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  • Electronic Resource  (2)
  • Aldosterone  (1)
  • Anastomose  (1)
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  • Electronic Resource  (2)
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  • 1
    Electronic Resource
    Electronic Resource
    Effects of restorative proctocolectomy on renal and adrenal function (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 1318-1324 
    Details
    ISSN: 1530-0358
    Keywords: Proctocolectomy ; Ileostomy ; Ulcerative colitis ; Familial adenomatous polyposis ; Aldosterone ; Renal function ; Acid-base balance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Restorative proctocolectomy is a standard procedure in the surgical treatment of ulcerative colitis and familial adenomatous polyposis. The radical removal of the colorectum with construction of an ileostomy often results in high stoma losses. These may lead to changes in the electrolyte and acid-base balance and to alterations in renal and suprarenal gland function. METHODS: In this study 33 patients who received an ileoanal pouch before and after proctocolectomy were investigated at different time intervals for electrolyte changes, alteration of the acid-base balance, kidney function, and hormonal changes of the suprarenal glands. Measurements were performed before proctocolectomy, ten days after proctocolectomy with ileal pouch-anal anastomosis under protective loop ileostomy, before ileostomy closure, and 6 to 12 months after ileostomy closure. Neither acute renal failure nor other vital complications were observed. RESULTS: Statistical analysis showed a significant decrease of urine pH to 5.4±0.22 (before ileostomy closure) and metabolic acidosis (pH 7.32±0.04; base excess −1.3±5.6 (before ileostomy closure)). Likewise, we found a decrease in renal clearance to 86 ml/minute (before ileostomy closure) without signs of tubular damage. The most important change during the phase with ileostomy was a functional secondary hyperaldosteronism with aldosterone levels of 63.2±70.8 ng/dl (before ileostomy closure). In comparison with preoperative levels, there was a ten-fold increase in mineralocorticoid adrenal activity. Additionally, during the period with protective ileostomy, the hepatic synthesis of aldosterone-18-glucuronide was only slightly increased, and the cortisol/cortisone ratio was extremely decreased. CONCLUSIONS: These results show that restorative proctocolectomy with ileal pouch-anal anastomosis and protective loop ileostomy significantly influences fluid, electrolyte, and acid-base balance. Functional secondary hyperaldosteronism is of central importance for subsequent renal recompensation. Approximately one-half year after ileostomy closure, the endogenous hormones with mineralocorticoid effects returned to normal levels.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02234222
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  • 2
    Electronic Resource
    Electronic Resource
    Restaurative Proktektomie Vergleich direkter coloanaler und colonpouchanaler Anastomosen zur Kontinuitätswiederherstellung (1997)
    Springer
    Der Chirurg 68 (1997), S. 630-632 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Restorative proctectomy ; Coloanal anastomosis ; Pouch-anal anastomosis. ; Schlüsselwörter: Proktektomie ; restaurative ; Anastomose ; coloanale ; Anastomose ; colonpouchanale.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Von 63 Patienten, welche eine tiefe anteriore Rectumresektion erhielten, wurden 39 mit einer direkten coloanalen Anastomose (CAA), 24 unter Zwischenschaltung eine Colon-J-Pouches als colonpouchanale Anastomose (CPA) rekonstruiert. Lokalseptische Komplikationen traten in 20,5 % aller Patienten nach CAA gegenüber 12,5 % nach CPA auf, die Stuhlfrequenz war nach zusätzlicher Pouchanlage 3,3 pro 24 h verglichen mit 5,2 pro 24 Std nach direkter coloanaler Anastomose (p = 0,053). Die postoperative Kontinenz war in der Pouchgruppe tendentiell besser (n. s.), die Analmanometrie zeigte lediglich einen signifikanten postoperativen Abfall des Ruhedruckes nach direkter coloanaler Anastomose. Die Ergebnisse sprechen für die Anlage eines primären Colonpouches, da die lokalseptische Komplikationsrate nach colonpouchanaler Anastomose niedriger und das funktionelle Ergebnis tendentiell günstiger ist.
    Notes: Summary. Thirty-nine of 63 patients undergoing deep anterior rectal resection received a straight coloanal anastomosis (CAA); the remaining 24 patients additionally had a colon-j-pouch (CPA) constructed. After pouch-anal anastomosis, local septic complications occurred in 12.5 % of patients compared to 20.5 % after coloanal anastomosis. Stool frequency after pouch-anal anastomosis was 3.3 per 24 h compared to 5.2 per 24 h after straight anastomosis within the first year after ileostomy closure (P = 0.053). Continence was slightly better in the pouch group (n. s.), and anal manometry showed a significant postoperative decrease only in resting pressure after straight coloanal anastomosis (P 〈 0.001). This study supports the construction of a colon-j-pouch after deep rectal resection, as the pouch-anal anastomosis has fewer local septic complications and seems to improve functional outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050243
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
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