Interposition of a gastric pouch between ileum and anus after proctocolectomy: Long-term results in 3 patients
Fiche publication
Date publication
mai 2009
Auteurs
Membres identifiés du Cancéropôle Est :
Dr FACY Olivier, Pr ORTEGA DEBALLON Pablo
Tous les auteurs :
Ortega-Deballon P, Cheynel N, Di-Giacomo G, Hareth R, Facy O, Rat P
Lien Pubmed
Résumé
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 7 with ulcerative colitis; 40, 4 9, 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. (Surgery 2009;145:568-72.)
Référence
Surgery. 2009 May;145(5):568-72.