Base de dados : MEDLINE
Pesquisa : A10.850.200 [Categoria DeCS]
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[PMID]:29292921
[Au] Autor:Jonsson O
[Ti] Título:Inrätta nationellt centrum för Kocks reservoar..
[So] Source:Lakartidningen;114, 2017 11 10.
[Is] ISSN:1652-7518
[Cp] País de publicação:Sweden
[La] Idioma:swe
[Mh] Termos MeSH primário: Serviços Centralizados no Hospital
Bolsas Cólicas
Coletores de Urina
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Garantia da Qualidade dos Cuidados de Saúde
[Pt] Tipo de publicação:LETTER
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180103
[St] Status:MEDLINE


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[PMID]:28595172
[Au] Autor:Cai JX; Barrow J; Parian A; Brant SR; Dudley-Brown S; Efron J; Fang S; Gearhart S; Marohn M; Safar B; Truta B; Wick E; Lazarev M
[Ad] Endereço:Department of Medicine, Division of Gastroenterology and Hepatology, Meyerhoff Inflammatory Bowel Disease Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
[Ti] Título:Routine Pouchoscopy Prior to Ileostomy Takedown May Not Be Necessary in Patients with Chronic Ulcerative Colitis.
[So] Source:Dig Dis;36(1):72-77, 2018.
[Is] ISSN:1421-9875
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Creation of a J pouch is the gold standard surgical intervention in the treatment of chronic ulcerative colitis (UC). Pouchoscopy prior to ileostomy takedown is commonly performed. We describe the frequency, indication, and findings on pouchoscopy, and determine if pouchoscopy affects rates of complications after takedown. METHODS: All UC or indeterminate inflammatory bowel disease patients with a J pouch were retrospectively evaluated from January 1994 to December 2014. Cases were defined as having routine (asymptomatic) pouchoscopy after pouch creation but before ileostomy takedown. Controls were defined as having no pouchoscopy or pouchoscopy on the same day as that of takedown. RESULTS: The study included 178 patients (81.5% cases, 18.5% controls). Fifty two percent of pouchoscopies were reported as normal. Common abnormal endoscopy findings included stricture (35%), pouchitis (7%), and cuffitis (0.7%). Length of stay during takedown hospitalization was shorter for cases than controls (3 vs. 5 days; p = 0.001), but neither short- nor long-term complications were statistically different between cases and controls. Abnormalities on pouchoscopy were not predictive for short-term complications (p = 0.73) or long-term complications (p = 0.55). Routine pouchoscopy did not delay takedown surgery in any of the included patients. CONCLUSIONS: Routine pouchoscopy may not be necessary prior to ileostomy takedown; its greatest utility is in patients with suspected pouch complications.
[Mh] Termos MeSH primário: Colite Ulcerativa/cirurgia
Bolsas Cólicas
Endoscopia
Ileostomia
[Mh] Termos MeSH secundário: Adulto
Idoso
Doença Crônica
Colite Ulcerativa/complicações
Constrição Patológica/cirurgia
Feminino
Seres Humanos
Doenças Inflamatórias Intestinais/complicações
Masculino
Meia-Idade
Complicações Pós-Operatórias/etiologia
Pouchite/cirurgia
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170609
[St] Status:MEDLINE
[do] DOI:10.1159/000475808


  3 / 1452 MEDLINE  
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[PMID]:29112570
[Au] Autor:Poylin V; Mowschenson P; Nagle D; Cataldo T
[Ad] Endereço:Colon and Rectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
[Ti] Título:Rectal Eversion Technique: A Method to Achieve Very Low Rectal Transection and Anastomosis With Particular Value in Laparoscopic Cases.
[So] Source:Dis Colon Rectum;60(12):1329-1331, 2017 Dec.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Transection of the rectum at the anorectal junction is required for proper resection in ulcerative colitis and restorative proctocolectomy. Achieving stapled transection at the pelvic floor is often challenging, particularly during laparoscopic proctectomy. Transanal mucosectomy and handsewn anastomosis are frequently used to achieve adequate resection. Rectal eversion provides an alternative for low anorectal transection and maintains the ability to perform stapled anastomosis. TECHNIQUE: The purpose of this article is to describe a technique for low anorectal transection. The work was conducted at tertiary care center by 2 colon and rectal surgeons on patients undergoing total proctocolectomy with creation of ileal pouch rectal anastomosis for ulcerative colitis. We measured the ability to achieve low stapled anastomosis. RESULTS: Very low transection was achieved, allowing for creation of IPAA without leaving significant rectal cuff. This study was limited because it is an early experience that was not performed in the setting of a scientific investigation. No sphincter or bowel functional data were obtained or evaluated. CONCLUSIONS: Rectal eversion technique provides an alternative to mucosectomy when low pelvic transection is difficult to achieve. See Video at http://links.lww.com/DCR/A441.
