the defect’s dimension, contraction and revascularization. Based on imaging studies no chronic presacral sinus or any other perianal disturbances were revealed at the time of five months follow up. Conclusions EVT is a promising method for management of IPAA leak. Although, it remains extremely difficult, EVT may serve as a method of choice in early pouch-related septic complications after RPC performed without defunctioning stoma

3

Trace elements and rat pouchitis

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Drzymała-Czyż S., Banasiewicz T., Walas S., Kościński T., Wenska-Chyży E., Drews M., Walkowiak J.

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EN

The procedure of restorative proctocolectomy is associated with a complete removal of the colon and slight reduction of ileum length, which together can lead to systemic shortages of trace elements. Inflammatory changes in the pouch mucosa may also have some impact. However, there is no data on trace elements in pouchitis. Therefore, in the present study we aimed to assess the effect of acute pouchitis on the status of selected trace elements in rats. Restorative proctocolectomy with the construction of intestinal J-pouch was performed in twenty-four Wistar rats. Three weeks after the surgery, pouchitis was induced. Eight untreated rats created the control group. Liver concentrations of selected micronutrients (Zn, Cu, Co, Mn, Se) were measured in both groups six weeks later, using inductively coupled plasma mass spectrometry. Liver concentrations of trace elements did not differ between the study and the control groups. However, copper, cobalt and selenium concentrations [μg/g] were statistically lower (p<0.02, p<0.05 and p<0.04, respectively) in rats with severe pouchitis (n=9) as compared with rats with mild pouchitis (n=7) [median (range): Cu - 7.05 (3.02-14.57) vs 10.47 (5.16-14.97); Co - 0.55 (0.37-0.96) vs 0.61 (0.52-0.86); Se - 1.17 (0.69-1.54) vs 1.18 (0.29-1.91)]. In conclusion, it seems that acute pouchitis can lead to a significant deficiency of trace elements.

4

Sexual activity in patients after proctocolectomy with ileal pouch-anal anastomosis

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Kluska P., Dzika-Andrysiak K., Mik M., Zelga P., Włodarczyk M., Kujawski R., Dziki Ł., Dziki A., Trzciński R.

Polish Journal of Surgery

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2021

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vol. 93

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issue 1

19-24

EN

Introduction: Proctocolectomy with ileal pouch-anal anastomosis is the gold standard in the surgical treatment of patients with ulcerative colitis, familial adenomatous polyposis and other colorectal diseases requiring colectomy. The treatment consists in removing the large intestine and creating an intestinal reservoir from the last ileum loop and then anastomosing the intestinal reservoir with the anal canal. Like any surgical procedure, RPC-IPAA also carries the risk of complications, both early and late. Late postoperative complications include sexual dysfunction. Aim: The main goal of the following work is to assess the quality of life and sexual activity in patients having undergone the RPC-IPAA procedure at the General and Colorectal Surgery Clinic. Material and methods: The study group consisted of patients aged 19–79 who had been subjected to RPC-IPAA procedures at the General and Colorectal Surgery Clinic in years 2010–2019. The study was conducted on the basis of a survey consisting of 50 questions about the social and mental condition, medical history and previous treatment as well as the quality of sexual life before and after surgery. The scale used for the assessment of the quality of sex life consisted of 5 grades: very low, low, medium, high, very high. Thirty subjects (21 men and 9 women) took part in the survey. Ulcerative colitis (86.6%) was the most common reason for qualification for restorative proctectomy among the examined patients; less common reasons included familial adenomatous polyposis (13.3%) and synchronous colorectal cancer (3.3%). A vast majority of the surgeries had been performed after 10 years’ duration of ulcerative colitis, and the intestinal reservoir had been functioning for over a year at the time of the examination. In addition, the effect of taking steroids and the impact of early postoperative complications on the quality of sex life of patients was assessed. Results: High or very high sexual activity before surgery was reported by 46% of patients whereas low or very low quality was reported by 13%. The rest of the responders assessed their pre-operative sexual activity as average. After surgery, 23% of patients rated their sexual activity as high or very high while 36.6% of patients rated it as low or very low (P = 0.07). It was also noted that taking corticosteroids before surgery decreased the quality of sex life after surgery (P = 0.07 for activity, P = 0.04 for quality). None of the women surveyed used artificial moisturizing of intimate places during sex. Only 1 person stated that they started using artificial moisturization of intimate places after the procedure (P = 0.5). None of the men surveyed had used pharmacological agents to help them obtain an erection before surgery while as many as 33% of responders reported the need for their use after surgery (P = 0.008). Other postoperative sexual dysfunctions were also registered, such as dyspareunia (13.3%), sensory disorder within the intimate region, fecal incontinence, and urinary incontinence. Conclusions: To sum up, sexual activity and quality of sexual life deteriorated after RPC-IPAA in our patients.

