Aspects in the Interdisciplinary Decision-Making for Surgical Intervention in Ulcerative Colitis and its Complications

Abstract

Ulcerative colitis (UC) is a chronic inflammation of the large bowel, predominantly affecting young adults of 20 to 30 years of age. Even though the majority of patients with limited and extensive UC can be managed medically, 20 to 30 % will require surgical intervention at some point in their life to gain control of the inflammatory process. The most common reason for urgent and emergency surgery is a lack of response to maximal medical inpatient therapy after five to ten days. Other indications include hemorrhage, free perforation, sepsis, and toxic megacolon. Procedure of choice for the majority of surgeons is open or laparoscopic subtotal colectomy and end ileostomy, with or without exteriorization of the rectal stump. The laparoscopic approach requires more time, but allows for faster return of bowel function and discharge from the hospital. Creation of a definite restoration in form of a J pouch should be delayed for at least three months. Indications for elective surgical intervention include cancer, dysplasia associated lesion or mass, and stricture. Preferably, the J pouch and Brooke ileostomy are performed in two stages, with a takedown of the ileostomy several months later. A single-stage operation is associated with increased anastomotic dehiscence, sepsis, and long-term pouch failure. The laparoscopic creation of a J pouch is largely dependent on the surgeon’s experience, but results in a number of advantages, including faster return of bowel function, tolerance of diet, and discharge. Regardless of emergency, urgent, or elective surgical intervention, early involvement of a team of gastroenterologist, surgeon, nutritionist, and stoma nurse is essential in the management of severe UC to maximize a satisfactory patient outcome.

Zusammenfassung

Die Colitis ulcerosa ist eine chronische Inflammation des Kolons vorwiegend jüngerer Erwachsener zwischen dem 20. und 30. Lebensjahr. Die Mehrheit der Patienten mit eher begrenzter als auch ausgedehnter Colitis ulcerosa kann medikamentös geführt und beherrscht werden, 20 − 30 % erfordern jedoch eine Operation in ihrem Leben, um den Entzündungsprozess nicht außer Kontrolle geraten zu lassen. Der häufigste Grund einer dringlichen oder Notfalloperation ist das ausbleibende Anschlagen einer initiierten, stationär geführten medikamentösen Behandlung betroffener Patienten von 5 − 10 Tagen. Andere Indikationen beinhalten Hämorrhagie, die freie Perforation, Sepsis und das toxische Megakolon. Die Methode der Wahl ist mehrheitlich die offene oder laparoskopische (sub-)totale Kolektomie und die endständige Ileostomie einschließlich als auch ohne Rektumstumpfexstirpation. Das laparoskopische Vorgehen ist zeitaufwendiger, gewährleistet jedoch in der Regel eine frühere Normalisierung der Darmfunktion als auch eine zügigere Rekonvaleszenz und damit verbundene kürzere Krankenhausverweildauer. Eine definitive Restauration in Form eines meist verwendeten J-Pouches (falls möglich) sollte um wenigstens 3 Monate aufgeschoben werden. Indikationen für eine elektive Operation beinhalten Malignität, Dysplasie und Striktur. Bevorzugt kommen J-Pouch und Brooke-Ileostomie zur Anwendung in 2 Sitzungen mit einer Ileostomarückverlagerung einige Wochen später, meist nach ca. 3 Monaten. Ein einzeitiges Vorgehen ist mit einer erhöhten Rate von Anastomoseninsuffizienzen, Sepsis und Pouch-Dysfunktion im Langzeitverlauf assoziiert. Die laparoskopische Anlage eines J-Pouches ist nicht unerheblich von der Erfahrung des Operateurs abhängig, weist jedoch eine Reihe von Vorteilen auf: zügigere Normalisierung der Darmfunktion, Wiederaufnahme der Kost und Entlassung. Unabhängig vom dringlichen, Notfall- oder Elektivvorgehen hinsichtlich der Operationsplanung im Management der schweren Colitis ulcerosa ist die kompetente interdisziplinäre Absprache eines Teams von Gastroenterologe, Chirurg, Ernährungsmediziner und Stomaschwester essenziell für die Gewährleistung einer maximalen Patientenzufriedenheit.

