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Author: Maie Abdalla
Publisher: Linköping University Electronic Press
ISBN: 9176851095
Category :
Languages : en
Pages : 117
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Book Description
Ulcerative colitis (UC) is a chronic inflammatory disease that affects the colon. According to the literature, some thirty percent of UC patients may require a subtotal colectomy and ileostomy due to failure of medical treatment, acute toxic colitis or dysplasia/cancer diagnosis. Some patients choose to get continence restored with either an ileorectal anastomosis (IRA) or an ileal pouch-anal anastomosis (IPAA). Worldwide most surgeons prefer an IPAA to an IRA, despite reports of pouchitis, impaired fertility and fecundity. Fear of recurring proctitis and fear of rectal cancer in the remaining rectum is contributing to the choice of an IPAA. Little is known regarding the outcomes of IRA compared with IPAA in UC patients. We aimed to investigate the anorectal function, quality of life (QoL), risk of failure and rectal cancer in patients with UC restored with IRA and IPAA respectively. Methods: Data about all Inflammatory bowel disease (IBD) patients was obtained from the Swedish National Patient Register (NPR) between 1964-2014 and in one study from the Linköping University Hospital medical records 2006-2012. Patients who developed cancer were identified from the Swedish National Cancer Register. We investigated the risk of cancer and inflammation, functional outcome and failure as well as the quality of life for IRA and IPAA patients. Investigation of risk for cancer in IRA and IPAA compared with the background population was performed using survival analytic techniques: uni-and multivariate regression, Kaplan Meier curves and standardized incidence ratio. Results: Twelve percent (7,889 /63,795) of UC patients required colectomy according to the NPR. The relative risk for rectal cancer among patients with an IRA was increased (SIR 8.7). However, the absolute risk was 1.8% after a mean follow up of 8.6 years and the cumulative risk 10- and 20-years after IRA was 1.6% and 5.6%, respectively. Risk factors for rectal cancer were primary sclerosing cholangitis in patients with an IRA (hazard ratio 6.12), and severe dysplasia or cancer of the colon prior to subtotal colectomy in patients with a diverted rectum in place (hazard ratio 3.67). Regarding IPAA, the relative risk to develop rectal cancer was (SIR 0.4) compared with the background population and the absolute risk was only 0.06% after a mean of 12.2 years of follow up. Among patients operated at the Linköping University Hospital: IRA patients reported better overall continence according to the Öresland score with in median3 (IQR 2–5) for IRA (n=38) and 10 (IQR 5–15) for IPAA (n=39, p<0.001). There were no major differences regarding the QoL. According to the NPR, after a median follow up of 12.4 years failure occurred in 265(32%) out of 1112 patients, of which 76 were secondarily reconstructed with an IPAA. Failure of the IPAA occurred in 103 (6%) patients with primary and in 6 (8%) patients after secondary IPAA (log-rank p=0.38). Conclusion: IRA is a safe restorative procedure for selected UC patients. Patients should be aware of the annual postoperative endoscopic evaluation with biopsies as well as the need to the use of local anti-inflammatory preparations. However, IRA should not be offered for UC patients with an associated primary sclerosing cholangitis diagnosis due to the increased risk to develop rectal cancer in their rectal mucosa. In such case, IPAA is probably the treatment of choice.