[Mh] Termos MeSH primário: Colite Ulcerativa/cirurgia
Laparoscopia/métodos
Proctocolectomia Restauradora
Reto/cirurgia
[Mh] Termos MeSH secundário: Adulto
Anastomose Cirúrgica
Bolsas Cólicas
Seres Humanos
Ileostomia
Masculino
Grampeamento Cirúrgico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171108
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000932


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[PMID]:28991085
[Au] Autor:Lightner AL; Fletcher JG; Pemberton JH; Mathis KL; Raffals LE; Smyrk T
[Ad] Endereço:1 Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 2 Division of Radiology, Mayo Clinic, Rochester, Minnesota 3 Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota 4 Division of Pathology, Mayo Clinic, Rochester, Minnesota.
[Ti] Título:Crohn's Disease of the Pouch: A True Diagnosis or an Oversubscribed Diagnosis of Exclusion?
[So] Source:Dis Colon Rectum;60(11):1201-1208, 2017 Nov.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: After IPAA, 8% of patients with ulcerative colitis are later diagnosed with Crohn's disease of the pouch, associated with an increased rate of pouch failure. No study has reported on how often the clinical diagnosis is correlated with histologic findings of Crohn's disease in the excised pouch. OBJECTIVE: The purpose of this study was to determine whether the clinical diagnosis is consistent with pathologic confirmation at pouch excision. SETTINGS: The study was conducted at a tertiary IBD referral center. PATIENTS: Patients with chronic ulcerative colitis who underwent pouch excision for presumed Crohn's disease of the pouch were included. MAIN OUTCOME MEASURES: Preoperative evaluation and pathologic variables at the time of pouch excision were measured. RESULTS: A total of 35 patients underwent pouch excision for Crohn's disease of the pouch based on a combination of clinical, radiographic, and endoscopic findings. Seven (20%) had surgical pathology consistent with Crohn's disease at pouch excision. There were no differences in those 7 patients and the remaining 28 in terms of diagnosis at colectomy, primary pouch symptoms, prepouch inflammation, ulceration, or granulomas at endoscopy. In the nonpathology-confirmed Crohn's disease, 40% (n = 11) had an anastomotic leak at time of IPAA versus 0% in the Crohn's disease group, and 86% (n = 24) had symptoms of pouch dysfunction within 5 months of ileostomy reversal versus 13 months in the Crohn's disease group. Of 28 without pathology-confirmed Crohn's disease, 100% (n = 28) were treated with antibiotics, 68% (n = 19) with steroids, 59% (n = 16) with immunomodulators, and 57% (n = 15) with biologic therapy for Crohn's disease of the pouch. LIMITATIONS: The study was limited by its single-center scope and lack of an established definition for Crohn's disease of the pouch. CONCLUSIONS: Pathologic confirmation of Crohn's disease was given to only one fifth of patients who underwent pouch excision for Crohn's disease of the pouch. Given the histologic variability in Crohn's disease, it may be unreasonable to expect histologic confirmation in every case; still, the diagnosis of Crohn's disease of the pouch may be overly ascribed, resulting in unnecessary immunosuppressive medications and exclusion from consideration for pouch reconstructive surgery. See Video Abstract at http://links.lww.com/DCRA432.
[Mh] Termos MeSH primário: Colite Ulcerativa/cirurgia
Bolsas Cólicas/patologia
Doença de Crohn/diagnóstico
Uso Excessivo de Produtos e Serviços de Saúde
Proctocolectomia Restauradora
[Mh] Termos MeSH secundário: Adulto
Idoso
Doença de Crohn/patologia
Doença de Crohn/cirurgia
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY; VIDEO-AUDIO MEDIA
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171010
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000918


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[PMID]:28982895
[Au] Autor:Kawahara H; Akiba T; Yanaga K
[Ad] Endereço:Department of Surgery, Kashiwa Hospital, Jikei University School of Medicine, Chiba, Japan kawahide@jikei.ac.jp.