5

Ileal-Pouch-Anal Anastomosis After Restorative Proctocolectomy in Patients With Ulcerative Colitis or Familial Adenomatous Polyposis - 11 Years of Experience

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Bednarz W., Olewiński R., Woldan J.

Polish Journal of Surgery

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2007

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vol. 79

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issue 5

362-367

EN

Restorative proctocolectomy is the "gold standard" in surgical treatment for ulcerative colitis and familial adenomatous polyposis. The two alternative techniques of ileal-pouch-anal anastomosis include handmade and double line stapled suture.The aim of the study was to analyze postoperative complications and functional results of the two types of anastomosis.Material and methods. The study group consisted of 108 patients operated between 1994 and 2005 for ulcerative colitis (n=97) or familial adenomatous polyposis (n=11). Stapled anastomosis was performed in 88 (81.5%) cases and hand-made suture was performed in 20 (18.5%) cases.Results. No significant differences between the two anastomotic techniques were found in terms of postoperative complications and late functional results.Conclusions. The low rate of complications and well-accepted functional outcomes prove that restorative proctocolectomy is a safe surgical procedure that can be offered to patients with ulcerative colitis or familial adenomatous polyposis. Double line stapled suture should be the preferred method of ilealpouch-anal anastomosis, however, the hand-made suture remains its valuable alternative and may be considered in selected cases.

6

Restorative Proctocolectomy for Emergency Cases of Ulcerative Colitis

100%

Hermann J., Sękowska M., Drews M.

Polish Journal of Surgery

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2007

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vol. 79

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issue 4

265-268

EN

Restorative proctocolectomy was performed for urgent indications in three stages and for elective purposes in two stages for ulcerative colitis (UC). Since the three-step procedure makes enormous demands on the patients, there was an attempt to introduce a primary pouch anal anastomosis for urgent indications in selected cases.The aim of the study was to compare early complications in patients after having undergone Hartmann's procedure with those that had restorative proctocolectomy for urgent indications in UC, based on the authors' experience and the literature.Material and methods. The medical records of 211 patients who underwent an operation for UC in this clinic from 1996 through 2005 were retrospectively evaluated. There were 107 (51%) males and 104 (49%) females in this study; the mean age was 38 years. The median duration of disease was 3 years.Results. An operation was performed in 77 (36%) patients for urgent indications. Finally, the study was entered by 60 (28%) patients after exclusion of the high-risk patients. All the patients were divided into two groups. The first group consisted of 25 (42%) patients who underwent the Hartmann's procedure, whereas the second group comprised 35 (58%) patients who had the pouch operation. There was no postoperative mortality in the surveyed group. Respiratory failure occurred in 6 (24%) patients after Hartmann's operation and in 5 (14%) patients who underwent the pouch procedure. Intra-abdominal sepsis developed in 3 (12%) patients after colectomy and in 5 (14%) after pouch-anal anastomosis. Wound dehiscence was present in 2 (8%) patients undergoing Hartmann's operation and in 3 (9%) after the pouch procedure. Bowel obstruction occurred in 1 patient after the former operation and in 2 (6%) patients after the latter one. Wound infection was diagnosed in 5 (20%) patients after colectomy and in 7 (20%) after proctocolectomy. Differences between the investigated groups of patients were not statistically significant.Results. The three-stage procedure with Hartmann's colectomy is the treatment of choice for urgent indications in UC.Primary restorative proctocolectomy is performed for urgent indications in acute UC in selected group of patients without septic signs due to a similar morbidity as the group of patients who had Hartmann's procedure.

Refine search results

Inulin supplementation in rat model of pouchitis

Ileal pouch anal anastomosis leak after restorative proctocolectomy without protective stoma successfully treated with endoscopic vacuum therapy

Trace elements and rat pouchitis

Sexual activity in patients after proctocolectomy with ileal pouch-anal anastomosis

Ileal-Pouch-Anal Anastomosis After Restorative Proctocolectomy in Patients With Ulcerative Colitis or Familial Adenomatous Polyposis - 11 Years of Experience

Restorative Proctocolectomy for Emergency Cases of Ulcerative Colitis