Key words

ulcerative colitis - operation - laparoscopic surgery - (sub)total colectomy - pouch - ileostomy

Schlüsselwörter

Colitis ulcerosa - Operation - laparoskopische Chirurgie - (sub-)totale Kolektomie - Pouch - Ileostoma

• References

• 1 Loftus Jr EV, Sandborn WJ. Epidemiology of inflammatory bowel disease. Gastroenterol Clin North Am 2002; 31: 1-20
• 2 Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 2004; 99: 1371-1385
• 3 Cho JH, Brant SR. Recent insights into the genetics of inflammatory bowel disease. Gastroenterology 2011; 140: 1704-1712
• 4 Boyko EJ, Koepsell TD, Perera DR et al. Risk of ulcerative colitis among former and current cigarette smokers. N Engl J Med 1987; 316: 707-710
• 5 Zijlstra FJ, Srivastava ED, Rhodes M et al. Effect of nicotine on rectal mucus and mucosal eicosanoids. Gut 1994; 35: 247-251
• 6 Cope GF, Heatley RV. Cigarette smoking and intestinal defences. Gut 1992; 33: 721-723
• 7 Srivastava ED, Russell MA, Feyerabend C et al. Effect of ulcerative colitis and smoking on rectal blood flow. Gut 1990; 31: 1021-1024
• 8 Evans JM, McMahon AD, Murray FE et al. Non-steroidal anti-inflammatory drugs are associated with emergency admission to hospital for colitis due to inflammatory bowel disease. Gut 1997; 40: 619-622
• 9 Takeuchi K, Smale S, Premchand P et al. Prevalence and mechanism of nonsteroidal anti-inflammatory drug-induced clinical relapse in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol 2006; 4: 196-202
• 10 Sandborn WJ, Stenson WF, Brynskov J et al. Safety of celecoxib in patients with ulcerative colitis in remission: a randomized, placebo-controlled, pilot study. Clin Gastroenterol Hepatol 2006; 4: 203-211
• 11 Truelove SC, Witts LJ. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J 1955; 2: 1041-1048
• 12 Carbonnel F, Lavergne A, Lemann M et al. Colonoscopy of acute colitis. A safe and reliable tool for assessment of severity. Dig Dis Sci 1994; 39: 1550-1557
• 13 Bossuyt P, Verhaegen J, Van Assche G et al. Increasing incidence of Clostridium difficile-associated diarrhea in inflammatory bowel disease. J Crohns Colitis 2009; 3: 4-7
• 14 Domenech E, Vega R, Ojanguren I et al. Cytomegalovirus infection in ulcerative colitis: a prospective, comparative study on prevalence and diagnostic strategy. Inflamm Bowel Dis 2008; 14: 1373-1379
• 15 Edwards FC, Truelove SC. The course and prognosis of ulcerative colitis. Gut 1963; 4: 299-315
• 16 Watts JM, De Dombal FT, Watkinson G et al. Early course of ulcerative colitis. Gut 1966; 7: 16-31
• 17 Kuriyama M, Kato J, Fujimoto T et al. Risk factors and indications for colectomy in ulcerative colitis patients are different according to patient’s clinical background. Dis Colon Rectum 2006; 49: 1307-1315
• 18 Sands BE, Tremaine WJ, Sandborn WJ et al. Infliximab in the treatment of severe, steroid-refractory ulcerative colitis: a pilot study. Inflamm Bowel Dis 2001; 7: 83-88
• 19 Lichtiger S, Present DH, Kornbluth A et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 1994; 330: 1841-1845
• 20 Meyers S, Lerer PK, Feuer EJ et al. Predicting the outcome of corticoid therapy for acute ulcerative colitis. Results of a prospective, randomized, double-blind clinical trial. J Clin Gastroenterol 1987; 9: 50-54
