Gardner's syndrome is an autosomal dominant disease characterized by the presence of colonic polyposis,osteomas and a multitude of soft tissue tumors. The syndrome may present at any age from 2 mo to 70 years with...Gardner's syndrome is an autosomal dominant disease characterized by the presence of colonic polyposis,osteomas and a multitude of soft tissue tumors. The syndrome may present at any age from 2 mo to 70 years with a variety of symptoms, either colonic or extracolonic.We present a case of a 11-year-old female patient with Gardner's syndrome who presented with a lumbar area desmoid tumor and treated with resection of the desmoid,restorative proctocolectomy and ileal pouch anal anastomosis,A review of the current literature has been performed.展开更多
Background:In patients with inflammatory bowel disease(IBD)for whom medical therapy is unsuccessful or who develop colitis-as-sociated neoplasia,restorative proctocolectomy with ileal pouch-anal anastomosis(IPAA)is of...Background:In patients with inflammatory bowel disease(IBD)for whom medical therapy is unsuccessful or who develop colitis-as-sociated neoplasia,restorative proctocolectomy with ileal pouch-anal anastomosis(IPAA)is often indicated.One consideration for surgeons performing this procedure is whether to create this anastomosis using a stapled technique without mucosectomy or using a hand-sewn technique with mucosectomy.This study tested the association between IPAA anastomosis technique and cuffitis and/or pouchitis,assessed endoscopically.Methods:This was a retrospective cohort study.We included consecutive adult patients with IBD who had undergone IPAA and had received index pouchoscopies at Columbia University Irving Medical Center between 2020 and 2022.Patients were then followed up from this index pouchoscopy for≤12 months to a subsequent pouchoscopy.The primary exposure was mucosectomy vs non-mucosectomy and the primary outcome was cuffitis and/or pouchitis,defined as a Pouch Disease Activity Index endoscopy subscore of≥1.Results:There were 76 patients who met study criteria including 49(64%)who had undergone mucosectomy and 27(36%)who had not.Rates of cuffitis and/or pouchitis were 49%among those with mucosectomy vs 41%among those without mucosectomy(P=0.49).Time-to-event analysis affirmed these findings(log-rank P=0.77).Stricture formation was more likely among patients with mucosectomy compared with those without mucosectomy(45%vs 19%,P=0.02).Conclusions:There was no association between anastomosis technique and cuffitis and/or pouchitis among patients with IBD.These results may support the selection of stapled anastomosis over hand-sewn anastomosis with mucosectomy.展开更多
文摘Gardner's syndrome is an autosomal dominant disease characterized by the presence of colonic polyposis,osteomas and a multitude of soft tissue tumors. The syndrome may present at any age from 2 mo to 70 years with a variety of symptoms, either colonic or extracolonic.We present a case of a 11-year-old female patient with Gardner's syndrome who presented with a lumbar area desmoid tumor and treated with resection of the desmoid,restorative proctocolectomy and ileal pouch anal anastomosis,A review of the current literature has been performed.
文摘Background:In patients with inflammatory bowel disease(IBD)for whom medical therapy is unsuccessful or who develop colitis-as-sociated neoplasia,restorative proctocolectomy with ileal pouch-anal anastomosis(IPAA)is often indicated.One consideration for surgeons performing this procedure is whether to create this anastomosis using a stapled technique without mucosectomy or using a hand-sewn technique with mucosectomy.This study tested the association between IPAA anastomosis technique and cuffitis and/or pouchitis,assessed endoscopically.Methods:This was a retrospective cohort study.We included consecutive adult patients with IBD who had undergone IPAA and had received index pouchoscopies at Columbia University Irving Medical Center between 2020 and 2022.Patients were then followed up from this index pouchoscopy for≤12 months to a subsequent pouchoscopy.The primary exposure was mucosectomy vs non-mucosectomy and the primary outcome was cuffitis and/or pouchitis,defined as a Pouch Disease Activity Index endoscopy subscore of≥1.Results:There were 76 patients who met study criteria including 49(64%)who had undergone mucosectomy and 27(36%)who had not.Rates of cuffitis and/or pouchitis were 49%among those with mucosectomy vs 41%among those without mucosectomy(P=0.49).Time-to-event analysis affirmed these findings(log-rank P=0.77).Stricture formation was more likely among patients with mucosectomy compared with those without mucosectomy(45%vs 19%,P=0.02).Conclusions:There was no association between anastomosis technique and cuffitis and/or pouchitis among patients with IBD.These results may support the selection of stapled anastomosis over hand-sewn anastomosis with mucosectomy.
