Gastroenterology & Hepatology

Biography

Biography: Gassan Joseph Ghanime

Abstract

INTRODUCTION AND OBJECTIVES: Familial adenomatous polyposis (FAP) is an inherited disease transmitted as an autosomal dominant genetic defect in the long arm of chromosome 5 (5q 21), and manifests with multiple adenomatous polyps in the large intestine ( over 100). carcinomatous degeneration is inevitable and natural evolution of the disease. The first case was published in 1881 by Sklifasouski. The incidence is 1 in 10000.El conventional surgical treatment of ulcerative colitis refractory to medical treatment and familial adenomatous polyposis was the total proctocolectomy and definitive ileostomy according Brooke. Los rectal sparing procedures, required reoperation to remove the rectum remnant, and finally making ileostomy terminal. Restorative Proctocolectomy, introduced by Park in 1978, represented a breakthrough for the treatment of these patients, mostly young people, because, apart from making a complete ablation of the disease, ileostomy is avoided, providing a better quality of life for patients.MATERIAL AND METHODS: In the period from January 1986 and February 2014, 124 cases were operated, 104 of ulcerative colitis (UC), and 20 cases of familial adenomatous polyposis (FAP), Restorative Proctocolectomy with “J” ileal Pouch anal-anastomosis .RESULTS: In ulcerative colitis the 104 cases, 54 were conducted in two stages, and 50 in three stages. Of the 20 patients with familial adenomatous polyposis, 17 in two stages, and 3 cases in one stage. In all cases we performed J Ileal Pouch of 15 to 20 cm long, in all but 6 cases with mechanical sutures and manual suture in only  6 cases. : Postoperative complications occurred in 30 cases, include: fistula at pouch-anal anastomosis: tow cases, pelvic sepsis: two cases, intestinal subocclusion: 8 cases.Haemorrages of pouch that required reoperation: two cases, fistula at ileostomy closure two cases, severe pouchitis (requiring hospitalization): 3 cases, moderate pouchitis: seven cases, maissive pulmonary postoperative embolism in one case.Mortality: nul. Functional outcomes: defecation / 24 hr.: Media 4.8, normal continence: 1108 daytime, night 98, ability to defer defecation> 30 min. 106 cases. Satisfactory sexual-social life 101. Elimination of the pouch: one case. Exclusion pouch: one case.CONCLUSIONS: Restorative Proctocolectomy remains the best method for surgical treatment of familial adenomatous polyposis and ulcerative colitis. Most postoperative complications were mild or moderate in nature, being the experience of the surgeon factor of great importance in this regard. Surgical mortality in our series was nul. Functional results are satisfactory, with a good quality of life . We recommend lateral temporal ileostomy (two or three stages times operation), in cases of severe ulcerative colitis, and in patients who have received high-dose corticosteroids and / or Ciclosporina. The incidence of pouchitis in our series is not very high, and usually controlled with medical treatment.