Staged Approaches to Restorative Proctocolectomy with Ileoanal Pouch—When and Why?

Though uncommon, ileoanal pouch-vaginal fistulas after restorative proctocolectomy present quite a challenge. Multiple salvage procedures, including endoanal, transabdominal, and trans-vaginal, have been used. Because of high recurrence rates, multiple operations are not uncommon, and ultimate pouch failure rates have been reported as high as 45 per cent. The Permacol™ Collagen Implant is a surgical implant that has been used successfully in a variety of operations ranging from urological to maxillofacial. Its properties allow fibroblast infiltration and revascularization so that it gradually becomes permanently incorporated into the surrounding tissue, providing strength and inhibiting scarring and contraction. We report the first documented case of Permacol™ use in repair of ileoanal pouch-vaginal fistula and we feel that it warrants further investigation as an option in the treatment of these fistulas.

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Laparoscopic versus conventional ileoanal pouch procedure in patients undergoing elective restorative proctocolectomy (LapConPouch Trial)—a randomized controlled trial

Langenbeck s Archives of Surgery ◽

10.1007/s00423-013-1088-z ◽

2013 ◽

Vol 398 (6) ◽

pp. 807-816 ◽

Cited By ~ 35

Author(s):

Serin Schiessling ◽

Christine Leowardi ◽

Peter Kienle ◽

Dalibor Antolovic ◽

Phillip Knebel ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Restorative Proctocolectomy ◽

Controlled Trial ◽

Ileoanal Pouch ◽

Randomized Controlled

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Indications and outcomes of home parenteral nutrition in patients with an ileoanal pouch

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0131 ◽

2019 ◽

Vol 101 (1) ◽

pp. 17-20 ◽

Cited By ~ 1

Author(s):

SM Oke ◽

J Segal ◽

SK Clark ◽

AL Hart ◽

SM Gabe

Keyword(s):

Restorative Proctocolectomy ◽

Adverse Outcome ◽

Rare Complication ◽

Intestinal Failure ◽

Ileoanal Pouch ◽

Normal Diet ◽

Adenomatous Polyposis ◽

Number Of Patients ◽

Adequate Hydration ◽

Parenteral Support

Introduction Restorative proctocolectomy is a surgical treatment for patients with medically refractory ulcerative colitis and some cases of familial adenomatous polyposis. Intestinal failure, defined as an inability to maintain adequate hydration and micronutrient balances when on a conventionally accepted normal diet, is a rare complication of restorative proctocolectomy. We describe our experience of patients with restorative proctocolectomy who have developed intestinal failure requiring parenteral support. Material and methods This was a retrospective analysis using a database of patients referred to our intestinal failure unit from January 1998 to January 2016. We analysed the records of all those patients who had restorative proctocolectomy who developed intestinal failure. Results 807 patient records analysed, 35 patients were found to have had a restorative proctocolectomy (13 male and 22 female). Ninety-one percent (n = 32) of patients developed IF as a consequence of unpredictable complications which occurred after RPC formation. Potentially predictable complications were noted in 9% (n = 3) of patients. Discussion and conclusions Most cases of intestinal failure in restorative proctocolectomy were unpredictable. In a small number of patients, accurate assessment and measurement of the small intestine may have better predicted the adverse outcome of intestinal failure allowing improved pre-operative counseling of patients.

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