scholarly journals QUALITY LIFE OF PATIENTS OPERATED FOR ULCERATIVE COLITIS

2019 ◽  
Vol 18 (1) ◽  
pp. 89-100 ◽  
Author(s):  
Sh. A. Binnatli ◽  
D. V. Aleshin ◽  
A. E. Kulikov ◽  
R. I. Romanov
Keyword(s):  
Ulcerative Colitis ◽  
Ileal Pouch ◽  
Meta Analysis ◽  
Advantages And Disadvantages ◽  
Similar Improvement ◽  
Disease Elimination ◽  
Quality Life ◽  
Study Results ◽  
Continue Research ◽  
Terminal Ileostomy

The review presents data from various Western and Russian papers, which assess QoL of patients with ulcerative colitis, who underwent a proctocolectomy with a terminal ileostomy or with ileal pouch. Both procedures have advantages and disadvantages. The QoL assessment was performed using different validated and not validated scales. Study results show that QoL of patients with ileal pouch and end ileostomy are relatively similar. Improvement of QoL after surgery mostly depends of disease elimination by proctocolectomy but by the restoration of anal defecation. However, meta-analysis is complicated due to the inability to comply with methodological requirements and use of different QoL scales. There is a need to continue research in this field.

Systematic Review and Meta-analysis of Outcomes After Ileal Pouch-anal Anastomosis in Primary Sclerosing Cholangitis and Ulcerative Colitis

2021 ◽  
Author(s):  
Edward L Barnes ◽  
Stefan D Holubar ◽  
Hans H Herfarth
Keyword(s):  
Systematic Review ◽  
Ulcerative Colitis ◽  
Primary Sclerosing Cholangitis ◽  
Sclerosing Cholangitis ◽  
Ileal Pouch ◽  
Meta Analysis ◽  
Ileal Pouch Anal Anastomosis ◽  
Pouch Failure ◽  
Increased Risk ◽  
Anal Anastomosis

Abstract Background The optimal restorative surgical management of patients with concomitant diagnoses of primary sclerosing cholangitis and ulcerative colitis [PSC-UC] who require colectomy is controversial, given that patients may have an increased risk for pouchitis after ileal pouch-anal anastomosis [IPAA]. We aimed to compare rates of pouchitis and pouch failure among patients with and without PSC by performing a systematic review and meta-analysis. Methods A systematic search performed through August 18, 2020, identified 12 studies that compared the rates of pouchitis [n = 11] and/or pouch failure [n = 6] among patients with PSC-UC and UC alone. We then performed a meta-analysis using random effects modelling to estimate the odds of developing any episodes of pouchitis or pouch failure. Results A total of 4108 patients underwent an ileal pouch-anal anastomosis after proctocolectomy for UC. Of these, 3799 [92%] were performed for UC alone and 309 [8%] were performed for PSC-UC. In a meta-analysis of 11 studies, patients with PSC-UC compared with UC alone were significantly more likely to develop any pouchitis (63% vs 30%, odds ratio [OR] 4.21, 95% confidence interval [CI] 2.86–6.18), chronic pouchitis [47% vs 15%, OR 6.37, 95% CI 3.41–11.9], and pouch failure [10% vs 7%, OR 1.85, 95% CI 1.08–3.17]. Conclusions Patients with PSC-UC were more likely to experience pouchitis and pouch failure than patients with UC alone. The risks of inflammatory complications after IPAA must be weighed against the potential complications with other surgical procedures, and future studies comparing outcomes among these procedures may inform decision making in this population.

scholarly journals Laparoscopic Proctocolectomy for Ulcerative Colitis and Crohn’s Disease of the Large Intestine: Short-Term and Long-Term Outcomes of 53 Cases

2016 ◽  
Vol 23 (3) ◽  
Author(s):  
M D Kucher ◽  
L S Bilianskyi ◽  
M I Kryvoruk ◽  
F H Tkachenko ◽  
A I Stelmakh
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Large Intestine ◽  
Ileal Pouch ◽  
Total Colectomy ◽  
Laparoscopic Approach ◽  
Anal Anastomosis ◽  
Terminal Ileostomy ◽  
Laparoscopic Proctocolectomy

