Colectomy with ileorectal anastomosis preserves female fertility in ulcerative colitis
Restorative proctocolectomy with ileoanal anastomosis (IPAA) is the surgical standard for patients with ulcerative colitis (UC). Significant reduction in female fertility and fecundity after IPAA has been shown in recent studies. In selected cases, colectomy with ileorectal anastomosis (IRA) is another surgical option. The aim of this study was to evaluate fertility in women with UC who underwent IRA. This study included all women with UC who underwent IRA between 1962 and 1999 and who were 40 years old or younger at the time of surgery, and older than 18 years of age at the time of the interview. Data were collected using a structured telephone interview concerning reproductive behavior and waiting times to pregnancy. Among 40 eligible patients, 37 whose mean age at IRA was 28 years (range 11-39) answered the questionnaire. Twenty-two were unmarried, not wishful of pregnancy and/or already had children. Among 15 females wishing children after IRA, 10 (66%) became pregnant: one had therapeutic abortion, two had a miscarriage, four had 1 child, two had 2 children and one had 4 children. Five patients were sterile after IRA. These preliminary results suggest that IRA for UC preserves female fertility. If confirmed in other series this information should be provided to young women with UC before deciding surgical option.
- [Show abstract] [Hide abstract] ABSTRACT: A report of the records of 20 patients with chronic ulcerative colitis in which ileorectal anastomosis was performed during the past 24 years has been presented. There were two deaths. Problems associated with this type of surgery are presented. In the final analysis, the decision to perform an ileorectal anastomosis will depend upon the patients’ desires and the attitude of the physician. Should an ileorectal anastomosis fail and complicated disease persist, it is still possible to perform a rectal excision and permanent ileostomy.0Comments 10Citations
- [Show abstract] [Hide abstract] ABSTRACT: Ulcerative colitis (UC) is a diffuse inflammatory disease of the mucosal lining of the colon and rectum that manifests clinically as diarrhea, abdominal pain, fever, weight loss, and rectal bleeding. Since removal of the affected organ is curative, surgery has assumed a pivotal position in the management of these patients. Although removal of the entire colon and rectum with a permanent ileostomy had been the standard operation for decades, increased experience with anal sphincter preservation has demonstrated the feasibility of performing surgical procedures which spare sphincter function while still removing all disease. This chapter considers the surgical alternatives, decision making, and techniques surrounding these procedures.0Comments 1Citation
- [Show abstract] [Hide abstract] ABSTRACT: In the design of application specific integrated circuits (ASIC), it is often required to partition a logic complex into smaller subcomplexes satisfying a number of constraints. Due to the complexity of the problem, most existing algorithms try to optimize on only one constraint. In this paper, we use the concept of evolution to derive a partitioning algorithm capable of handling a number of constraints. Our algorithm provides a uniform multi-way partitioning scheme, obtains good partitions, and has a fast execution time.0Comments 32Citations