Author: Maie Abdalla
Publisher: Linköping University Electronic Press
ISBN: 9176851095
Category :
Languages : en
Pages : 117
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Book Description
Ulcerative colitis (UC) is a chronic inflammatory disease that affects the colon. According to the literature, some thirty percent of UC patients may require a subtotal colectomy and ileostomy due to failure of medical treatment, acute toxic colitis or dysplasia/cancer diagnosis. Some patients choose to get continence restored with either an ileorectal anastomosis (IRA) or an ileal pouch-anal anastomosis (IPAA). Worldwide most surgeons prefer an IPAA to an IRA, despite reports of pouchitis, impaired fertility and fecundity. Fear of recurring proctitis and fear of rectal cancer in the remaining rectum is contributing to the choice of an IPAA. Little is known regarding the outcomes of IRA compared with IPAA in UC patients. We aimed to investigate the anorectal function, quality of life (QoL), risk of failure and rectal cancer in patients with UC restored with IRA and IPAA respectively. Methods: Data about all Inflammatory bowel disease (IBD) patients was obtained from the Swedish National Patient Register (NPR) between 1964-2014 and in one study from the Linköping University Hospital medical records 2006-2012. Patients who developed cancer were identified from the Swedish National Cancer Register. We investigated the risk of cancer and inflammation, functional outcome and failure as well as the quality of life for IRA and IPAA patients. Investigation of risk for cancer in IRA and IPAA compared with the background population was performed using survival analytic techniques: uni-and multivariate regression, Kaplan Meier curves and standardized incidence ratio. Results: Twelve percent (7,889 /63,795) of UC patients required colectomy according to the NPR. The relative risk for rectal cancer among patients with an IRA was increased (SIR 8.7). However, the absolute risk was 1.8% after a mean follow up of 8.6 years and the cumulative risk 10- and 20-years after IRA was 1.6% and 5.6%, respectively. Risk factors for rectal cancer were primary sclerosing cholangitis in patients with an IRA (hazard ratio 6.12), and severe dysplasia or cancer of the colon prior to subtotal colectomy in patients with a diverted rectum in place (hazard ratio 3.67). Regarding IPAA, the relative risk to develop rectal cancer was (SIR 0.4) compared with the background population and the absolute risk was only 0.06% after a mean of 12.2 years of follow up. Among patients operated at the Linköping University Hospital: IRA patients reported better overall continence according to the Öresland score with in median3 (IQR 2–5) for IRA (n=38) and 10 (IQR 5–15) for IPAA (n=39, p<0.001). There were no major differences regarding the QoL. According to the NPR, after a median follow up of 12.4 years failure occurred in 265(32%) out of 1112 patients, of which 76 were secondarily reconstructed with an IPAA. Failure of the IPAA occurred in 103 (6%) patients with primary and in 6 (8%) patients after secondary IPAA (log-rank p=0.38). Conclusion: IRA is a safe restorative procedure for selected UC patients. Patients should be aware of the annual postoperative endoscopic evaluation with biopsies as well as the need to the use of local anti-inflammatory preparations. However, IRA should not be offered for UC patients with an associated primary sclerosing cholangitis diagnosis due to the increased risk to develop rectal cancer in their rectal mucosa. In such case, IPAA is probably the treatment of choice.
Author: Masato Kusunoki
Publisher: Springer
ISBN: 4431555226
Category : Medical
Languages : en
Pages : 151
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Book Description
As the number of patients with colitis-associated cancer (CAC) is on the increase, the purpose of this book is to review the latest topics concerning management of the disease. In recent years, the diagnostic power of endoscopy and molecular pathology has also grown tremendously, as a result of which they now have a far greater influence on the treatment of CAC. At the moment, appropriate monitoring programs for ulcerative colitis and Crohn’s disease remain uncertain. At the same time, the latest findings on DNA methylation and microRNAs hold the promise of making revolutionary changes in these areas. Moreover, recent drug advances in the treatment of inflammatory bowel diseases have changed surgical indications. On the other hand, the indication of mucosectomy on colorectal cancer in ulcerative colitis and prophylactic abdominoperineal resection for Crohn’s disease remain controversial. This book provides the latest information on the remaining issues of CAC from the point of view of expert surgeons.