[Ti] Título:Cuff-less J Pouch Anal Stapling Anastomosis for Ulcerative Colitis.
[So] Source:Anticancer Res;37(10):5743-5745, 2017 10.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:BACKGROUND/AIM: For ulcerative colitis, J pouch anal anastomosis with preserved rectal cuff had been popularized with its acceptable defecation function. However, some complications associated with rectal cuff after surgery have been reported. We are performing a novel procedure, laparoscopic cuff-less J pouch anal stapling anastomosis. PATIENTS AND METHODS: From January 2014 to December 2016, ten patients with ulcerative colitis, including three with concomitant cancer underwent this procedure. J pouch anal anastomosis was performed at the dentate line in all patients by our original procedure. In a manometric examination of all patients more than one year after the operation, maximum resting pressure was 68.0 (52-84) mmHg, maximum squeeze pressure was 101.7 (87-121) mmHg, length of high-pressure zone was 32.3 (30-35), and none had observed rectoanal reflex. Good defecation was confirmed by defecography. CONCLUSION: Cuff-less J pouch anal stapling anastomosis seems to be a useful procedure for patients with ulcerative colitis.
[Mh] Termos MeSH primário: Canal Anal/cirurgia
Colite Ulcerativa/cirurgia
Bolsas Cólicas
Laparoscopia
Proctocolectomia Restauradora/métodos
Reto/cirurgia
Grampeamento Cirúrgico
[Mh] Termos MeSH secundário: Adulto
Idoso
Canal Anal/diagnóstico por imagem
Canal Anal/fisiopatologia
Anastomose Cirúrgica
Colite Ulcerativa/diagnóstico por imagem
Colite Ulcerativa/fisiopatologia
Bolsas Cólicas/efeitos adversos
Defecação
Feminino
Seres Humanos
Laparoscopia/efeitos adversos
Masculino
Meia-Idade
Proctocolectomia Restauradora/efeitos adversos
Recuperação de Função Fisiológica
Reto/diagnóstico por imagem
Reto/fisiopatologia
Grampeamento Cirúrgico/efeitos adversos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171007
[St] Status:MEDLINE


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[PMID]:28940230
[Au] Autor:Diederen K; Sahami SS; Tabbers MM; Benninga MA; Kindermann A; Tanis PJ; Oomen MW; de Jong JR; Bemelman WA
[Ad] Endereço:Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
[Ti] Título:Outcome after restorative proctocolectomy and ileal pouch-anal anastomosis in children and adults.
[So] Source:Br J Surg;104(12):1640-1647, 2017 Nov.
[Is] ISSN:1365-2168
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Studies comparing the outcome of ileal pouch-anal anastomosis (IPAA) in children and adults are scarce. This complicates decision-making in young patients. The aim of this study was to compare adverse events and pouch function between children and adults who underwent IPAA. METHODS: This cross-sectional cohort study included all consecutive children (aged less than 18 years) and adults with a diagnosis of inflammatory bowel disease or familial adenomatous polyposis who underwent IPAA in a tertiary referral centre between 2000 and 2015. Adverse events were assessed by chart review, and pouch function by interview using a pouch function score (PFS). RESULTS: In total, 445 patients underwent IPAA: 41 children (median age 15 years) and 404 adults (median age 39 years), with a median follow-up of 22 (i.q.r. 8-68) months. Being overweight (P = 0·001), previous abdominal surgery (P = 0·018), open procedures (P < 0·001) and defunctioning ileostomy (P = 0·014) were less common among children than adult patients. The occurrence of anastomotic leakage, surgical fistulas, chronic pouchitis and Crohn's of the pouch was not associated with paediatric age at surgery, nor was pouch failure. The development of anastomotic strictures was associated with having IPAA surgery during childhood (odds ratio 4·22, 95 per cent c.i. 1·13 to 15·77; P = 0·032). Pouch function at last follow-up was similar in the children and adult groups (median PFS 5·0 versus 6·0 respectively; P = 0·194). CONCLUSION: Long-term pouch failure rates and pouch function were similar in children and adults. There is no need for a more cautious attitude to use of IPAA in children based on concerns about poor outcome.
