Short- and long-term outcomes of ileal pouch-anal anastomosis for ulcerative colitis

Abstract

Ileal pouch-anal anastomosis was an important advancement in the treatment of ulcerative colitis. The aim of this study was to determine whether early complications of ileal pouch-anal anastomosis in patients with ulcerative colitis are associated with poor late functional results. PATIENTS AND METHODS:Eighty patients were operated on from 1986 to 2000, 62 patients with ileostomy and 18 without. The early and late complications were recorded. Specific emphasis has been placed on the incidence of pouchitis with prolonged follow-up. RESULTS:The ileostomy was closed an average of 9.2 months after the first operation. Fourteen patients were excluded from the long-term evaluation; 6 patients were lost to regular follow-up, 4 died, and 4 patients still have the ileostomy. Of the 4 patients that died, 1 died from surgical complications. Early complications after operation (41) occurred in 34 patients (42.5%). Late complications (29) occurred in 25 patients as follows: 16 had pouchitis, 3 associated with stenosis and 1 with sexual dysfunction; 5 had stenosis; and there was 1 case each of incisional hernia, ileoanal fistula, hepatic cancer, and endometriosis. Pouchitis occurred in 6 patients (9.8%) 1 year after ileal pouch-anal anastomosis, 9 (14.8%) after 3 years, 13 (21.3%) after 5 years, and 16 (26.2%) after more than 6 years. The mean daily stool frequency was 12 before and 5.8 after operation. One pouch was removed because of fistulas that appeared 2 years later.CONCLUSIONS: Ileal pouch-anal anastomosis is associated with a considerable number of early complications. There was no correlation between pouchitis and severe disease, operation with or without ileostomy, or early postoperative complications. The incidence of pouchitis was directly proportional to duration of time of follow-up.

Histopathological evaluation and risk factors related to the development of pouchitis in patients with ileal pouches for ulcerative colitis

“…This disorder can also be accompanied by extra-intestinal manifestations of UC. Acute or chronic forms can be observed, although the acute forms are more common (29). Additionally, recurrent episodes are reported at variable rates, ranging from 24.6 (7) to 66% (12).…”

Advances in the diagnosis and management of inflammatory bowel disease: Challenges and uncertainties

“…Early complications include pouch–anal anastomotic leak, bowel obstruction, and wound infections. [256] Late complications occur in 36% of cases, which include pouchitis, bowel obstruction, pouch-associated fistula, intra-abdominal infections, infertility, stricture formation at the pouch–anal anastomosis, and cuffitis. [256257258259] Pouchitis is the most common late complication after IPAA, and its incidence varies between 16 and 48%.…”

“…[256] Late complications occur in 36% of cases, which include pouchitis, bowel obstruction, pouch-associated fistula, intra-abdominal infections, infertility, stricture formation at the pouch–anal anastomosis, and cuffitis. [256257258259] Pouchitis is the most common late complication after IPAA, and its incidence varies between 16 and 48%. Laparoscopic IPAA can be performed safely with better short-term outcomes, including shorter time to regular diet, less narcotic use, and shorter length of stay, with comparable complication rates to the open approach.…”

Role of Biological Mesh in Surgical Treatment of Paracolostomy Hernias

“…Parastomal and ventral hernias are not infrequent complications after bowel surgery. [10][11][12] The incidence of paraileostomy hernia has been reported to range between 0.8 and 28 percent. 13 Paracolostomy hernias have been reported to develop in 5 to 58 percent of patients.…”