tailieunhanh - Emergencies and Complications in Gastroenterology - part 7

một chẩn đoán ban đầu của điều kiện độc hại, quản lý liên ngành, và phẫu thuật cắt bỏ nhanh chóng của đại tràng [15]. Phẫu thuật tự chọn Có ba chỉ định mổ: không điều trị y tế, những thay đổi tiền ác tính hoặc ác tính và chậm phát triển ở trẻ em. | Fig. 2. Learning curve Decrease of pouch-related septic complications by specialization high frequency of operations modifications of indications and technical development of pouch formation from 38 with permission . Fig. 3. Ileoanal J-pouch. by an early diagnosis of the toxic condition interdisciplinary management and rapid surgical resection of the colon 15 . Elective Surgery There are three indications for elective surgery failed medical treatment premalignant or malignant changes and growth retardation in children. Today the golden standard in surgery for UC is total restorative proctocolectomy with ileal J pouch-anal anastomosis IPAA formation which implies the removal of the complete colonic mucosa including the rectum and proctomucosectomy. The anal sphincter is preserved and an ileoanal anastomosis is constructed after the creation of an ileal reservoir fig. 2 . In Heidelberg a two-stage procedure is generally performed the temporary protective loop ileostomy is usually closed 3 months after the ileoanal pouch procedure. Our data demonstrate a clear learning curve showing that even a large specialized center needs some time and experience to reduce specific complications and implies that this complex operation should only be performed by experienced surgeons fig. 3 . The same operation is also used for treatment of patients with familiar adenomatous polyposis. A protective stoma may be omitted in selected patients. Postoperative Morbidity and Mortality The most frequent complications after IPAA are pouch-related septic complications and pouchitis 26 . Between January 1982 and December 2001 885 IPAAs were performed in our institution 621 for UC and 164 for familial adenomatous polyposis table 3 . Early and late complications occur in up to 50 of all patients including general complications like ileus. Specific complications of this procedure also referred to as pouch-related septic complications are present in of UC patients comprising anastomotic leaks