Author
Ravi P. Kiran
Bio: Ravi P. Kiran is an academic researcher from Cleveland Clinic. The author has contributed to research in topics: Pouch & Colectomy. The author has an hindex of 48, co-authored 200 publications receiving 7698 citations.
Papers published on a yearly basis
Papers
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TL;DR: IPAA is an excellent option for patients with MUC, IC, FAP, and select patients with Crohn's disease and functional outcomes and QOL were good or excellent in 95% of patients and similar in each histopathological subgroup.
Abstract: Background:Ileal pouch anal anastomosis (IPAA) is the treatment of choice for chronic, medically refractory mucosal ulcerative colitis, indeterminate colitis, familial adenomatous polyposis (FAP), and a select group of patients with Crohn's disease.Aim:We report outcomes, complications, and quality
550 citations
TL;DR: Laroscopic colectomy results in significantly lower direct costs compared with open colectom for carefully matched patients, and this resulted inificantly lower total costs.
Abstract: ObjectiveComparison of outcome and costs after laparoscopic and open colectomy.Summary Background DataPrevious studies comparing laparoscopic and open colectomy report conflicting results with regard to clinical outcome and costs.MethodsLaparoscopic colectomy patients from a prospective database wer
250 citations
TL;DR: Infliximab use within 3 months before surgery is associated with increased postoperative sepsis, abscess, and readmissions in Crohn’s patients, and diverting stoma may protect against these complications.
236 citations
TL;DR: The LAP approach is independently associated with a reduced SSI when compared with open surgery and should, when feasible, be considered for colon and rectal conditions.
Abstract: Background The goal of this study was to compare surgical site infection (SSI) rates between laparoscopic (LAP) and open colorectal surgery using the National Surgical Quality Improvement Program (NSQIP) database. Study Design We identified patients included in the NSQIP database from 2006 to 2007 who underwent LAP and open colorectal surgery. SSI rates were compared for the 2 groups. Association between patient demographics, diagnosis, type of procedure, comorbidities, laboratory values, intraoperative factors, and SSI within 30 days of surgery, were determined using a logistic regression analysis. Results Among 10,979 patients undergoing colorectal surgery (LAP 31.1%, open 68.9%), the SSI rate was 14.0% (9.5% LAP vs 16.1% open, p 180 minutes, appendicitis or diverticulitis, and regional enteritis diseases were found to be significantly associated with high SSI; the LAP approach was associated with a reduced SSI rate. Conclusions The LAP approach is independently associated with a reduced SSI when compared with open surgery and should, when feasible, be considered for colon and rectal conditions.
201 citations
TL;DR: Risk for neoplasia in patients with UC and IPAA is small and not eliminated by colectomy or mucosectomy, and a preoperative diagnosis of dysplasia or cancer of colon or rectum is a risk factor for pouch dys plasia or adenocarcinoma.
180 citations
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TL;DR: Laroscopic colectomy was associated with earlier recovery of bowel function, need for fewer analgesics, and with a shorter hospital stay compared with open colectology.
Abstract: Laparoscopic surgery versus open surgery for colon cancer : short-term outcomes of a randomised trial.
2,113 citations
TL;DR: It has been proposed that only aggressive therapeutic approaches, based on treatment of early recurrent lesions in asymptomatic individuals, have a significant impact on progression of these chronic diseases.
1,809 citations
TL;DR: This paper is the second in a series of three publications relating to the European evidence-based consensus on the diagnosis and management of Crohn's disease and concerns the management of active disease, maintenance of medically induced remission and surgery.
Abstract: This paper is the second in a series of three publications relating to the European evidence-based consensus on the diagnosis and management of Crohn's disease and concerns the management of active disease, maintenance of medically induced remission and surgery. The aims and methods of the ECCO Consensus, as well as sections on diagnosis and classification are covered in the first paper [van Assche et al. JCC 2009a]. The final paper covers post-operative recurrence, fistulating disease, the management of paediatric and adolescent IBD, pregnancy, psychosomatics, extraintestinal manifestations and complementary or alternative therapy for Crohn's disease [Van Assche et al JCC 2009b]. #### Principal changes with respect to the 2006 ECCO guidelines
The early use of azathioprine/mercaptopurine or methotrexate in combination with steroids is an appropriate option in moderately active localised ileocaecal CD. Anti-TNF therapy should be considered as an alternative for patients with objective evidence of active disease who have previously been steroid-refractory, steroid-dependent, or steroid-intolerant (based on Statement 5B).
For those patients with severely active localised ileocaecal Crohn's disease and objective evidence of active disease who have relapsed, anti-TNF therapy with or without an immunomodulator is an appropriate option [EL1a, RG B for infliximab]. For some patients who have infrequently relapsing disease, restarting steroids with an immunomodulator may be appropriate (based on Statement 5C).
All currently available anti-TNF therapies appear to have generally similar efficacy and adverse-event profiles for inflammatory (‘luminal’) Crohn's disease, so the choice depends on availability, route of delivery, patient preference, cost and national guidelines \[EL5, RG D\] (Statement 5I).
Patients receiving azathioprine or mercaptopurine who relapse should be evaluated for adherence to therapy and have their dose optimised. Changing their maintenance therapy to methotrexate [EL1b RG B] or anti-TNF therapy [EL1a RGB] should be considered. Surgery should always be considered as an option in localised disease [EL4, …
1,477 citations
TL;DR: The most widely used index for severe UC remains that of Truelove and Witts3: any patient who has a bloody stool frequency ≥ 6/day and a tachycardia (> 90 bpm), or temperature > 37.8 °C, or anaemia (haemoglobin 30 mm/h) has severe ulcerative colitis (Table 1.3) as mentioned in this paper.
1,318 citations