PMID- 19318001
OWN - NLM
STAT- MEDLINE
DCOM- 20090402
LR  - 20191210
IS  - 1879-1190 (Electronic)
IS  - 1072-7515 (Linking)
VI  - 208
IP  - 3
DP  - 2009 Mar
TI  - Ileal pouch rectal anastomosis: a viable alternative to permanent ileostomy in 
      Crohn's proctocolitis patients.
PG  - 390-9
LID - 10.1016/j.jamcollsurg.2008.10.037 [doi]
AB  - BACKGROUND: Ileal pouch rectal anastomosis (IPRA) is a possible alternative to 
      permanent ileostomy when a short, normal-appearing rectal stump remains after 
      total colectomy. Its outcomes in Crohn colitis (CC) patients have not been 
      reported. STUDY DESIGN: CC patients who underwent IPRA from 1992 to 2004 were 
      identified. Operative and morbidity data were collected. Functional outcomes and 
      quality-of-life (QOL) data were obtained using a mailed questionnaire and 
      compared with matched patients who underwent straight ileorectal anastomosis 
      (SIRA). RESULTS: Twenty-three CC patients underwent IPRA. Perioperative 
      complications included three pelvic septic fluid collections and five small bowel 
      obstructions or ileus, and were treated nonoperatively. Twenty-two patients were 
      available for longterm followup (median 98 months). Fourteen patients (64%) had 
      disease recurrence. Two (9%) have lost a functioning anastomosis. Nine (41%) 
      required additional operations. Matched SIRA patients had higher level of 
      anastomosis (23.4 +/- 5.5 versus 9.0 +/- 4.1 cm above the dentate line; p < 
      0.0001). Bowel movement frequency (median 6.5/24 hours in both groups), 
      incontinence, and urgency rates were similar. Nighttime seepage and pad usage 
      were more frequent in IPRA. No differences were found in QOL parameters 
      (Cleveland Global QOL score: 0.78 versus 0.73 [0 = worst, 1 = best], IPRA versus 
      SIRA, respectively; p = 0.31). All patients with a functioning IPRA stated they 
      would have their operation again if needed, and 94% would recommend it to others. 
      CONCLUSIONS: IPRA offers durable preservation of bowel continuity and good 
      function and QOL in selected CC patients who might otherwise require a permanent 
      ileostomy.
FAU - Kariv, Yehuda
AU  - Kariv Y
AD  - Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH 
      44195, USA.
FAU - Remzi, Feza H
AU  - Remzi FH
FAU - Strong, Scott A
AU  - Strong SA
FAU - Hammel, Jeffrey P
AU  - Hammel JP
FAU - Preen, Miriam
AU  - Preen M
FAU - Fazio, Victor W
AU  - Fazio VW
LA  - eng
PT  - Comparative Study
PT  - Evaluation Study
PT  - Journal Article
DEP - 20090121
PL  - United States
TA  - J Am Coll Surg
JT  - Journal of the American College of Surgeons
JID - 9431305
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Anastomosis, Surgical/adverse effects
MH  - *Colonic Pouches/adverse effects
MH  - Crohn Disease/*surgery
MH  - Fecal Incontinence/etiology
MH  - Female
MH  - Humans
MH  - Ileostomy
MH  - Intestinal Obstruction/etiology
MH  - Male
MH  - Middle Aged
MH  - Pouchitis/etiology
MH  - Proctocolitis/*surgery
MH  - Quality of Life
MH  - Rectal Fistula/etiology
MH  - Rectum/surgery
MH  - Recurrence
MH  - Retrospective Studies
MH  - Treatment Outcome
EDAT- 2009/03/26 09:00
MHDA- 2009/04/03 09:00
CRDT- 2009/03/26 09:00
PHST- 2008/05/05 00:00 [received]
PHST- 2008/10/02 00:00 [revised]
PHST- 2008/10/02 00:00 [accepted]
PHST- 2009/03/26 09:00 [entrez]
PHST- 2009/03/26 09:00 [pubmed]
PHST- 2009/04/03 09:00 [medline]
AID - S1072-7515(08)01627-X [pii]
AID - 10.1016/j.jamcollsurg.2008.10.037 [doi]
PST - ppublish
SO  - J Am Coll Surg. 2009 Mar;208(3):390-9. doi: 10.1016/j.jamcollsurg.2008.10.037. 
      Epub 2009 Jan 21.