Complications after ileal pouch-anal anastomosis in Korean patients with ulcerative colitis

AIM: To investigate the outcomes of treatments for complications after ileal pouch-anal anastomosis (IPAA) in Korean patients with ulcerative colitis.

Surgical management of colonic diverticular disease:Discrepancy between right- and left-sided diseases

AIM:To compare the outcome of the surgical management of left-sided and right-sided diverticular disease.METHODS:The medical records of 77 patients who were surgically treated for diverticular disease between 1999 and 2010 in a tertiary referral hospital were retrospectively reviewed.The study population was limited to cases wherein the surgical specimen was confirmed as diverticulosis by pathology.Rightsided diverticula were classified as those arising from the cecum,ascending colon,and transverse colon,and those from the descending colon,sigmoid colon,and rectum were classified as left-sided diverticulosis.To assess the changing trend of occurrence of diverticulosis,data were compared with two previous studies of 51 patients.RESULTS:The proportion of left-sided disease cases was significantly increased compared to the results of our previous studies in 1994 and 2001,(27.5%vs48.1%,P<0.05).Moreover,no differences in gender,body mass index,multiplicity of the diverticula,fever,or leukocytosis were noted between patients with rightsided and left-sided disease.However,patients with right-sided disease were significantly younger(50.9year vs 64.0 year,P<0.01).Furthermore,left-sided disease was significantly associated with a higher incidence of complicated diverticulitis(89.2%vs 57.5%,P<0.01),combined resection due to extensive inflammation(21.6%vs 5.0%,P<0.05),operative complications(51.4%vs 27.5%,P<0.05),and in-hospital mortality(10.8%vs 0%,P<0.05),along with longer post-operative hospitalization duration(21.3±10.2 d vs 10.6±8.1 d,P<0.05).CONCLUSION:Compared with right-sided diverticular disease,the incidence of left-sided disease in Korea has increased since 2001 and is associated with worse surgical outcomes.

Favorable surgical treatment outcomes for chronic constipation with features of colonic pseudo-obstruction

AIM:To determine long-term outcomes of surgical treatments for patients with constipation and features of colonic pseudo-obstruction.METHODS:Consecutive 42 patients who underwent surgery for chronic constipation within the last 13 years were prospectively collected.We identified a subgroup with colonic pseudo-obstruction(CPO) features,with dilatation of the colon proximal to the narrowed transitional zone,in contrast to typical slowtransit constipation(STC),without any dilated colonic segments.The outcomes of surgical treatments for chronic constipation with features of CPO were analyzed and compared with outcomes for STC.RESULTS:Of the 42 patients who underwent surgery for constipation,33 patients had CPO with dilatation of the colon proximal to the narrowed transitional zone.There were 16 males and 17 females with a mean age of 51.2 ± 16.1 years.All had symptoms of chronic intestinal obstruction,including abdominal distension,pain,nausea,or vomiting,and the mean duration of symptoms was 67 mo(range:6-252 mo).Preoperative defecation frequency was 1.5 ± 0.6 times/wk(range:1-2 times/wk).Thirty-two patients underwent total colectomy,and one patient underwent diverting transverse colostomy.There was no surgery-related mortality.Postoperative histologic examination showed hypoganglionosis or agangliosis in 23 patients and hypoganglionosis combined with visceral neuropathy or myopathy in 10 patients.In contrast,histology of STC group revealed intestinal neuronal dysplasia type B(n = 6) and visceral myopathy(n = 3).Early postoperative complications developed in six patients with CPO;wound infection(n = 3),paralytic ileus(n = 2),and intraabdominal abscess(n = 1).Defecation frequencies 3 mo after surgery improved to 4.2 ± 3.2 times/d(range:1-15 times/d).Long-term follow-up(median:39.7 mo) was available in 32 patients;all patients had improvements in constipation symptoms,but two patients needed intermittent medication for management of diarrhea.All 32 patients had distinct improvements in constipation symptoms(with a mean bowel frequency of 3.3 ± 1.3 times/d),social activities,and body mass index(20.5 kg/m 2 to 22.1 kg/m 2) and were satisfied with the results of their surgical treatment.In comparison with nine patients who underwent colectomy for STC without colon dilatation,those in the CPO group had a lower incidence of small bowel obstructions(0% vs 55.6%,P < 0.01) and less difficulty with long-distance travel(6.7% vs 66.7%,P = 0.007) on long-term follow-up.CONCLUSION:Chronic constipation patients with features of CPO caused by narrowed transitional zone in the left colon had favorable outcomes after total colectomy.

Surgical outcomes of Korean ulcerative colitis patients with and without colitis-associated cancer

AIM: To determine the clinicopathologic characteristics of surgically treated ulcerative colitis(UC) patients, and to compare the characteristics of UC patients with colitis-associated cancer(CAC) to those without CAC. METHODS: Clinical data on UC patients who underwent abdominal surgery from 1980 to 2013 were collected from 11 medical institutions. Data were analyzed to compare the clinical features of patients with CAC and those of patients without CAC.RESULTS: Among 415 UC patients, 383(92.2%) underwent total proctocolectomy, and of these, 342(89%) were subjected to ileal pouch-anal anastomosis. CAC was found in 47 patients(11.3%). Adenocarcinoma was found in 45 patients, and the others had either neuroendocrine carcinoma or lymphoma. Comparing the UC patients with and without CAC, the UC patients with CAC were characteristically older at the time of diagnosis, had longer disease duration, underwent frequent laparoscopic surgery, and were infrequently given preoperative steroid therapy(P < 0.001-0.035). During the 37 mo mean follow-up period, the 3-yearoverall survival rate was 82.2%.CONCLUSION: Most Korean UC patients experience early disease exacerbation or complications. Approximately 10% of UC patients had CAC, and UC patients with CAC had a later diagnosis, a longer disease duration, and less steroid treatment than UC patients without CAC.