• 21 Bernal I, Manosa M, Domenech E et al. Predictors of clinical response to systemic steroids in active ulcerative colitis. Dig Dis Sci 2006; 51: 1434-1438
• 22 Jarnerot G, Rolny P, Sandberg-Gertzen H. Intensive intravenous treatment of ulcerative colitis. Gastroenterology 1985; 89: 1005-1013
• 23 Turner D, Walsh CM, Steinhart AH et al. Response to corticosteroids in severe ulcerative colitis: a systematic review of the literature and a meta-regression. Clin Gastroenterol Hepatol 2007; 5: 103-110
• 24 Travis SP, Farrant JM, Ricketts C et al. Predicting outcome in severe ulcerative colitis. Gut 1996; 38: 905-910
• 25 Jalan KN, Sircus W, Card WI et al. An experience of ulcerative colitis. I. Toxic dilation in 55 cases. Gastroenterology 1969; 57: 68-82
• 26 Buckell NA, Williams GT, Bartram CI et al. Depth of ulceration in acute colitis: correlation with outcome and clinical and radiologic features. Gastroenterology 1980; 79: 19-25
• 27 Mogan GR, Sachar DB, Bauer J et al. Toxic megacolon in ulcerative colitis complicated by pneumomediastinum: report of two cases. Gastroenterology 1980; 79: 559-562
• 28 Fry RD, Shemesh EI, Kodner IJ et al. Perforation of the rectum and sigmoid colon during barium-enema examination. Management and prevention. Dis Colon Rectum 1989; 32: 759-764
• 29 Ng SS, Yiu RY, Lee JF et al. Portal venous gas and thrombosis in a Chinese patient with fulminant Crohn’s colitis: a case report with literature review. World J Gastroenterol 2006; 12: 5582-5586
• 30 Truelove SC, Willoughby CP, Lee EG et al. Further experience in the treatment of severe attacks of ulcerative colitis. Lancet 1978; 2: 1086-1088
• 31 Cohen JL, Strong SA, Hyman NH et al. Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon Rectum 2005; 48: 1997-2009
• 32 Greenstein AJ, Sachar DB, Gibas A et al. Outcome of toxic dilatation in ulcerative and Crohn’s colitis. J Clin Gastroenterol 1985; 7: 137-143
• 33 Grieco MB, Bordan DL, Geiss AC et al. Toxic megacolon complicating Crohn’s colitis. Ann Surg 1980; 191: 75-80
• 34 Norland CC, Kirsner JB. Toxic dilatation of colon (toxic megacolon): etiology, treatment and prognosis in 42 patients. Medicine 1969; 48: 229-250
• 35 Fazio VW. Toxic megacolon in ulcerative colitis and Crohn’s colitis. Clin Gastroenterol 1980; 9: 389-407
• 36 Heppell J, Farkouh E, Dube S et al. Toxic megacolon. An analysis of 70 cases. Dis Colon Rectum 1986; 29: 789-792
• 37 Teeuwen PH, Stommel MW, Bremers AJ et al. Colectomy in patients with acute colitis: a systematic review. J Gastrointest Surg 2009; 13: 676-686
• 38 Ferrante M, D’Hoore A, Vermeire S et al. Corticosteroids but not infliximab increase short-term postoperative infectious complications in patients with ulcerative colitis. Inflamm Bowel Dis 2009; 15: 1062-1070
• 39 Dinnewitzer AJ, Wexner SD, Baig MK et al. Timing of restorative proctectomy following subtotal colectomy in patients with inflammatory bowel disease. Colorectal Dis 2006; 8: 278-282
• 40 Hyman NH, Cataldo P, Osler T. Urgent subtotal colectomy for severe inflammatory bowel disease. Dis Colon Rectum 2005; 48: 70-73
• 41 Marcello PW, Milsom JW, Wong SK et al. Laparoscopic total colectomy for acute colitis: a case-control study. Dis Colon Rectum 2001; 44: 1441-1445
