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2007 | 79 | 4 | 265-268

Article title

Restorative Proctocolectomy for Emergency Cases of Ulcerative Colitis

Content

Title variants

Languages of publication

EN

Abstracts

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.

Year

Volume

79

Issue

4

Pages

265-268

Physical description

Dates

published
1 - 4 - 2007
online
17 - 10 - 2007

Contributors

author
  • Department of General, Gastrointestinal and Endocrinologic Surgery, K. Marcinkowski Medical University, Poznan
  • Department of General, Gastrointestinal and Endocrinologic Surgery, K. Marcinkowski Medical University, Poznan
author
  • Department of General, Gastrointestinal and Endocrinologic Surgery, K. Marcinkowski Medical University, Poznan

References

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  • Galandiuk S, Scott NA, Dozois RR et al.: Ileal pouch-anal anastomosis. Ann Surg 1990; 212(4): 446-52.
  • Kelly KA, Pemberton JH, Wolff BG et al.: Ileal pouch-anal anastomosis. Curr Probl Surg 1992; 29(2): 61-131.
  • Allan RN, Rhodes JM, Hanauer SB et al.: Inflammatory bowel diseases. Churchill Livingstone, 1997.
  • Crile GC, Thomas CY: The treatment of acute toxic ulcerative colitis by ileostomy and simultaneous colectomy. Gastroenterology 1951; 19: 58-68.[PubMed]
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  • Ritchie JK: Ulcerative colitis treated by ileostomy and excisional surgery. Br J Surg 1972; 59: 345-51.
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  • Penna C, Daude F, Parc P: Previous subtotal colectomy with ileostomy and sigmoidostomy improves the morbidity and early functional results after ileal pouch-anal anastomosis in ulcerative colitis. Dis Col Rectum 1993; 36: 343-48.
  • Mrowiec S, Dobija P, Lampe P i wsp.: Jakość życia i wyniki leczenia u chorych z wrzodziejącym zapaleniem jelita grubego i polipowatością rodzinną poddanych proktokolektomii z wytworzeniem zbiornika jelitowego, kolektomii z zespoleniem ileorektalnym lub proktokolektomii z ileostomią. Pol Przegl Chir 2006; 3: 295-12.
  • Harms BA, Myers GA, Rosenfeld DJ et al.: Management of fulminant ulcerative colitis by primary restorative proctocolectomy. Dis Col Rectum 1994; 37: 971-78.
  • Ziv Y, Fazio VW, Church JM et al.: Safety of urgent restorative proctocolectomy with ileal pouchanal anastomosis for fulminant colitis. Dis Col Rectum 1995; 38: 345-49.
  • Heyvaert G, Penninckx F, Filez L et al.: Restorative proctocolectomy in elective and emergency cases of ulcerative colitis. Int J Colorectal Dis 1994; 9: 73-76.[Crossref]

Document Type

Publication order reference

Identifiers

YADDA identifier

bwmeta1.element.-psjd-doi-10_2478_v10035-007-0040-8
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