A review of early small bowel obstructions in staged IPAA procedures.

Background: Small bowel obstructions (SBOs) are a common complication following staged IPAA. Our goal was to compare early post-operative SBO outcomes between different staged ileal pouch-anal anastomosis (IPAA) and to further analyze the type of procedures required in patients who needed operative management of SBO.

Methods: In this retrospective cohort study, we selected all patients who presented to our tertiary care center between 2008 and 2017, with ulcerative colitis or IBD-Unspecified colitis and who underwent a primary total proctocolectomy with IPAA for medically refractory disease or dysplasia (n = 623).

Emergent Subtotal Colectomies Have Higher Leak Rates in Subsequent J-Pouch Stages.

Purpose: The most common surgery for ulcerative colitis (UC) is the staged restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). On occasion, an emergent first-stage subtotal colectomy must be performed. The purpose of this study was to compare rates of postoperative complications in three-stage IPAA patients who underwent emergent vs non-emergent first-stage subtotal colectomies in the subsequent staged procedures.

Management of Anastomotic Leaks in Ileal Pouch Anal Anastomosis for Ulcerative Colitis.

Anastomotic leaks remain a dreaded complication after ileal pouch anal anastomosis (IPAA). Their impacts can be devastating, ranging from an acute leak leading to postoperative sepsis to chronic leaks and sinus tracts resulting in long-term pouch dysfunction and subsequent pouch failure. The management of acute leaks is intricate.

Ulcerative colitis is characterized by a plasmablast-skewed humoral response associated with disease activity.

B cells, which are critical for intestinal homeostasis, remain understudied in ulcerative colitis (UC). In this study, we recruited three cohorts of patients with UC (primary cohort, n = 145; validation cohort 1, n = 664; and validation cohort 2, n = 143) to comprehensively define the landscape of B cells during UC-associated intestinal inflammation. Using single-cell RNA sequencing, single-cell IgH gene sequencing and protein-level validation, we mapped the compositional, transcriptional and clonotypic landscape of mucosal and circulating B cells.

The association between pre-colectomy thiopurine use and risk of neoplasia after ileal pouch anal anastomosis in patients with ulcerative colitis or indeterminate colitis: a propensity score analysis.

Background: The risk of neoplasia of the pouch or residual rectum in patients with ulcerative colitis (UC) who undergo total proctocolectomy (TPC) with ileal pouch anal anastomosis (IPAA) is incompletely investigated. Thiopurine use is associated with a reduced risk of colorectal neoplasia in patients with UC. We tested the hypothesis that thiopurine use prior to TPC may be associated with a reduced risk of primary neoplasia after IPAA.

Slow and Steady Wins the Race: A Solid Case for a 3-Stage Approach in Ulcerative Colitis.

Background: Approximately 10% to 20% of patients with ulcerative colitis require surgery during their disease course, of which the most common is the staged restorative proctocolectomy with IPAA.

Objective: The aim was to compare the rates of anastomotic leaks among all staged restorative proctocolectomy with IPAA procedures.

Design: This was a retrospective cohort study.

A case report of foreign body appendicitis caused by tongue piercing ingestion.

Introduction: Foreign body ingestion is an uncommon clinical problem in healthy adults. Furthermore, it is even less common for an ingested foreign body to cause any obstructive symptoms within the gastrointestinal tract.

Presentation Of Case: Here, we describe an unusual case of acute appendicitis induced by a tongue piercing that was ingested by a 32-year-old woman with a recent history of endotracheal intubation.

The role of laparoscopic surgery in repeat ileocolic resection for Crohn's disease.

Aim: Laparoscopic surgery is the preferred approach for primary uncomplicated ileocolic resection (ICR); however, its role for repeat resections is unclear. This study assessed the outcomes of primary and repeated ICRs for Crohn's disease to examine rates of laparoscopy and patient morbidity.

Methods: A retrospective review of a prospectively maintained database was conducted at a tertiary centre between 2013 and 2019.

Luminal Narrowing Alone Allows an Accurate Diagnosis of Crohn's Disease Small Bowel Strictures at Cross-Sectional Imaging.

Background And Aims: Current consensus recommendations define small bowel strictures [SBS] in Crohn's disease [CD] on imaging as luminal narrowing with unequivocal upstream bowel dilation. The aim of this study was to [1] evaluate the performance of cross-sectional imaging for SBS diagnosis in CD using luminal narrowing with upstream SB dilation and luminal narrowing with or without upstream dilation, and [2] compare the diagnostic performance of computed tomography [CT] and magnetic resonance enterography [MRE] for SBS diagnosis.

Methods: In total, 111 CD patients [81 with pathologically confirmed SBS, 30 controls] who underwent CT and/or MRE were assessed.

Ileostomy reversal after subtotal colectomy in Crohn's disease: a single institutional experience at a high-volume center.

Purpose: Our aim was to evaluate factors leading to ostomy reversal among a group of 44 patients with Crohn's disease (CD) who underwent subtotal colectomy (STC) between June 2011 and September 2018.

Methods: Our study design was a retrospective chart review. Patients with CD who underwent STC were included.

Recycling of Precolectomy Anti-Tumor Necrosis Factor Agents in Chronic Pouch Inflammation Is Associated With Treatment Failure.

