Aim

The purpose of the study was to determine the risk of postoperative complications and the functional outcome after a hand-sewn ileal pouch–anal anastomosis (IPAA) for ulcerative colitis using a single J-shaped pouch design.



Methods

Preoperative function, operative morbidity and long-term functional outcome were assessed prospectively in 1310 patients who underwent IPAA between 1981 and 1994 for ulcerative colitis.



Results

Three patients died after operation. Postoperative pelvic sepsis rates decreased from 7 per cent in 1981–1985 to 3 per cent in 1991–1994 (P=0·02). After mean follow-up of 6·5 (range 2–15) years, the mean number of stools was 5 per day and 1 per night. Frequent daytime and night-time incontinence occurred in 7 and 12 per cent of patients respectively, and did not change over a 10-year period. The cumulative probability of suffering at least one episode of ‘clinical’ pouchitis was 18 and 48 per cent at 1 and 10 years and the cumulative probability of pouch failure at 1 and 10 years was 2 and 9 per cent respectively.



Conclusion

These results indicate that increased experience decreases the risk of pouch-related complications and that with time the functional results remain stable, but the failure rate increases. © 1998 British Journal of Surgery Society Ltd

J ileal pouch–anal anastomosis for chronic ulcerative colitis: complications and long‐term outcome in 1310 patients

BACKGROUND AND AIMS
No gold standard exists for nutritional screening/assessment. This cross-sectional study aimed to collect/use a comprehensive set of clinical, anthropometric, functional data, explore interrelations, and derive a feasible/sensitive/specific method to assess nutritional risk and status in hospital practice.


PATIENTS AND METHODS
100 surgical patients were evaluated, 49M:51F, 55 +/- 18.9 (18-88) years. Nutritional risk assessment: Kondrup's Nutritional Risk Assessment, BAPEN's Malnutrition Screening Tool, Nutrition Screening Initiative, Admission Nutritional Screening Tool. Nutritional status: anthropometry categorised by Body Mass Index and McWhirter & Pennington criteria, recent weight loss > 10%, dynamometry, Subjective Global Assessment.


RESULTS
There was a strong agreement between all nutritional risk (k = 0.69-0.89, p < 0.05) and between all nutritional assessment methods (k = 0.51-0.88, p < or = 0.05) except for dynamometry. Weight loss > 10% was the only method that agreed with all tools (k = 0.86-0.94, p < or = 0.05), and was thereafter used as the standard. Kondrup's Nutritional Risk Assessment and Admission Nutritional Screening Tool were unspecific but highly sensitive (> or = 95%). Subjective Global Assessment was highly sensitive (100%) and specific (69%), and was the only method with a significant Youden value (0.7).


CONCLUSIONS
Kondrup's Nutritional Risk Assessment and Admission Nutritional Screening Tool emerged as sensitive screening methods; the former is simpler to use, Kondrup's Nutritional Risk Assessment has been devised to direct nutritional intervention. Recent unintentional weight loss > 10% is a simple method whereas Subjective Global Assessment identified high-risk/undernourished patients.

Nutritional risk and status assessment in surgical patients: a challenge amidst plenty.

Objective Severe obesity (ie, at least 100% overweight or body mass index > or =40 kg/m2) is associated with significant morbidity and increased mortality. It is apparently becoming more common in this country. Conventional weight-loss treatments are usually ineffective for severe obesity and bariatric surgery is recommended as a treatment option. However, longitudinal data on the long-term outcome of bariatric surgery are sparse. Available data indicate that the outcome of bariatric surgery, although usually favorable in the short term, is variable and weight regain sometimes occurs at 2 years after surgery. The objective of this study is to present a review of the outcome of bariatric surgery in three areas: weight loss and improvement in health status, changes in eating behavior, and psychosocial adjustment. The study will also review how eating behavior, energy metabolism, and psychosocial functioning may affect the outcome of bariatric surgery. Suggestions for additional research in these areas are made. Method Literature review. Results On average, most patients lose 60% of excess weight after gastric bypass and 40% after vertical banded gastroplasty. In about 30% of patients, weight regain occurs at 18 months to 2 years after surgery. Binge eating behavior, which is common among the morbidly obese, may recur after surgery and is associated with weight regain. Energy metabolism may affect the outcome of bariatric surgery, but it has not been systematically studied in this population. Presurgery psychosocial functioning does not seem to affect the outcome of surgery, and psychosocial outcome is generally encouraging over the short term, but there are reports of poor adjustment after weight loss, including alcohol abuse and suicide. Conclusions Factors leading to poor outcome of bariatric surgery, such as binge eating and lowered energy metabolism, should be studied to improve patient selection and outcome. Long-term outcome data on psychosocial functioning are lacking. Longitudinal studies to examine the long-term outcome of bariatric surgery and the prognostic indicators are needed.

