This journal is
indexed in Scopus
Year 2020 Vol. 28 No 2
GENERAL & SPECIAL SURGE
S.E. KATORKIN, A.A. CHERNOV, A.V. ZHURAVLEV, A.V. KOLSANOV, P.M. ZELTER
DIRECT AND REMOTE RESULTS OF SURGICAL TREATMENT OF RESISTANT FORMS OF ULCERATIVE COLITIS WITH FORMATION OF J-SHAPED SMALL INTESTINAL RESERVOIR
Samara State Medical University, Samara
The Russian Federation
Objective. To evaluate the functional results of coloproctectomy with the formation of a J-shaped small intestinal pelvic reservoir in patients with severe ulcerative colitis by using CT-reservoirography with 3D visualization and sphincterometry.
Methods. Surgical treatment was performed in 87 (31.6%) of 275 patients with severe ulcerative colitis. Coloproctectomy with a primary J-reservoir and ileo-anal anastomosis was performed in 16 (18.4%) patients. The final proctectomy with the formation of a delayed reservoir was performed in 8 (26.7%) of 29 patients 6±3.1 months after colectomy. Before restoration of the small itestine integrity, an endoscopic examination of the reservoir, X-ray contrast reservoirography, CT-reservoirography with the construction of the 3D model and sphincterometry were performed.
Results. In 24 patients, J-reservoirs from the ileum with ileo-anal anastomosis were formed, which made up 22.6% of all 106 operated on for ulcerative colitis. Postoperative complications were registered in 11 (68.8%) patients with primary and 3 (37.5%) patients with delayed reservoir formation. Complications of 3-4 severity according to P. Clavien and D. Dindo were observed in 5 (20.8%) patients. Restoration of the integrity of the small intestine was performed in 13 (81.3%) patients with primary and in 7 (87.5%) with a delayed reservoir. Long-term treatment results were monitored in 17 (85%) patients with a functioning reservoir in terms of 53±6.4 months. The frequency in the daytime of stools was 6±3 times, nighttime bowel movements – from 1 to 2 times. Deficiency of the anal sphincter of the 1st degree according to sphincterometry was detected in 2 (18.2%) patients. The incontinence on the S.D.Wexner scale was 2±1 points.
Conclusions. The three-stage scheme of reconstructive intervention in patients with ulcerative colitis has fewer postoperative complications. The use of CT-reservoirography with the construction of 3D model and sphincterometry allow timely diagnosing the postoperative complications and objectifying the result of surgical intervention.
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443013, Russian Federation,
Samara, pr. Karl Marks 165 b,
Samara State Medical University,
the chair and clinic of hospital surgery
tel. +7 927 206-71-02,
Sergey E. Katorkin
Katorkin Sergey E., PhD, AssociateProfessor, Head of the Chair and Clinic of Hospital Surgery, Samara State Medical University, Samara, Russian Federation.
Chernov Andrey A., Candidate of Medical Sciences (PhD), Surgeon of the Coloproctological Unit of the Hospital Surgery Clinic, Assistant of the Chair of Hospital Surgery, Samara State Medical University, Samara, Russian Federation.
Zhuravlev Andrey V., Candidate of Medical Sciences (PhD), Head of the Coloproctological Unit of the Hospital Surgery Clinic, Associate Professor of the Chair of Hospital Surgery, Samara State Medical University, Samara, Russian Federation.
Kolsanov Alexander V., MD, Professor, Head of the Chair of the Operative Surgery and Clinical Anatomy, Professor RAS, Rector Samara State Medical University, Samara, Russian Federation.
Zelter Pavel M., Candidate of Medical Sciences (PhD), Assistant of the Chair of Radiation Diagnostics and Radiation Therapy with a Course in Medical Informatics, Samara State Medical University, Samara, Russian Federation.