- [Two cases of multiple adenomas in the ileal pouch after total proctocolectomy in patients with familial adenomatous polyposis]. [Case Reports]
- KJKorean J Gastroenterol 2010; 56(1):49-53
- Familial adenomatous polyposis (FAP) is an inherited disease characterized by the development of hundreds of colorectal adenomas, leading to a 100% lifetime risk of colorectal cancer. A prophylactic …
Familial adenomatous polyposis (FAP) is an inherited disease characterized by the development of hundreds of colorectal adenomas, leading to a 100% lifetime risk of colorectal cancer. A prophylactic colectomy is recommended for patients with FAP to prevent colorectal cancer. Four surgical strategies are available for patients with FAP: proctocolectomy with permanent ileostomy, colectomy with ileorectal anastomosis, proctocolectomy with Kochs pouch continent ileostomy (Koch), and restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). Koch and IPAA, which make ileal pouch, have theoretical advantage of the elimination of the risk of colorectal cancer and adenomas and good functional outcome of reduced defecation frequency. However, recent reports have shown frequent development of adenomas and carcinomas in the ileal pouch after Koch or IPAA. We experienced 2 cases of multiple pouch adenomas after pouch surgery in FAP patients. Both patients were treated with endoscopic mucosal resection without complications. We report these 2 cases with a review of literatures.
- Totally laparoscopic versus conventional ileoanal pouch procedure--design of a single-centre, expertise based randomised controlled trial to compare the laparoscopic and conventional surgical approach in patients undergoing primary elective restorative proctocolectomy--LapConPouch-Trial. [Journal Article]
- BSBMC Surg 2006 Nov 24; 6:13
- CONCLUSIONS: The trial will answer the question whether there is indeed an advantage in the laparoscopic group in regard to blood loss and the need for blood transfusions. Moreover, it will generate data on the safety and potential advantages and disadvantages of the minimally invasive approach.
- The Camey-Le Duc antireflux technique for the Koch pouch: evaluation of the upper urinary tract. [Journal Article]
- EUEur Urol 1995; 27(3):236-40
- Between November 1989 and June 1993, 41 patients (78 renal units) underwent Camey-Le Duc technique for prevention of reflux of a Kock pouch. In 30 patients the ileal reservoir was connected to the sk…
Between November 1989 and June 1993, 41 patients (78 renal units) underwent Camey-Le Duc technique for prevention of reflux of a Kock pouch. In 30 patients the ileal reservoir was connected to the skin for cutaneous urinary diversion, and in 11 it was connected to the urethra for lower urinary reconstruction. The mean postoperative follow-up period was 23 months, with a range of 6-47 months. Postoperative excretory urography (IVP) was performed at least once a year to evaluate the upper urinary tract configuration, and ascending cystography was performed to evaluate the reflux. No urinary tract dilatation was observed in 73 renal units (93.6%), while slight dilatation was noted in 3 (3.8%), moderate dilatation in 1 (1.3%), and marked dilatation in 1 (1.3%). Reflux was not found in any patient. Of 23 renal units in 12 patients in whom the last IVP examination was performed 6 months postoperatively, dilatation was noted in 4 (17.4%). In contrast, of 55 renal units in 29 patients in whom the last IVP examination was performed 12 months or more after the Kock pouch operation, dilatation was noted in only 1 (1.8%). We conclude that the Camey-Le Duc antireflux technique is effective in terms of simplicity and reliability.
- [Morphological changes of Kock pouch investigated by autopsy two years nine months postoperatively]. [Case Reports]
- HKHinyokika Kiyo 1994; 40(4):353-5
- A 62-year-old male patient consulted us because of gross hematuria and was diagnosed as having a bladder tumor. Total cystectomy was performed and a Koch pouch was utilized. Two years and nine months…
A 62-year-old male patient consulted us because of gross hematuria and was diagnosed as having a bladder tumor. Total cystectomy was performed and a Koch pouch was utilized. Two years and nine months later, he died as a result of recurrence of bladder tumor and pathological autopsy was performed. A microscopic section of the reservoir mucosa showed a reduction in the number of crypts and an increase in the number of goblet cells. These morphological changes seemed to be caused by chronic exposure to urine, but have a favorable effect upon metabolic alterations following the utilization of the Kock pouch.