Author: Bo Shen
Publisher: Academic Press
ISBN: 0128113898
Category : Medical
Languages : en
Pages : 382
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Book Description
Interventional Inflammatory Bowel Diseases: Endoscopic Management and Treatment of Complications covers the preparation, principle, techniques, and damage control of complications in endoscopic therapy, providing the ultimate guidance in endoscopic management of IBD. With contributions from a panel of international leading experts in the field, perspectives are included from GI pathologists, GI radiologists, gastroenterologists, advanced endoscopists, IBD specialists and colorectal surgeons. Recommendations from experts are also included within each chapter. By bridging medical and surgical treatment modalities for IBD, this is the perfect reference for GI researchers, medical students, therapeutic GI endoscopists, IBD specialists, surgeons and advanced health care providers. - Incorporates state-of-the-art of research in the area of therapeutic endoscopy in Crohn's Disease and Ulcerative Colitis - Makes the connection between the understanding of the complex nature and disease course of IBD with corresponding advanced endoscopic procedures - Explores endoscopic treatment as the missing link between medical and surgical treatment for complex Crohn's Disease and Ulcerative Colitis - Contains access to videos demonstrating important procedural concepts
Author: Stephen M. Kavic
Publisher:
ISBN: 9781634826914
Category : HEALTH & FITNESS
Languages : en
Pages : 284
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Book Description
Crohn's disease is a chronic illness that afflicts millions of patients worldwide. Despite its increasing recognition as a medical specialty within gastroenterology, there has been little attention devoted to Crohn's from a surgical perspective. This volume fills that void and acts as the first catalogue to address the surgical management of Crohn's disease. The goal of this work was to provide surgeons with the latest medical and surgical information to manage patients with Crohn's disease effectively.In this book, contributions from both gastroenterologists describe the history, diagnosis, nutrition, medical management, and surveillance of Crohn's disease. Chapters from general and colorectal surgeons detail common clinical techniques, minimally invasive surgical approach and management of perianal disease. In addition, surgical complications specific to Crohn's disease are also reviewed.This book provides all of the essential information needed in the surgical management of Crohn's disease in one simple volume. It aims to be a useful resource for practicing surgeons and surgical residents as well as gastroenterologists. The authors wish readers to understand the complex decision making and sophisticated surgical techniques that these patients often demand.
Author: Janindra Warusavitarne
Publisher: Springer
ISBN: 3319943855
Category : Medical
Languages : en
Pages : 196
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Book Description
This book gives a comprehensive overview of surgery that results in creating an ileoanal pouch or continent ileostomy. It deals with the entire journey of pouch surgery starting from patient selection and counselling to technical tips and tricks and ending in managing pouch function and failure. Containing a patient experience section this volume helps clinicians better understand what a patient expects from the ileoanal pouch. This is a very specialised topic but one that is covered very poorly and this book has the potential to consolidate all that is known about the topic to provide a comprehensive overview on the surgery and its consequences.
Author: Pär Myrelid
Publisher: Springer
ISBN: 3319955918
Category : Medical
Languages : en
Pages : 201
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Book Description
This book is about the recently revived technique of Kock pouch in inflammatory bowel disease. It discusses the Kock pouch as an alternative to patients not suitable for a pelvic pouch or where the pelvic pouch has failed. It provides clinicians with all the necessary information on patient guidance and surgical revisions after a long life with a Kock pouch. The reader will learn about the development of the pouch, pre and post-operative strategies, surveillance, complications and the limitations and weaknesses of the method. New pioneering experimental methods used by the authors are also discussed. The use of ileorectal anastomosis and Kock’s continent ileostomy has regained interest as the long term problems of the pelvic pouch have and this book brings the knowledge and valuable experiences of a few experts at international centres to a large audience. This is an indispensable guide for colorectal surgeons, gastroenterologists and stoma therapi sts involved in the care of patients with inflammatory bowel disease where colectomy is still needed, either in an emergency setting or due to dysplasia or cancer.