[Mh] Termos MeSH primário: Polipose Adenomatosa do Colo/cirurgia
Bolsas Cólicas/fisiologia
Doenças Inflamatórias Intestinais/cirurgia
Complicações Pós-Operatórias
Proctocolectomia Restauradora/efeitos adversos
Proctocolectomia Restauradora/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Fatores Etários
Canal Anal/cirurgia
Estudos Transversais
Feminino
Seres Humanos
Masculino
Meia-Idade
Qualidade de Vida
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171025
[Lr] Data última revisão:
171025
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170924
[St] Status:MEDLINE
[do] DOI:10.1002/bjs.10678


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[PMID]:28682966
[Au] Autor:Boyce SA; Harris C; Stevenson A; Lumley J; Clark D
[Ad] Endereço:1 Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, United Kingdom 2 Royal Brisbane and Women's Hospital, Herston, Queensland, Australia 3 Wesley Hospital, Auchenflower, Queensland, Australia.
[Ti] Título:Management of Low Colorectal Anastomotic Leakage in the Laparoscopic Era: More Than a Decade of Experience.
[So] Source:Dis Colon Rectum;60(8):807-814, 2017 Aug.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Anastomotic leak after colorectal surgery increases postoperative mortality, cancer recurrence, permanent stoma formation, and poor bowel function. Anastomosis between the colon and rectum is a particularly high risk. Traditional management mandates laparotomy, disassembly of the anastomosis, and formation of an often-permanent stoma. After laparoscopic colorectal surgery it may be possible to manage anastomotic failure with laparoscopy, thus avoiding laparotomy. OBJECTIVE: The purpose of this study was to determine the feasibility of the laparoscopic management of failed low colorectal anastomoses. SETTING: This was a single-institute case series. PATIENTS: A total of 555 laparoscopic patients undergoing anterior resection with primary anastomosis within 10 cm of the anus in the period 2000-2012 were included. MAIN OUTCOME MEASURES: Anastomotic failure, defined as any clinical or radiological demonstrable defect in the anastomosis; complications using the Clavien-Dindo system; mortality within 30 days; and patient demographics and risk factors, as defined by the Charlson index, were measured. RESULTS: Leakage occurred in 44 (7.9%) of 555 patients, 16 patients with a diverting ileostomy and 28 with no diverting ileostomy. Leakage was more common in those with anastomoses <5 cm form the anus, male patients, and those with a colonic J-pouch and rectal cancer. Diverting ileostomy was not protective of anastomotic leakage. In those patients with anastomotic leakage and a primary diverting ileostomy, recourse to the peritoneal cavity was required in 4 of 16 patients versus 24 of 28 without a diverting ileostomy (p = 0.0002). In 74% of those cases, access to the peritoneal cavity was achieved through laparoscopy. Permanent stoma rates were very low, including 14 (2.5%) of 555 total patients or 8 (18.0%) of 44 patients with anastomotic leakage. Thirty-day mortality was rare (0.6%). LIMITATIONS: This study was limited by the lack of a cohort of open cases for comparison. CONCLUSIONS: Laparoscopic anterior resection is associated with low levels of complications, including anastomotic leak, postoperative mortality, and permanent stoma formation. Anastomotic leakage can be managed with laparoscopy in the majority of cases. See Video Abstract at http://links.lww.com/DCR/A353.
[Mh] Termos MeSH primário: Fístula Anastomótica/cirurgia
Doenças do Colo/cirurgia
Procedimentos Cirúrgicos do Sistema Digestório
Diverticulite/cirurgia
Endometriose/cirurgia
Laparoscopia
Doenças Retais/cirurgia
Neoplasias Retais/cirurgia
[Mh] Termos MeSH secundário: Anastomose Cirúrgica
Bolsas Cólicas
Bases de Dados Factuais
Estudos de Viabilidade
Feminino
Seres Humanos
Ileostomia
Masculino
Meia-Idade
Reoperação
Fatores Sexuais
[Pt] Tipo de publicação:JOURNAL ARTICLE; VIDEO-AUDIO MEDIA
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170828
[Lr] Data última revisão:
170828
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000822


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[PMID]:28682131
[Au] Autor:Farag A; Mashhour AN; Elbarmelgi MY; Raslan MM; Abdelsalam AM; Mohsen AA
[Ad] Endereço:Department of General Surgery, Cairo University , Egypt.