Despite improvements in medical management, 10%-15% of patients with ulcerative colitis (UC) require total proctocolectomy (TPC) with ileal pouch anal anastomosis (IPAA) for refractory disease. Acute pouchitis is the most common post-IPAA inflammatory condition, with cumulative incidence of 45% at 5 years. Up to 20%-30% of patients develop chronic pouch inflammation (CPI), categorized as antibiotic responsive, antibiotic refractory, or Crohn's disease-like (CDL).

Analysis of Outcomes by Extraction Site following Subtotal Colectomy in Ulcerative Colitis: A Retrospective Cohort Study.

Background: Ulcerative colitis frequently requires surgery as a definitive management strategy. The colonic specimen can be extracted from various sites including a midline incision, the stoma site, or a Pfannenstiel incision. It is unclear if one extraction site offers improved outcomes and fewer complications.

Surgical Techniques and Differences in Postoperative Outcomes for Patients With Crohn's Disease With Ileosigmoid Fistulas: A Single-Institution Experience, 2010-2016.

Background: Surgical treatment of ileosigmoid fistulas in Crohn's disease is poorly characterized.

Objective: The purpose of this study was to identify differences in patient postoperative outcomes for isolated ileosigmoid fistulas by surgical approach (laparoscopic versus open) and sigmoid colon repair type (sigmoid resection versus primary repair).

Design: Using a prospectively collected database, we gathered perioperative data from chart reviews to calculate differences and associations between treatment groups.

Single-Cell Analysis of Crohn's Disease Lesions Identifies a Pathogenic Cellular Module Associated with Resistance to Anti-TNF Therapy.

Clinical benefits of cytokine blockade in ileal Crohn's disease (iCD) are limited to a subset of patients. Here, we applied single-cell technologies to iCD lesions to address whether cellular heterogeneity contributes to treatment resistance. We found that a subset of patients expressed a unique cellular module in inflamed tissues that consisted of IgG plasma cells, inflammatory mononuclear phagocytes, activated T cells, and stromal cells, which we named the GIMATS module.

Impact of Intravenous Acetaminophen on Perioperative Opioid Utilization and Outcomes in Open Colectomies: A Claims Database Analysis.

Background: The value of intravenous acetaminophen in postoperative pain management remains debated. The authors tested the hypothesis that intravenous acetaminophen use, in isolation and in comparison to oral, would be associated with decreased opioid utilization (clinically significant reduction defined as 25%) and opioid-related adverse effects in open colectomy patients.

Methods: Using national claims data from open colectomy patients (Premier Healthcare Database, Premier Healthcare Solutions, Inc.

Managing acute cholecystitis among Medicaid insured in New York State: opportunities to optimize care.

Background: Identifying sources of unnecessary cost within Medicaid will help focus cost containment efforts. This study sought to identify differences in surgical management and associated costs of cholecystitis between Medicaid and privately insured in New York State.

Methods: The New York State all-payer mandatory discharge database from 2003 to 2013, had 297,635 patients with Medicaid (75,512) and privately (222,123) insurance who underwent cholecystectomy for cholecystitis.

Outcome of incisional hernia repair in patients with Inflammatory Bowel Disease.

Background: Incisional Hernia (IH) repair in patients with Inflammatory Bowel Disease (IBD) has not been well studied.

Methods: Outcomes of 170 patients with IBD who underwent IH repair were included in the study.

Results: The incidence of recurrence after IH repair in IBD is 27%.

Can laparoscopic surgery prevent incisional hernia in patients with Crohn's disease: a comparison study of 750 patients undergoing open and laparoscopic bowel resection.

Background: Incisional hernia (IH) is a frequent occurrence following open surgery for Crohn's disease (CD). This study compares the IH rates of patients with CD undergoing open versus laparoscopic bowel resection.

Methods: Seven hundred and fifty patients with CD operated by the authors at the Mount Sinai Medical Center, New York, USA, were reviewed from a prospectively maintained surgical database.

Controversies in J Pouch Surgery for Ulcerative Colitis: A Focus on Handsewn Versus Stapled Anastomosis.

The accepted current standard for treatment of medically refractory ulcerative colitis is total proctocolectomy with an ileal pouch-anal anastomosis for restoration of continence. There are 2 techniques by which the anastomosis can be performed, including handsewn and stapled. Handsewn anastomosis with mucosectomy was the first method described; however, it has been associated with significant incontinence.

A review of the impact of biologics on surgical complications in Crohn's disease.

Anti-tumor necrosis factor therapy has revolutionized the treatment of Crohn's disease. Despite the increased use in the past decade and a half, a majority of patients with Crohn's disease with ultimately require operative management of their disease. No clear consensus has been made in the literature regarding the surgical outcomes in patients who have been exposed to anti-tumor necrosis factor therapy.

Oversewing staple lines to prevent anastomotic complications in primary ileocolic resections for Crohn's disease.

Background: Oversewing staple lines may be a novel way to reduce anastomotic complications after primary ileocolic resections for Crohn's disease (CD).

Study Design: This is a single-institution, non-concurrent cohort study of CD patients undergoing primary ileocolic resections (ICR) with stapled anastomoses from 2007 to 2013. Demographic and clinical characteristics were collected.

Ileal j pouch complications and surgical solutions: a review.

Ileal pouch-anal anastomosis is currently accepted as the standard method to restore continence after total proctocolectomy for medically refractory ulcerative colitis and familial adenomatous polyposis. Ileal pouches offer improved quality of life and high patient satisfaction; however, there are many pouch-related complications due to the original disease process and change in anatomy. This is a review article of the common and some rare surgical complications after J pouches, which can be subdivided into the septic and nonseptic categories.