Salvage surgery effective treatment alternative for J-pouch afferent limb stricture

Written By : Dr. Shravani Dali |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-09-19T20:00:28+05:30 | Updated On 20 Sept 2023 11:46 AM IST

Salvage surgery effective treatment alternative for J-pouch afferent limb stricture suggests a new study published in the Surgery.

Restorative proctocolectomy with ileal pouch–anal anastomosis is the surgical treatment of choice for patients requiring surgery for inflammatory bowel disease. A stricture located at the inlet of the afferent limb can lead to small bowel obstruction in a limited number of patients with a pelvic pouch. This paper aims to examine our experience with afferent limb stricture surgical correction when other endoscopic treatment methods have failed to control obstructive symptoms.

All consecutive eligible patients with ileal pouch–anal anastomosis and afferent limb stricture were identified from our institutional review board–approved database from 1990 to 2021. Patients surgically treated with excision and reimplantation/strictureplasty of afferent limb stricture were included in this study.

Results

Twenty patients met our inclusion criteria. Fifteen (75%) were female, and the overall mean age was 41 ± 10.3 years at afferent limb stricture surgery. The interval from ileal pouch–anal anastomosis formation to surgery for afferent limb stricture was 13.5 ± 6.7 years. Nine (45%) underwent strictureplasty, and 11 (55%) had resection and reimplantation of the afferent limb into the pouch. Before afferent limb stricture surgery, 3 (15%) required a diverting ileostomy for their obstructive symptoms. An additional 12 (60%) had a stoma constructed during afferent limb stricture surgery, and 5 had a strictureplasty and no stoma. Postoperatively, 1 patient (5%) had a leak at the afferent limb stricture repair site. All patients had their ileostomy closed 3.2 (2.99–3.6) months after surgery. Long-term after afferent limb stricture surgery, recurrent small bowel obstruction symptoms recurred in 7 (35%) patients 3.9 (2.6–5.8) years later.

Afferent limb stricture can be treated effectively with salvage surgery. The surgical intervention appears durable and provides an acceptable outcome for their obstructive symptoms.

Reference:

Ana M. Otero-Piñeiro, Crina Floruta, Marianna Maspero, Jeremy M. Lipman, Stefan D. Holubar, Scott R. Steele, Tracy L. Hull, Salvage surgery is an effective alternative for J-pouch afferent limb stricture treatment, Surgery, Volume 174, Issue 4, 2023, Pages 753-757, ISSN 0039-6060,. https://doi.org/10.1016/j.surg.2023.03.006.

(https://www.sciencedirect.com/science/article/pii/S0039606023001289)

Keywords:

Salvage, surgery, effective, treatment, alternative, J-pouch, afferent, limb, stricture, surgery, Ana M. Otero-Piñeiro, Crina Floruta, Marianna Maspero, Jeremy M. Lipman, Stefan D. Holubar, Scott R. Steele, Tracy L. Hull

Salvage surgeryeffectivetreatmentalternativeJ-pouchafferentlimb strictureSurgery

Source : Surgery

Dr. Shravani Dali

Dr. Shravani Dali has completed her BDS from Pravara institute of medical sciences, loni. Following which she extensively worked in the healthcare sector for 2+ years. She has been actively involved in writing blogs in field of health and wellness. Currently she is pursuing her Masters of public health-health administration from Tata institute of social sciences. She can be contacted at editorial@medicaldialogues.in.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751