• 42 Bell RL, Seymour NE. Laparoscopic treatment of fulminant ulcerative colitis. Surg Endosc 2002; 16: 1778-1782
• 43 Chung TP, Fleshman JW, Birnbaum EH et al. Laparoscopic vs. open total abdominal colectomy for severe colitis: impact on recovery and subsequent completion restorative proctectomy. Dis Colon Rectum 2009; 52: 4-10
• 44 Carter FM, McLeod RS, Cohen Z. Subtotal colectomy for ulcerative colitis: complications related to the rectal remnant. Dis Colon Rectum 1991; 34: 1005-1009
• 45 Keighley MR, Winslet MC, Flinn R et al. Multivariate analysis of factors influencing the results of restorative proctocolectomy. Br J Surg 1989; 76: 740-744
• 46 Wibmer AG, Kroesen AJ, Grone J et al. Predictors of permanent ileostomy after restorative proctocolectomy. Br J Surg 1900;
• 47 Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut 2001; 48: 526-535
• 48 Jayaram H, Satsangi J, Chapman RW. Increased colorectal neoplasia in chronic ulcerative colitis complicated by primary sclerosing cholangitis: fact or fiction?. Gut 2001; 48: 430-434
• 49 Hata K, Watanabe T, Kazama S et al. Earlier surveillance colonoscopy programme improves survival in patients with ulcerative colitis associated colorectal cancer: results of a 23-year surveillance programme in the Japanese population. Br J Cancer 2003; 89: 1232-1236
• 50 Reiser JR, Waye JD, Janowitz HD et al. Adenocarcinoma in strictures of ulcerative colitis without antecedent dysplasia by colonoscopy. Am J Gastroenterol 1994; 89: 119-122
• 51 Blackstone MO, Riddell RH, Rogers BH et al. Dysplasia-associated lesion or mass (DALM) detected by colonoscopy in long-standing ulcerative colitis: an indication for colectomy. Gastroenterology 1981; 80: 366-374
• 52 Gorfine SR, Bauer JJ, Harris MT et al. Dysplasia complicating chronic ulcerative colitis: is immediate colectomy warranted?. Dis Colon Rectum 2000; 43: 1575-1581
• 53 Bernstein CN, Shanahan F, Weinstein WM. Are we telling patients the truth about surveillance colonoscopy in ulcerative colitis?. Lancet 1994; 343: 71-74
• 54 McGuire BB, Brannigan AE, O’Connell PR. Ileal pouch-anal anastomosis. Br J Surg 2007; 94: 812-823
• 55 Hahnloser D, Pemberton JH, Wolff BG et al. The effect of ageing on function and quality of life in ileal pouch patients: a single cohort experience of 409 patients with chronic ulcerative colitis. Ann Surg 2004; 240: 615-621 ; discussion 621-623
• 56 McIntyre PB, Pemberton JH, Wolff BG et al. Comparing functional results one year and ten years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Dis Colon Rectum 1994; 37: 303-307
• 57 Martin A, Dinca M, Leone L et al. Quality of life after proctocolectomy and ileo-anal anastomosis for severe ulcerative colitis. Am J Gastroenterol 1998; 93: 166-169
• 58 Tiainen J, Matikainen M. Health-related quality of life after ileal J-pouch-anal anastomosis for ulcerative colitis: long-term results. Scand J Gastroenterol 1999; 34: 601-605
• 59 Carmon E, Keidar A, Ravid A et al. The correlation between quality of life and functional outcome in ulcerative colitis patients after proctocolectomy ileal pouch anal anastomosis. Colorectal Dis 2003; 5: 228-232
• 60 Scarpa M, Angriman I, Ruffolo C et al. Health-related quality of life after restorative proctocolectomy for ulcerative colitis: long-term results. World J Surg 2004; 28: 124-129