- [Results of Kock pouch construction fully utilizing an auto-suture instrument]. [Journal Article]
- NHNihon Hinyokika Gakkai Zasshi 1991; 82(12):1964-71
- From March 1987 to the end of February 1991, we performed Koch pouch construction as a urinary diversion on 20 patients who had undergone radical cystectomy due to bladder cancer. The operation was d…
From March 1987 to the end of February 1991, we performed Koch pouch construction as a urinary diversion on 20 patients who had undergone radical cystectomy due to bladder cancer. The operation was done according to the method of Skinner et al. We fully utilized an auto-suture instrument to ensure safe and stable suturing of the ileum and to shorten the operating time. It was of great concern that the staples placed at several portions might cause stone formation or aggravate infection. However, stone formation was observed only in one patient (5%) at the tip of a nipple valve in which a staple became the nucleus of the stone. Staples are usually not regarded as an obstacle as they are usually covered by the mucous membrane. In all patients, the maximum capacity of the pouch was more than 500 ml, intra-pouch pressure was kept low even when the pouch was inflated up to the maximum capacity, and reflux of urine into the upper urinary tract was not observed. As for complications, there was a slight degree of obstructive uropathy in 4 patients (20%), difficulty in catheter insertion was noted in 3 patients (15%), and stress incontinence-like urinary leakage was present in one patient when the capacity exceeded 500 ml. However, there were no complications which necessitated reoperation. In terms of blood chemistry, although there was a tendency towards a slight increase in BUN or hyperchloremia, no specific treatment was necessary as far as the kidney function was normal.(ABSTRACT TRUNCATED AT 250 WORDS)
- Pregnancy and delivery in patients with urinary diversion through the continent ileal reservoir. [Journal Article]
- SGSurg Gynecol Obstet 1991; 173(5):350-2
- The social and psychologic sequelae after external urinary diversion are known to be fewer in patients with urinary diversion through the continent ileal reservoir (Kock pouch) compared with those wi…
The social and psychologic sequelae after external urinary diversion are known to be fewer in patients with urinary diversion through the continent ileal reservoir (Kock pouch) compared with those with diversion through the incontinent ileal conduit. Therefore, in young female patients treated surgically with urinary diversion through the continent ileal reservoir, a number of pregnancies can be expected. We report herein the results of four pregnancies in three women with this type of reservoir. All deliveries were vaginal. One patient showed urinary obstruction at the end of the pregnancy and delivery was induced. This particular infant was treated with phototherapy because of hyperbilirubinemia; the other three infants were mature. No damage to renal function was noted and revisional surgical treatment of the reservoir was not necessary in any. Consequently, pregnancy is not contraindicated after urinary diversion through the continent ileal reservoir (Koch pouch).
- Kock pouch urinary diversion: follow-up by ultrasound. [Journal Article]
- BJBr J Radiol 1988; 61(729):811-6
- In the post-operative follow-up of 24 patients who received a continent Kock pouch for urinary diversion, several complications were encountered, including hydronephrosis, stone formation and valve d…
In the post-operative follow-up of 24 patients who received a continent Kock pouch for urinary diversion, several complications were encountered, including hydronephrosis, stone formation and valve dysfunction, resulting in reflux and/or urinary incontinence. After comparing findings on ultrasound with those obtained by Koch pouch cystography, intravenous urography, plain abdominal radiography, Kock pouch endoscopy and operation, we consider ultrasound to be an important technique in the follow-up, especially in non-symptomatic patients. All cases of hydronephrosis and pouch calculi were detected by ultrasound and no false positive findings were encountered in either group. A good correlation is demonstrated between nipple length, as measured by ultrasound, and valve dysfunction, clinically important only for the afferent nipple.