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Interposition of a gastric pouch between ileum and anus after proctocolectomy: long-term results in 3 patients.

Abstract : BACKGROUND: After proctocolectomy, ileal pouch-anal anastomosis may not be feasible, especially in the case of desmoid tumor or after failed ileal pouch-anal anastomosis requiring excision of the pouch. We designed a gastric pouch interposed between the terminal ileum and the anus to avoid a permanent ileostomy for these patients. Long-term results and quality of life with this technique remain unknown. METHODS: After proctocolectomy, ileal pouch-anal anastomosis was not feasible or had failed in 3 patients (2 with familial adenomatous polyposis and 1 with ulcerative colitis; 40, 49, and 50 years of age, respectively). Of these patients, 2 had undergone end ileostomy 7 and 8 years previously. A pouch was created using the left half of the gastric fundus, supplied through the right gastroepiploic vessels; the pouch was anastomosed proximally to the terminal ileum and distally to the anus. Diverting ileostomy was performed in all patients. RESULTS: After a mean follow-up of 6 years, all 3 patients were highly satisfied with the operation and described their quality of life as good. The median stool frequency during the day and night were 6 and 1, respectively. No patient reported incontinence or urgency. Of the 3 patients, 2 had minimal soiling with gastric juice; 1 patient had anastomotic ulcers with bleeding requiring resection with reanastomosis. All of the patients needed long-term proton pump inhibitor therapy and topical perianal treatment to prevent skin burning. CONCLUSION: Inter-ileoanal gastroplasty is a surgical salvage technique that can avoid a permanent ileostomy. The procedure provides a good quality of life for patients with unfeasible or failed ileal pouch.
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https://www.hal.inserm.fr/inserm-00475172
Contributor : Pablo Ortega Deballon <>
Submitted on : Wednesday, April 21, 2010 - 4:48:54 PM
Last modification on : Wednesday, April 21, 2010 - 4:48:54 PM
Long-term archiving on: : Wednesday, November 30, 2016 - 5:29:40 PM

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Pablo Ortega-Deballon, Nicolas Cheynel, Giovanni Di-Giacomo, Rezkallah Hareth, Olivier Facy, et al.. Interposition of a gastric pouch between ileum and anus after proctocolectomy: long-term results in 3 patients.. Surgery, Elsevier, 2009, 145 (5), pp.568-72. ⟨10.1016/j.surg.2008.12.014⟩. ⟨inserm-00475172⟩

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