Ulcerative Colitis: Alves A

Alves A, Panis Y. · Service de chirurgie digestive, hôpital Lariboisière, 2 rue Ambroise-Paré, 75475 Paris cedex 10, France. · Ann Chir. · Pubmed #15950920 No free full text.

Abstract: Total coloproctectomy with ileal pouch-anal anastomosis is the operation of choice for both ulcerative colitis and familial adenomatous polyposis. In experienced teams, it is now possible to do this operation through a laparoscopic approach. Laparoscopy allows to perform the same operation than during open surgery, but with reduction of the surgical trauma, especially for the abdominal wound.

Lefevre JH, Bretagnol F, Ouaïssi M, Taleb P, Alves A, Panis Y. · Department of Colorectal Surgery, Beaujon Hospital (APHP), University Paris VII, 100 Boulevard du Général Leclerc, 92118, Clichy Cedex, France. · Surg Endosc. · Pubmed #18814000 No free full text.

Abstract: BACKGROUND: Ileal pouch-anal anastomosis (IPAA) is the recommended procedure for ulcerative colitis and profuse familial adenomatous polyposis. The aims of this study were to report a consecutive series of 82 unselected patients who undergone a total laparoscopic IPAA with a special focus on the postoperative morbidity and 1-year functional results. METHODS: Between 2002 and 2008, 82 consecutive patients undergoing IPAA under a total laparoscopic approach were enrolled. Patient data, surgical procedure, and 1-year functional outcome were analyzed. RESULTS: Among the 82 patients, 44 (54%) had a former subtotal colectomy (STC) before IPAA. No patient died postoperatively. Conversion rate was 11%. Overall morbidity was 32%. Symptomatic anastomotic fistulas were observed in nine patients (10%). Reoperation was needed in 5/82 (6%) of the patients. One-year functional results were 4.7 +/- 1.9 during the day and 1 +/- 1.2 during the night. Operating time decreased significantly after the first 40 laparoscopic IPAA (p = 0.0183). No difference was observed in the morbidity and functional results between patients operated for IPAA after a former colectomy or during a restorative proctocolectomy. CONCLUSIONS: This study suggested the feasibility and safety of the total laparoscopic approach IPAA. Total laparoscopic approach could become the best approach for IPAA. Prior colectomy does not modify the result of this demanding surgical procedure.

Ouaïssi M, Lefevre JH, Bretagnol F, Alves A, Valleur P, Panis Y. · Department of Colorectal Surgery, PMAD, Beaujon Hospital (APHP), Clichy, France. · Surg Laparosc Endosc Percutan Tech. · Pubmed #18716534 No free full text.

Abstract: BACKGROUND: To compare the results of a total laparoscopic versus open approach 3-time ileal pouch anal anastomosis (IPAA) for patients with acute or severe colitis complicating inflammatory bowel disease. METHODS: Consecutive subtotal colectomy was followed by IPAA then by stoma closure. Between 2000 and 2006, 23 consecutive patients, operated through a total laparoscopic approach were well matched with 22 patients operated by open approach. RESULTS: Overall major complications rate was lower after laparoscopic than after open approach (5/23 vs. 9/22; NS). Mean hospital stay for the 3 consecutive procedures was significantly reduced after laparoscopic versus open approach (27+/-7 d vs. 39+/-27 d; P<0.05). CONCLUSIONS: Our case-control study suggests that, in experienced centers, a total laparoscopic approach can be viewed as a viable alternative to conventional open 3-step IPAA for the treatment of acute or severe colitis complicating inflammatory bowel disease.

Alves A, Penna C. · Service de chirurgie digestive, hôpital Beaujon, 100, boulevard Général-Leclerc, 92110 Clichy, France. · Ann Chir. · Pubmed #16338216 No free full text.

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Alves A, Panis Y, Bouhnik Y, Maylin V, Lavergne-Slove A, Valleur P. · Department of Surgery, Lariboisiére Hospital, Paris, France. · J Am Coll Surg. · Pubmed #12946792 No free full text.

Abstract: BACKGROUND: Management of severe acute colitis (SAC) complicating inflammatory bowel disease remains a challenge despite significant advances in medical therapy. The aim of this study was to report a 20-year experience with subtotal colectomy (STC) performed for SAC. STUDY DESIGN: A total of 164 consecutive patients with a mean age of 37 +/- 15 years (range 16 to 86 years) underwent STC for SAC defined according to the criteria of Truelove and Witts. The decision for surgical treatment was based on clinical, biologic, radiologic, and endoscopic severity criteria both at entry and during hospitalization after failure to improve under medical treatment. A Brooke ileostomy was made to the right iliac fossa and a sigmoidostomy was made to the midline incision. All complications before discharge were recorded as in-hospital morbidity or mortality. RESULTS: Colonoscopy was performed in 153 patients and endoscopic diagnosis of SAC was confirmed by pathologic examination in 84% of the cases. STC was performed on an emergency basis in 40 patients with complications and only after failure of medical treatment in the remaining 124 patients. The mortality rate was 0.6%. The overall morbidity rate was 33%; 24 patients required reoperation, including 8% undergoing reoperation during followup for small bowel obstruction. Definitive pathologic diagnosis changed in one half of the patients; the final diagnosis was Crohn's disease in 110 cases, ulcerative colitis in 35, and indeterminate colitis in 19. CONCLUSIONS: Our results demonstrated the safety of STC performed in a tertiary care center for patients with SAC who presented with complications or failed to respond to intensive medical therapy.