[Ti] Título:Taeniectomy pouch as neorectum after low rectal resection.
[So] Source:Ann R Coll Surg Engl;99(7):555-558, 2017 Sep.
[Is] ISSN:1478-7083
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background and purpose The functional outcomes of incontinence and high stool frequency resulting from restorative surgery are often criticised. The aim of this study was to assess the taeniectomy pouch in comparison with other pouches described in the literature. Material and methods This was a prospective cohort study. All patients who were candidate for low rectal resection presenting to the colorectal unit at Cairo University hospitals during the period February 2013 to February 2015 were included in the study (90 patients). Safety and feasibility of the new technique were assessed, including operative time, leakage, postoperative urgency, incontinence, number of daily motions and difficulty in evacuation. These parameters were assessed clinically, by means of defecography and anorectal manometry. Results The mean age of patients was 49.6 years. Percentages of postoperative mortality and leakage were 2.2% and 3.4%, respectively. Mean operative time was 117 minutes. Mean numbers of daily motions were 3.04 and 1.52 at 3 and 12 months, respectively. Mean Wexner score for continence at 3 and 12 months were 3.21 and 1.32, respectively. Mean resting pressure was 51.63 mmHg, squeeze pressure was 130.42 mmHg and mean threshold volume was 118.68 ml. Conclusions Taeniectomy is a novel technique for pouch formation after low rectal resection, which can be used as an alternative to other pouches, especially the widely used transverse coloplasty.
[Mh] Termos MeSH primário: Bolsas Cólicas
Reto/cirurgia
[Mh] Termos MeSH secundário: Bolsas Cólicas/efeitos adversos
Feminino
Seres Humanos
Masculino
Meia-Idade
Duração da Cirurgia
Estudos Prospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE
[do] DOI:10.1308/rcsann.2017.0085


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[PMID]:28614561
[Au] Autor:Kulaylat AS; Kulaylat AN; Schaefer EW; Tinsley A; Williams E; Koltun W; Hollenbeak CS; Messaris E
[Ad] Endereço:Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey.
[Ti] Título:Association of Preoperative Anti-Tumor Necrosis Factor Therapy With Adverse Postoperative Outcomes in Patients Undergoing Abdominal Surgery for Ulcerative Colitis.
[So] Source:JAMA Surg;152(8):e171538, 2017 Aug 16.
[Is] ISSN:2168-6262
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Despite the increasing use of anti-tumor necrosis factor (TNF) therapy in ulcerative colitis, its effects on postoperative outcomes remain unclear, with many patients requiring surgical intervention despite optimal medical management. Objective: To assess the association of preoperative use of anti-TNF agents with adverse postoperative outcomes. Design, Setting, and Participants: This analysis used insurance claims data from a large national database to identify patients 18 years or older with ulcerative colitis. These insured patients had inpatient and/or outpatient claims between January 1, 2005, and December 31, 2013, with Current Procedural Terminology codes for a subtotal colectomy or total abdominal colectomy, a total proctocolectomy with end ileostomy, or a combined total proctocolectomy and ileal pouch-anal anastomosis. Only data regarding the first or index surgical admission within the time frame were abstracted. Use of anti-TNF agents, corticosteroids, and immunomodulators within 90 days of surgery was identified using Healthcare Common Procedure Coding System codes. Inclusion in the study required the patient to have an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code for ulcerative colitis. Exclusion occurred if the patient had a secondary ICD-9-CM diagnosis code for Crohn disease or if the patient was not continuously enrolled in an insurance plan for at least 180 days before and after the index surgery. Data were collected and analyzed from February 1, 2015, to June 2, 2016. Main Outcomes and Measures: Outcomes included 90-day complications, emergency department visits, and readmissions. Multivariable logistic regression was used to model covariates, including anti-TNF agent use, on the occurrence of outcomes. Results: Of the 2476 patients identified, 1379 (55.7%) were men, and the mean (SD) age was 42.1 (12.9) years. Among these, 950 (38.4%) underwent subtotal colectomy or total abdominal colectomy, 354 (14.3%) underwent total proctocolectomy with end ileostomy, and 1172 (47.3%) received ileal pouch-anal anastomoses. In univariate analyses, increased postoperative complications were observed among patients in the ileal pouch cohort who received anti-TNF agents preoperatively vs those who did not (137 [45.2%] vs 327 [37.6%]; P = .02) but not among those in the colectomy or proctocolectomy cohorts. An increase in complications was also observed on multivariable analyses among patients in the ileal pouch cohort (odds ratio, 1.38; 95% CI, 1.05-1.82). Conclusions and Relevance: Unlike preoperative anti-TNF agent use among patients who underwent colectomy or total proctocolectomy and experienced no significant increase in postoperative complications, anti-TNF agent use within 90 days of surgery among patients who underwent ileal pouch-anal anastomosis was associated with higher 90-day postoperative complication rates.