• 61 Tan HT, Connolly AB, Morton D et al. Results of restorative proctocolectomy in the elderly. Int J Colorectal Dis 1997; 12: 319-322
• 62 Takao Y, Gilliland R, Nogueras JJ et al. Is age relevant to functional outcome after restorative proctocolectomy for ulcerative colitis? Prospective assessment of 122 cases. Ann Surg 1998; 227: 187-194
• 63 Delaney CP, Fazio VW, Remzi FH et al. Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch-anal anastomosis. Ann Surg 2003; 238: 221-228
• 64 Longo WE, Virgo KS, Bahadursingh AN et al. Patterns of disease and surgical treatment among United States veterans more than 50 years of age with ulcerative colitis. Am J Surg 2003; 186: 514-518
• 65 Choen S, Tsunoda A, Nicholls RJ. Prospective randomized trial comparing anal function after hand sewn ileoanal anastomosis with mucosectomy versus stapled ileoanal anastomosis without mucosectomy in restorative proctocolectomy. Br J Surg 1991; 78: 430-434
• 66 Luukkonen P, Jarvinen H. Stapled vs hand-sutured ileoanal anastomosis in restorative proctocolectomy. A prospective, randomized study. Arch Surg 1993; 128: 437-440
• 67 Reilly WT, Pemberton JH, Wolff BG et al. Randomized prospective trial comparing ileal pouch-anal anastomosis performed by excising the anal mucosa to ileal pouch-anal anastomosis performed by preserving the anal mucosa. Ann Surg 1997; 225: 666-676 ; discussion 676-677
• 68 Galandiuk S, Wolff BG, Dozois RR et al. Ileal pouch-anal anastomosis without ileostomy. Dis Colon Rectum 1991; 34: 870-873
• 69 Jarvinen HJ, Luukkonen P. Comparison of restorative proctocolectomy with and without covering ileostomy in ulcerative colitis. Br J Surg 1991; 78: 199-201
• 70 Cohen Z, McLeod RS, Stephen W et al. Continuing evolution of the pelvic pouch procedure. Ann Surg 1992; 216: 506-511 ; discussion 511-512
• 71 Grobler SP, Hosie KB, Keighley MR. Randomized trial of loop ileostomy in restorative proctocolectomy. Br J Surg 1992; 79: 903-906
• 72 Sugerman HJ, Newsome HH. Stapled ileoanal anastomosis without a temporary ileostomy. Am J Surg 1994; 167: 58-65 ; discussion 65-66
• 73 Gorfine SR, Gelernt IM, Bauer JJ et al. Restorative proctocolectomy without diverting ileostomy. Dis Colon Rectum 1995; 38: 188-194
• 74 Heuschen UA, Allemeyer EH, Hinz U et al. Outcome after septic complications in J pouch procedures. Br J Surg 2002; 89: 194-200
• 75 Mowschenson PM, Critchlow JF, Peppercorn MA. Ileoanal pouch operation: long-term outcome with or without diverting ileostomy. Arch Surg 2000; 135: 463-465 ; discussion 465-466
• 76 Gullberg K, Liljeqvist L. Stapled ileoanal pouches without loop ileostomy: a prospective study in 86 patients. Int J Colorectal Dis 2001; 16: 221-227
• 77 MacLean AR, Cohen Z, MacRae HM et al. Risk of small bowel obstruction after the ileal pouch-anal anastomosis. Ann Surg 2002; 235: 200-206
• 78 Gunnarsson U, Karlbom U, Docker M et al. Proctocolectomy and pelvic pouch – is a diverting stoma dangerous for the patient?. Colorectal Dis 2004; 6: 23-27
• 79 Wexner SD, Cera SM. Laparoscopic surgery for ulcerative colitis. Surg Clin North Am 2005; 85: 35-47, viii