One- or two-stage restorative total colectomy is recognized as surgery of choice when treating ulcerative colitis and Crohn’s disease of the large intestine. The possible advantages of laparoscopic approach are still being discussed. The objective of the research was to evaluate postoperative quality of life, short-term and long-term functional outcomes of 53 cases of laparoscopically assisted proctocolectomy for ulcerative colitis and Crohn’s disease of the large intestine in order to improve further application of laparoscopic approach.  Materials and methods. Primary restorative proctocolectomy with transanal mucosectomy and the ileal pouch-anal anastomosis was performed in 5 patients with ulcerative colitis; total colectomy with low anterior resection of the rectum and double stapling ileal pouch-rectal anastomosis was performed in 8 patients; total proctocolectomy (with abdominoperineal resection of the rectum, terminal ileostomy) was performed in 3 patients with Crohn’s disease and multiple perianal fistulas; total colectomy, low anterior resection of the rectum, and terminal ileostomy (the first stage of surgical treatment) was performed in 37 patients; the second stage restorative surgery (J-pouch construction and the pouch-anal/low rectal anastomosing) was performed in 17 patients. The restorative procedure was followed by temporary diverting ileostomy in all patients.Results. The conversion to laparotomy was required in 3 (5.7%) cases. In one case during the second stage restorative surgery the urine bladder wall was damaged, and sutured laparoscopically. There was no postoperative mortality. The major complications of the early postoperative period included pelvic abscesses (4 patients), pouch-anal anastomosis leakage (1 patient), postoperative ileus (3 patients), and ileal pouch-perineal fistula (1patient). Stool frequency was about 6 times in a 24 hour period (4-11 times) 12 months after ileostomy closure.  Pouchitis was observed in 4 patients. Pouch failure occurred in 1 patient due to severe pouchitis and anal incontinence.Conclusions. Laparoscopic proctocolectomy with extracorporeal ileal pouch construction, transanal mucosectomy, and pouch-anal anastomosis are considered as surgery of choice for ulcerative colitis. The pouch-rectal anastomosing is feasible for Crohn’s disease in individual cases. Total laparoscopic proctocolectomy with intracorporeal ileal pouch construction may be the next step in clinical trials.

Covered and Uncovered Self-Expandable Metallic Stents in the Treatment of Malignant Biliary Obstruction

2020 ◽  
Vol 22 (7) ◽  
Author(s):  
Lian-Biao Li ◽  
Wen-Yan Qin ◽  
Wen-Ping Peng ◽  
Jin-Zhen Li ◽  
Ming-Ming Zhang ◽  
...  
Keyword(s):  
Biliary Obstruction ◽  
Meta Analysis ◽  
Malignant Biliary Obstruction ◽  
Metallic Stents ◽  
Metal Stents ◽  
Stent Patency ◽  
Advantages And Disadvantages ◽  
Study Results ◽  
Significant Difference ◽  
Expandable Metallic Stents

Context: Self-expandable metal stents (SEMSs) are commonly used in the treatment of malignant biliary obstruction. We performed a meta-analysis to compare the efficacy of covered self-expandable metallic stents (CSEMSs) and uncovered self-expandable metallic stents (UCSEMSs) for patients with malignant distal biliary obstruction. Methods: A comprehensive search was conducted using PubMed, Embase, Cochrane, and CNKI databases from 2010 to 2019. All randomized controlled trials, which compared the use of the CSEMSs and UCSEMSs for the treatment of malignant distal biliary obstruction were included in this study. Results: This meta-analysis included 1,539 patients enrolled in 13 trials. There was no difference between the two groups in terms of patients’ survival (hazard ratio (HR) 0.96, 95% confidence interval (CI): 0.87 - 1.07; I2 = 32.6%), stent patency (HR 0.92, 95% CI: 0.69 - 1.22; I2 = 56.3%), and the overall complication rate (relative risks (RR) 1.35, 95% CI: 0.82 - 2.23; I2 = 0%). In particular, the CSEMSs group presented a lower rate of tumor ingrowth (RR 0.30, 95% CI: 0.15 - 0.57; I2 = 58.5%) than the UCSEMSs group. However, the CSEMSs group exhibited a higher rate of tumor overgrowth (RR 1.63, 95% CI: 1.00 - 2.66; I2 = 0%), sludge formation (RR 2.28, 95% CI: 1.36 - 3.82; I2 = 0%), and migration (RR 5.14, 95% CI: 1.90 - 13.88; I2 = 0%). Conclusions: Our meta-analysis indicated that there was no significant difference between the two stents, and each one had its advantages and disadvantages.

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