Nonsurgical factors that influence the outcome of bariatric surgery: a review.

https://www.endo.theclinics.com/article/S0889-8529(05)70367-4/pdf

Surgery for obesity

ISBI Practice Guidelines for Burn Care

Between August 1982 and November 1985, 100 patients underwent ileal "J" pouch-anal anastomosis (IPAA) at the University of Utah All operations were performed in a standard fashion by a single surgeon Seventy-eight patients were operated on for chronic ulcerative colitis and 22 for familial polyposis coli Sixty of the patients were male and 40 were female with a mean age of 332 years and a range of 11-63 years Mean +/- SEM operating time was 59 +/- 04 hours, blood loss was 666 +/- 49 ml, and total hospitalization was 101 +/- 03 days No operative deaths occurred The overall operative morbidity was 13% after IPAA Clinical "pouchitis" was observed in 18 patients, all of whom were operated on for chronic ulcerative colitis No patients had frank incontinence Twenty per cent of patients experienced frequent nocturnal leakage in the early postoperative period with a significant improvement over the ensuing 6 months Stool frequency at 1, 3, 6, 12, and 24 months was 75 +/- 02, 65 +/- 01, 62 +/- 03, 54 +/- 01, and 54 +/- 02, respectively Stool frequency at 12 months correlated inversely with ileal pouch capacity and the diagnosis of familial polyposis It is concluded that ileal pouch-anal anastomosis is a safe and effective operation for patients with chronic ulcerative colitis and familial polyposis coli

Ileal Pouch-Anal Anastomosis: A Single Surgeon's Experience with 100 Consecutive Cases

Changes in body composition and dietary intake after gastric partitioning for morbid obesity.

Management of the temporary loop ileostomy following colectomy, mucosal proctectomy, and ideal pouch-anal anastomosis.

At least nine different equations have been published for calculating metabolic expenditure by indirect calorimetry. This study examined the differences between equations when they are used for the nutritional assessment in an intensive care unit (ICU). Oxygen consumption and carbon dioxide production were measured in 36 ICU patients and used to calculate metabolic expenditure with the nine equations. The equations produced differences in metabolic expenditure which averaged from 0.8-96 kcal/day. The largest difference produced by any two of the nine equations was 189 kcal/day. Although differences in original stoichiometric data have resulted in numerous different equations for the calculation of metabolic expenditure, these differences are not clinically important. It makes little difference which equation is used for nutritional assessment in an ICU.

Calculation of Metabolic Expenditure and Substrate Utilization from Gas Exchange Measurements

The use of indirect calorimetry in assessing and monitoring nutritional support in burn patients is reported. Twenty-nine patients with a mean burn size of 35% TBSA were monitored with 228 measurements of resting energy expenditure (REE), calculations of respiratory quotient (RQ), and substrate metabolism. Daily weights, nitrogen balance determinations, and routine laboratory tests were also obtained. Oxygen consumption (VO2) was 186 +/- 39 ml/min/M2, corresponding to REE of 2,506 +/- 543 kcal/day. REE varied during the course of wound healing, demonstrating a biphasic course. Metabolic rate was also significantly increased with the performance of routine procedures such as dressings and surgery. Measurements of REE were a mean 76% of predictions based on the Curreri formula, and 1.47 times basal energy expenditure (BEE) calculated by the Harris-Benedict equation. Neither formula provided for the great variations observed in daily, and individual, measurements of REE. During the study, patients consumed 2,900 +/- 811 kcal/day, which exceeded REE by 1.14. This was associated with mean weight loss of 3.2% (range, -16 to 9%). RQ was less than 0.85 in 9% of determinations, but exceeded 1.0 24% of the time. Protein accounted for 17 +/- 3% of total metabolism, corresponding to a calorie:nitrogen ratio of 128:1. Practically, however, provision of this much protein proved difficult. Routine use of indirect calorimetry permits tailoring of nutritional support for burn patients, and is valuable in the early detection of significant under- or overnutrition.

Use of indirect calorimetry in the nutritional management of burned patients.

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