• 80 Berdah SV, Mardion RB, Grimaud JC et al. Mid-term functional outcome of laparoscopic restorative proctocolectomy: a prospective study of 40 consecutive cases. J Laparoendosc Adv Surg Tech A 2009; 19: 485-488
• 81 Benavente-Chenhalls L, Mathis KL, Dozois EJ et al. Laparoscopic ileal pouch-anal anastomosis in patients with chronic ulcerative colitis and primary sclerosing cholangitis: a case-matched study. Dis Colon Rectum 2008; 51: 549-553
• 82 Pinto RA, Canedo J, Murad-Regadas S et al. Ileal pouch-anal anastomosis in elderly patients: is there a difference in morbidity compared with younger patients?. Colorectal Dis 2011; 13: 177-183
• 83 Marcello PW, Milsom JW, Wong SK et al. Laparoscopic restorative proctocolectomy: case-matched comparative study with open restorative proctocolectomy. Dis Colon Rectum 2000; 43: 604-608
• 84 Telem DA, Vine AJ, Swain G et al. Laparoscopic subtotal colectomy for medically refractory ulcerative colitis: the time has come. Surg Endosc 2010; 24: 1616-1620
• 85 Fichera A, Silvestri MT, Hurst RD et al. Laparoscopic restorative proctocolectomy with ileal pouch anal anastomosis: a comparative observational study on long-term functional results. J Gastrointest Surg 2009; 13: 526-532
• 86 Indar AA, Efron JE, Young-Fadok TM. Laparoscopic ileal pouch-anal anastomosis reduces abdominal and pelvic adhesions. Surg Endosc 2009; 23: 174-177
• 87 Fazio VW, Ziv Y, Church JM et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 1995; 222: 120-127
• 88 Meagher AP, Farouk R, Dozois RR et al. J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients. Br J Surg 1998; 85: 800-803
• 89 Bach SP, Mortensen NJ. Ileal pouch surgery for ulcerative colitis. World J Gastroenterol 2007; 13: 3288-3300
• 90 Shen B, Lashner BA, Bennett AE et al. Treatment of rectal cuff inflammation (cuffitis) in patients with ulcerative colitis following restorative proctocolectomy and ileal pouch-anal anastomosis. Am J Gastroenterol 2004; 99: 1527-1531
• 91 Lavery IC, Sirimarco MT, Ziv Y et al. Anal canal inflammation after ileal pouch-anal anastomosis. The need for treatment. Dis Colon Rectum 1995; 38: 803-806
• 92 Sequens R. Cancer in the anal canal (transitional zone) after restorative proctocolectomy with stapled ileal pouch-anal anastomosis. Int J Colorectal Dis 1997; 12: 254-255
• 93 Rotholtz NA, Pikarsky AJ, Singh JJ et al. Adenocarcinoma arising from along the rectal stump after double-stapled ileorectal J-pouch in a patient with ulcerative colitis: the need to perform a distal anastomosis. Report of a case. Dis Colon Rectum 2001; 44: 1214-1217
• 94 Baratsis S, Hadjidimitriou F, Christodoulou M et al. Adenocarcinoma in the anal canal after ileal pouch-anal anastomosis for ulcerative colitis using a double stapling technique: report of a case. Dis Colon Rectum 2002; 45: 687-691 ; discussion 691-692
• 95 O’Riordain MG, Fazio VW, Lavery IC et al. Incidence and natural history of dysplasia of the anal transitional zone after ileal pouch-anal anastomosis: results of a five-year to ten-year follow-up. Dis Colon Rectum 2000; 43: 1660-1665
• 96 Bullard KM, Madoff RD, Gemlo BT. Is ileoanal pouch function stable with time? Results of a prospective audit. Dis Colon Rectum 2002; 45: 299-304
