Restorative proctocolectomy (total proctocolectomy and ileal J pouch anal anastomosis) has been accepted as the operation of choice in the setting of chronic ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess operative safety and functional outcome after restorative proctocolectomy. A total of sixteen patients underwent surgery between January 1996 and December 1999. Hand sewn anastomosis with diverting ileostomy was performed in 9 patients and double stapled anastomosis in 7 patients. The underlying disease was ulcerative colitis in 9 cases and familial adenomatous polyposis in 7. Postoperative complications developed in 8 cases (50%), and intestinal obstruction was found in 4 cases (2 cases were operated upon). Anastomosis related complications were stenosis (n=2), leak (n=1) and perianal abscess (n=1). All patients were followed up at the outpatient clinic using questionnaires, with a mean follow up period of 19.9 months. The frequency of bowel movement was 8.2 per day in hand sewn anastomosis (HS), and 12 per day in double stapled anastomosis (DS) 3 months after surgery (period 1). This frequency decreased to 5.5 per day in HS, and 4.6 per day in DS after one year (period 2). Day and night continence was shown in 12/15, and 5/15, respectively in period 1, but improved to 10/11, and 10/11, respectively in period 2. Night time incontinence was noted in 10 of 15 patients in period 1 (seepage 3/15, soiling 7/15). The need to take anti-diarrheal medication, and to use a pad was noted in 2/15, and 10/15, respectively in period 1, but no patient took antidiarrheal medication or wore a protective pad in period 2. Postoperative urinary function was satisfactory in 13/14 patients. Postoperative sexual function was analyzed in a total of 8 patients, who showed good erection (5/5), ejaculation (5/5) and satisfactory sexual life (5/5). In females, 3 patients showed a satisfactory sexual life. In conclusion, restorative proctocolectomy for chronic ulcerative colitis and familial adenomatous polyposis can be performed safely with excellent functional outcomes, including bowel movement, urinary and sexual functions one year after surgery.
Adenomatous Polyposis Coli/surgery ; Adult ; Colitis, Ulcerative/surgery ; Defecation ; Ejaculation ; Female ; Human ; Male ; Patient Satisfaction ; Penile Erection ; Proctocolectomy, Restorative*/adverse effects ; Safety ; Sex Behavior ; Treatment Outcome

During renal ischemia, ATP is degraded to hypoxanthine and xanthine oxidase is accumulated. When reperfusion develops, large amount of oxygen is supplied and superoxide radicals are generated. Free radical species were generated by a series of oxygen mediated reaction resulted in lipid peroxidation in the cellular membrane, which causes renal injury. Cyclosporin (CsA) is a potent immunosuppresant. however, one of the main adverse effects of CsA is nephrotoxicity. The mechanism of nephrotoxicity is still not fully understood. Only we proposed it as being responsible for the derangement of renal function, enhanced free radical species, vasoconstriction, ATP depletion, several vasoactive mediators. Based on the previously studied data with experimental animals, we studied a relationship between ischemia and reperfusion renal injury and cyclosporine with experimental rats. Four groups of Sprague-Dawley rats were studied: 1) a control group, only 60 minnites clamping and on day 3 is sacrified, 2) second control group, 60 minnites clamping and on day 5 is sacrified, 3) in the third and fourth group, after 60 minnites clamping, cyclosporine, 20 mg/kg/day was administrated intraperitoneally and were sacrified on day 3 and day 5, respectively. Antioxidant enzymes (SOD, Catalase), TBA-RS, GGT were measured by a specific biochemical method, and results were analyzed according to Wilcoxon rank sum test. p-value <0.05 was considered statistically significant. In cyclosporin administrated rats, GGT was elevated significantly on day 3 and day 5 (p=0.0367, p=0.0216), but SOD, Catalase, TBA-RS were not identified a significant change. In conclusion, on renal ischemia and reperfusion,cyclosporin induced renal injury is not related to free radical species, which suggests that other unknown mechanisms influence renal injury.
Adenosine Triphosphate ; Animals ; Catalase ; Constriction ; Cyclosporine* ; Free Radicals ; Hypoxanthine ; Ischemia ; Kidney ; Lipid Peroxidation ; Membranes ; Oxygen ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury* ; Reperfusion* ; Superoxides ; Vasoconstriction ; Xanthine Oxidase