Key factors influencing bowel function after ileal W-pouch anal anastomosis: a spectral analysis of W-pouch motor activity

The effects of stress during the mirror drawing test on electrogastrograms of subjects who underwent gastrointestinal surgery involving either total gastrectomy, distal gastrectomy, or total esophagectomy with colonic replacement

Electrogastrograms (EGGs) were recorded from 16 locations on the thoraco-abdominal surface to find the maximum absolute power foci during rest (RAP) and the maximum ratio of the % content during the mirror drawing test (MDT) compared to that during rest (%C-MDT/R) for both the 3 cpm (2.4–4.9) and 6 cpm (5.0–7.4) groups. The maximum foci were obtained from control subjects and those who received gastro-intestinal surgery via total gastrectomy (TG), distal gastrectomy (DG), and total esophagectomy with colonic replacement (CR). The control mean of the infraumbilical channels 10–16 (I) expressed as %C-MDT/R of the 3 cpm group was higher than the mean of the supraumbilical channels 1–9 (S) (I>S, P<0.001). The maximum focus of the 3-cpm %C-MDT/R was in the left umbilical area, while that of the 6-cpm %C-MDT/R was found bilaterally in the right epigastric and left umbilical areas, interposed by the lower %C-MDT/R gastric area. Therefore, the presence of gastric EGG inhibition and colonic facilitation are suggested to occur during MDT. In TG and DG, the foci of the %C-MDT/R in the 3-cpm group were located bilaterally in the right epigastric and left umbilical areas. The shifts of foci suggest colonic EGG facilitation. The mean S of the 3-cpm group was significantly higher than the mean I with CR (S>I, P<0.05). The maximum foci of the 3- and 6-cpm groups were in the epigastrium. These results suggest colonic EGG facilitation in the epigastrium, as the stomach has been removed and the original gastric location is instead occupied by the transverse colon in CR.

Small Bowel Obstruction After Ileal Pouch-Anal Anastomosis With a Loop Ileostomy in Patients With Ulcerative Colitis

Purpose

Small bowel obstruction (SBO) remains a common complication after pelvic or abdominal surgery. However, the risk factors for SBO in ulcerative colitis (UC) surgery are not well known. The aim of the present study was to clarify the risk factors associated with SBO after ileal pouch-anal anastomosis (IPAA) with a loop ileostomy for patients with UC.

Methods

The medical records of 96 patients who underwent IPAA for UC between 1999 and 2011 were reviewed. SBO was confirmed based on the presence of clinical symptoms and radiographic findings. The patients were divided into 2 groups: the SBO group and the non-SBO group. We also analyzed the relationship between SBO and computed tomography (CT) scan image parameters.

Results

The study included 49 male and 47 female patients. The median age was 35.5 years (range, 14–72 years). We performed a 2- or 3-stage procedure as a total proctocolectomy and IPAA for patients with UC. SBO in the pretakedown of the loop ileostomy after IPAA occurred in 22 patients (22.9%). Moreover, surgical intervention for SBO was required for 11 patients. In brief, closure of the loop ileostomy was performed earlier than expected. A multivariate logistic regression analysis revealed that the 2-stage procedure (odds ratio, 2.850; 95% confidence interval, 1.009–8.044; P = 0.048) was a significant independent risk factor associated with SBO. CT scan image parameters were not significant risk factors of SBO.

Conclusion

The present study suggests that a 2-stage procedure is a significant risk factor associated with SBO after IPAA in patients with UC.

Practical strategies for treating postsurgical bowel dysfunction

Postsurgical bowel dysfunction is a potential complication for patients undergoing ileoanal anastomosis, restorative proctocolectomy, and low anterior anastomosis. In our setting, these patients are referred to the Anorectal Physiology Clinic at the Townsville Hospital, Queensland, for comprehensive behavioral therapy. The goals of the therapy are as follows: improve stool consistency, improve control over stool elimination, decrease fecal frequency and rectal urgency, fecal continence without excessive restrictions on food and fluid intake, and increase quality of life. This article outlines our holistic approach and specific treatment strategies, including assessment, education, support and assistance with coping, individualized dietary and fluid modifications, medications, and exercise. Biofeedback is used to help patients improve anal sphincter and pelvic floor muscle function and bowel elimination habits. Information on the biofeedback component of the treatment program will be described in a subsequent article.