• 97 Lohmuller JL, Pemberton JH, Dozois RR et al. Pouchitis and extraintestinal manifestations of inflammatory bowel disease after ileal pouch-anal anastomosis. Ann Surg 1990; 211: 622-627 ; discussion 627-629
• 98 Penna C, Dozois R, Tremaine W et al. Pouchitis after ileal pouch-anal anastomosis for ulcerative colitis occurs with increased frequency in patients with associated primary sclerosing cholangitis. Gut 1996; 38: 234-239
• 99 Nasmyth DG, Johnston D, Godwin PG et al. Factors influencing bowel function after ileal pouch-anal anastomosis. Br J Surg 1986; 73: 469-473
• 100 Coffey JC, Rowan F, Burke J et al. Pathogenesis of and unifying hypothesis for idiopathic pouchitis. Am J Gastroenterol 2009; 104: 1013-1023
• 101 Fleshner PR, Vasiliauskas EA, Kam LY et al. High level perinuclear antineutrophil cytoplasmic antibody (pANCA) in ulcerative colitis patients before colectomy predicts the development of chronic pouchitis after ileal pouch-anal anastomosis. Gut 2001; 49: 671-677
• 102 Stelzner M, Fonkalsrud EW. The endorectal ileal pullthrough procedure in patients with ulcerative colitis and familial polyposis with carcinoma. Surg Gynecol Obstet 1989; 169: 187-194
• 103 Wiltz O, Hashmi HF, Schoetz Jr DJ et al. Carcinoma and the ileal pouch-anal anastomosis. Dis Colon Rectum 1991; 34: 805-809
• 104 Pironi L, Miglioli M, Ruggeri E et al. Nutritional status of patients undergoing ileal pouch-anal anastomosis. Clin Nutr 1991; 10: 292-297
• 105 Buckman SA, Heise CP. Nutrition considerations surrounding restorative proctocolectomy. Nutr Clin Pract 2010; 25: 250-256
• 106 Jayaprakash A, Creed T, Stewart L et al. Should we monitor vitamin B12 levels in patients who have had end-ileostomy for inflammatory bowel disease?. Int J Colorectal Dis 2004; 19: 316-318
• 107 El Muhtaseb MS, Duncan A, Talwar DK et al. Assessment of dietary intake and trace element status in patients with ileal pouch-anal anastomosis. Dis Colon Rectum 2007; 50: 1553-1557
• 108 Bain IM, Mostafa AB, Harding LK et al. Bile acid absorption from ileoanal pouches using enema scintigraphy. Br J Surg 1995; 82: 614-617
• 109 Johnson P, Richard C, Ravid A et al. Female infertility after ileal pouch-anal anastomosis for ulcerative colitis. Dis Colon Rectum 2004; 47: 1119-1126
• 110 Gorgun E, Remzi FH, Goldberg JM et al. Fertility is reduced after restorative proctocolectomy with ileal pouch anal anastomosis: a study of 300 patients. Surgery 2004; 136: 795-803
• 111 Ording Olsen K, Juul S, Berndtsson I et al. Ulcerative colitis: female fecundity before diagnosis, during disease, and after surgery compared with a population sample. Gastroenterology 2002; 122: 15-19
• 112 Fazio VW, Tekkis PP, Remzi F et al. Quantification of risk for pouch failure after ileal pouch anal anastomosis surgery. Ann Surg 2003; 238: 605-614 ; discussion 614-617
• 113 McLeod RS, Baxter NN. Quality of life of patients with inflammatory bowel disease after surgery. World J Surg 1998; 22: 375-381
• 114 Jimmo B, Hyman NH. Is ileal pouch-anal anastomosis really the procedure of choice for patients with ulcerative colitis?. Dis Colon Rectum 1998; 41: 41-45
• 115 Carlstedt A, Fasth S, Hulten L et al. Long-term ileostomy complications in patients with ulcerative colitis and Crohn’s disease. Int J Colorectal Dis 1987; 2: 22-25