[Mh] Termos MeSH primário: Fatores Biológicos/efeitos adversos
Colite Ulcerativa/cirurgia
Complicações Pós-Operatórias/induzido quimicamente
Fator de Necrose Tumoral alfa/antagonistas & inibidores
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Colectomia/efeitos adversos
Bolsas Cólicas/efeitos adversos
Feminino
Seres Humanos
Masculino
Meia-Idade
Proctocolectomia Restauradora/efeitos adversos
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biological Factors); 0 (Tumor Necrosis Factor-alpha)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170615
[St] Status:MEDLINE
[do] DOI:10.1001/jamasurg.2017.1538


  10 / 1452 MEDLINE  
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[PMID]:28481854
[Au] Autor:Pachler FR; Brandsborg SB; Laurberg S
[Ad] Endereço:Colorectal Surgical Unit, Aarhus University Hospital, Aarhus, Denmark.
[Ti] Título:Paradoxical Impact of Ileal Pouch-Anal Anastomosis on Male and Female Fertility in Patients With Ulcerative Colitis.
[So] Source:Dis Colon Rectum;60(6):603-607, 2017 Jun.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Birth rates in males with ulcerative colitis and ileal pouch-anal anastomosis have not been studied. OBJECTIVE: This study aimed to estimate birth rates in males and females with ulcerative colitis and study the impact of ileal pouch-anal anastomosis. DESIGN: This was a retrospective registry-based cohort study that was performed over a 30-year period. SETTINGS: Records for parenting a child from the same period were cross-linked with patient records, and birth rates were calculated using 15 through 49 years as age limits. All data were prospectively registered. PATIENTS: All patients with ulcerative colitis and ulcerative colitis with ileal pouch-anal anastomosis between 1980 and 2010 were identified in Danish national databases. MAIN OUTCOME MEASURES: The primary outcomes measured were birth rates in females and males with ulcerative colitis and ulcerative colitis with ileal pouch-anal anastomosis. RESULTS: We included 27,379 patients with ulcerative colitis (12,812 males and 14,567 females); 1544 had ileal pouch-anal anastomosis (792 males and 752 females). Patients with ulcerative colitis have slightly reduced birth rates (males at 40.8 children/1000 years, background population 43.2, females at 46.2 children/1000 years, background population 49.1). After ileal pouch-anal anastomosis, males had increased birth rates at 47.8 children/1000 years in comparison with males with ulcerative colitis without ileal pouch-anal anastomosis (40.5 children/1000 years), whereas females had reduced birth rates at 27.6 children/1000 years in comparison with females with ulcerative colitis without ileal pouch-anal anastomosis (46.8 children/1000 years). LIMITATIONS: Only birth rates were investigated and not fecundability. Furthermore, there is a question about misattributed paternity, but this has previously been shown to be less than 5%. CONCLUSIONS: Ulcerative colitis per se has little impact on birth rates in both sexes, but ileal pouch-anal anastomosis surgery leads to a reduction in birth rates in females and an increase in birth rates in males. This has clinical impact when counseling patients before ileal pouch-anal anastomosis surgery.
[Mh] Termos MeSH primário: Coeficiente de Natalidade
Colite Ulcerativa/cirurgia
Bolsas Cólicas
Fertilidade
Proctocolectomia Restauradora
[Mh] Termos MeSH secundário: Adolescente
Adulto
Estudos de Coortes
Dinamarca/epidemiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170731
[Lr] Data última revisão:
170731
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170509
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000796



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