Ulcerative Colitis: Panis Y

Panis Y. · No affiliation provided · Gastroenterol Clin Biol. · Pubmed #12434064 No free full text.

This publication has no abstract.

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.

Gambiez L, Cosnes J, Guedon C, Karoui M, Sielezneff I, Zerbib P, Panis Y. · Service de chirurgie digestive et transplantation, Hôpital Claude Huriez, 59034 Lille. · Gastroenterol Clin Biol. · Pubmed #15672572 No free full text.

This publication has no abstract.

Panis Y. · Service de Chirurgie Digestive, Hôpital Lariboisière, Paris, France. · Gastroenterol Clin Biol. · Pubmed #12704302 No free full text.

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Mariani P, Panis Y, Valleur P. · Service de chirurgie digestive, Hôpital Lariboisière, Paris. · J Chir (Paris). · Pubmed #10429931 No free full text.

Abstract: Surgical treatment of chronic ulcerative colitis requires restorative proctocolectomy with ilial pouch-anal anastomosis to remove all the disease bowel and provide cure. A one-stage or two-stage procedure can be performed after subtotal colectomy with ileostomy and colostomy. Restorative proctocolectomy is not advised for very old patients or patients with anal sphincter insufficiency. In such cases, total colectomy with ileo-rectal anastomosis is proposed. The rectal stump must be examined regularly by rectoscopy because of the risk of cancer. A proctocolectomy with definitive ileostomy is proposed after pouch-anal excision for pelvic septic complications (5% of ileal pouch-anal anastomoses). Surgical treatment of chronic ulcerative colitis is indicated when medical treatment fails, at onset of fulminant acute colitis, or because of colorectal dysplasia.

Ettorre GM, Pescatori M, Panis Y, Nemeth J, Crescenzi A, Valleur P. · Coloproctology Unit, Villa Claudia Hospital, Rome, Italy. · Dis Colon Rectum. · Pubmed #11156461 No free full text.

Abstract: PURPOSE: Inflammation and dysplasia may affect the ileal pouch after restorative proctocolectomy and ileal pouch-anal anastomosis. The aim of this prospective study was to evaluate the morphologic changes and the risk of dysplasia within the pouch after ileal pouch-anal anastomosis. METHODS: Thirty-seven patients with ileal pouch-anal anastomosis underwent endoscopies and biopsies of the pouch: 21 patients were affected by ulcerative colitis and 16 by Crohn's colitis. The mucosal biopsy specimens were studied to investigate the degree of acute and chronic inflammation and the occurrence of dysplasia. A score system was calculated for each patient and correlated with the histologic diagnosis of ulcerative colitis or Crohn's colitis. RESULTS: After a median follow-up of 85 (range, 7-198) months, the inflammation histologic score evaluated was 3.8 (95 percent confidence interval, 2.4-5.1) and 3.5 (95 percent confidence interval, 2.6-4.3), respectively, in patients with Crohn's colitis and ulcerative colitis (mean and 95 percent confidence interval; P = 0.74, not significant), and no patient developed mucosal dysplasia. Fifteen patients (40.5 percent) developed clinical pouchitis that occurred in Crohn's colitis (9/16 patients or 56 percent) and in ulcerative colitis (6/21 patients or 28 percent; P not significant). The score was 4.1 (95 percent confidence interval, 3.2-5) in patients with pouchitis and 3.2 (95 percent confidence interval, 2.1-4.3) in patients without clinical pouchitis (P = 0.012) and was 4.1 (95 percent confidence interval, 2.6-5.5) and 4 (95 percent confidence interval, 2.9-5.3), respectively, in pouchitis patients with Crohn's colitis and ulcerative colitis. CONCLUSION: No difference in the inflammation histologic score was observed in ileal pouches after restorative proctocolectomy for ulcerative and Crohn's colitis. In our series, which includes those patients with longer follow-up (>5 years) or with chronic unremitting pouchitis, no case of dysplasia was found. The occurrence of pouchitis was higher in the case of ileal pouch-anal anastomosis for Crohn's disease than for ulcerative colitis, but no difference in the severity of the histologic score was noted.

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.

Loriau J, Benoist S, Panis Y, Joly F, Messing B, Valleur P. · Departments of Surgery and Gastroenterology, Lariboisière Hospital, 2 Rue Ambroise Paré, 75475 Paris CEDEX 10, France. · Surgery. · Pubmed #15614290 No free full text.

This publication has no abstract.

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.

Régimbeau JM, Panis Y, Pocard M, Hautefeuille P, Valleur P. · Service de Chirurgie Générale et Digestive, Hôpital Lariboisière, Paris, France. · Dis Colon Rectum. · Pubmed #11805562 No free full text.

Abstract: PURPOSE: During ileal pouch-anal anastomosis, both conservation of the anal transitional zone during the stapled technique and incomplete mucosectomy in the standard Park's procedure may expose the patient to disease recurrence. We propose here an technique whose aim is to solve both problems by performing handsewn ileal pouch-anal anastomosis on the dentate line after rectal eversion and total proctectomy. METHODS: We reviewed the records of 172 consecutive patients who had undergone ileal pouch-anal anastomosis since 1984 for chronic ulcerative colitis (n = 80), familial adenomatous polyposis (n = 48), selected cases of Crohn's disease (n = 42), or other causes (n = 2). RESULTS: One patient (0.5 percent) died postoperatively. Operative morbidity was similar to that reported after the Park's and stapled procedures. Of our 128 patients with a five-year follow-up, anastomotic stricture occurred in 15 (12 percent), and 4 patients (3 percent) had to have pouch removal. Stool frequency per 24 hours was 4.8 +/- 1.6 (range, 1-11), continence was perfect in 104 patients (81 percent), and sexual activity was estimated to be unchanged in 120 (94 percent). No evidence of disease recurrence was noted in the patients with familial adenomatous polyposis or ulcerative colitis. CONCLUSIONS: During ileal pouch-anal anastomosis, Park's procedure carries the risk of incomplete mucosectomy and disease recurrence, and the stapled procedure requires a long-term follow-up of the anal transitional zone. Our alternative technique with total proctectomy avoids both problems and gives similar long-term functional results.