Résumé
Une technique de coloproctectomie évitant la confection d’une iléostomie définitive a été développée pour les patients atteints d’une rectocolite hémorragique ou d’une polypose adénomateuse familiale. Après l’exérèse de l’intégralité des organes malades, un réservoir utilisant l’iléon terminal est confectionné et descendu au travers du canal anal après mucosectomie, et une anastomose iléoanale est alors réalisée. Vingt et un patients (17 rectocolites hémorragiques et quatre polyposes) ont été traités, et 20 ont été suivis entre 2 et 34 mois (délai moyen 13,5 mois). La mortalité fut nulle, et neuf patients ont présenté une complication précoce. Tous les patients sont, actuellement, en bon état général sans retentissement sexuel ou urinaire. La continence diurne aux selles était parfaite, et un patient avait des épisodes d’incontinence la nuit. Le nombre moyen de selles était de 3,8 par 24 heures. Dix patients avaient des exonérations sans manoeuvres. Tous les patients avaient un régime alimentaire normal, et seulement deux prenaient un ralentisseur du transit. Cette intervention semble être une alternative à la coloproctectomie associée à une iléostomie définitive.
Abstract
A technique of proctocolectomy avoiding an ileostomy has been developed for patients with chronic ulcerative colitis or polyposis coli. After excision of all diseased tissue a reservoir of terminal ileum is constructed and brought up through the anal canal after performing a mucosectomy; an ileo-anal anastomosis is then carried out. Twenty one patients (17 chronic ulcerative colitis, 4 polyposis) were treated and 20 followed for between 2 to 34 months (average 13.5 months). There was no mortality but early complications occurred in 9 patients. All patients are currently well, with no disturbance of urinary or sexual function. Continence of faeces was perfect in all patients during the day, and 1 patient has episodic nocturnal incontinence. The average frequency of evacuation is 3.8 times in 24 hours. Ten patients void spontaneously. All patients tolerate a full diet and only 2 use peristalsis slowdown medication. This operation appears to be a satisfactory alternative to proctocolectomy with a permanent ileostomy.
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Lefevre, J.H. Coloproctectomie avec réservoir et anastomose iléo-anale. Colon Rectum 3, 107–110 (2009). https://doi.org/10.1007/s11725-009-0155-7
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DOI: https://doi.org/10.1007/s11725-009-0155-7
Mots clés
- Côlon
- Rectum
- Coloproctectomie
- Anastomose iléo-anale
- Rectocolite hémorragique
- Polypose adénomateuse familiale