Author: Bo Shen
Publisher: Academic Press
ISBN: 0128096292
Category : Medical
Languages : en
Pages : 574
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Book Description
Pouchitis and Ileal Pouch Disorders: A Multidisciplinary Approach for Diagnosis and Management provides much needed information on the evolution of pouch surgery, pouch surgery techniques, and surgery-associated complications, including inflammatory, functional, neoplastic, and metabolic complications. The book provides information on the anatomy of the pouch, pathogenesis of pouchitis and other pouch disorders, proper diagnostic modalities, and medical, endoscopic and surgical options for those disorders. The information has been compiled from a panel of national and international leading experts in the field, including basic scientists, gastrointestinal (GI) pathologists, GI radiologists, gastroenterologists, and more. - Features never-before-published information and technology from the vast experience of the contributors and editors in diagnosis and medical, endoscopic, and surgical management of pouchitis and other pouch disorders - Contains easy to access recommendations from experts - Provides access to an accompanying website with videos of endoscopic demonstrations of various configurations of the pouch, endoscopic evaluation of pouch disorders, and endoscopic treatment of pouch strictures, fistula, and anastomotic leaks/sinuses
Author: Alexander Herold
Publisher: Springer Science & Business Media
ISBN: 3540712178
Category : Medical
Languages : en
Pages : 274
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Book Description
EMM: Coloproctology presents the state-of-the-art in coloproctology. The topics covered include anatomy, physiology, anal disorders, dermatology, functional disorders, inflammatory bowel disease, benign and malignant tumours, endoscopy, emergencies and pain syndromes. All chapters give a comprehensive overview of aetiology, incidence, epidemiology, diagnostics, medical and surgical treatment, complications and individual special considerations. This work presents surgical trainees with a comprehensive and condensed guide to the core knowledge required for the European Board of Surgery Qualification (EBSQ) examination. The manual will also be of assistance to practising coloproctologists across Europe and beyond who have an interest in continued professional development. Written by an international team of experts who have each made noteworthy contributions in their field, the coverage of most aspects of coloproctology in an easy-to-follow format also makes this manual valuable to other specialists.
Author: Francis Seow-Choen
Publisher: World Scientific
ISBN: 9789812383747
Category : Medical
Languages : en
Pages : 414
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Book Description
Colorectal surgery is a very ancient art that has, over the last few decades, found a sound basis in science. Amongst its famous ancient practitioners was Hippocrates himself. Colorectal-surgical departments have been springing up worldwide and many of the surgical colleges and academies are beginning to see the importance of this branch of medicine. After rising from humble beginnings, the specialty of colorectal surgery is now a much-sought-after career amongst young doctors all over the world.Topics in Colorectal Surgery is an invaluable book from one of the leading colorectal centres in the world. It represents some of the most important lectures given over the last eight years at the Annual Singapore General Hospital Colorectal Week. This event has become an internationally acclaimed gathering and the book contains updated lecture notes from the last seven conferences. These lecture notes, together with the book chapters, contain material not often found in other books and will be a valuable source of reference for clinicians dealing with the problems discussed in the text.
Author: Bruce George
Publisher: John Wiley & Sons
ISBN: 1118674782
Category : Medical
Languages : en
Pages : 356
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Book Description
Using a case-based approach, Colorectal Surgery: Clinical Care and Management provides practical, clinical and expert guidance to illustrate the best care and clinical management of patients requiring colorectal surgery for colorectal disease. Real-life cases illustrate the entire syllabus of GI/colorectal surgery, being specially selected to highlight topical or controversial aspects of colorectal care. Cases have a consistent approach throughout and as well as outlining the actual management of each individual case, also offer an honest appraisal of the chosen management route, its successes and areas that could have been managed differently. Pedagogic features such as learning and decision points boxes aid rapid understanding/learning, enabling the reader to improve their patient management. In full colour and containing over 100 outstanding clinical photos and slides to support the cases, each section also covers recent developments/ landmark papers/ scoring systems and a thorough discussion of clinical management based on the major society guidelines from NICE, ASCRS and ECCO. Reliable, well-written and perfect for consultation in the clinical setting, Colorectal Surgery: Modern Clinical Care and Management is the perfect tool for all members of the multi-disciplinary team managing patients suffering from colorectal disease, specifically GI surgeons, gastroenterologists, oncologists and general surgeons.
