Ileal pouch-anal anastomosis: Points of controversy

Trigui, A.; Frikha, F.; Rejab, H.; Ameur, Hazem Ben; Triki, H.; Amar, Mohamed Ben

doi:10.1016/j.jviscsurg.2014.05.004

Cited by 13 publications

(8 citation statements)

References 48 publications

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“…In one meta-analysis of over 9000 patients undergoing IPAA, the indications for surgery were: UC (87.5%); indeterminate colitis (IC) (2%); Crohn’s disease (0.8%); FAP (8.9%); and other diagnoses (0.7%)[23]. For all indications, though, the aim of RPC/IPAA remains the same: To definitively cure disease and prevent malignant degeneration, while providing adequate continence and avoiding a permanent stoma[24].…”

Section: Indicationsmentioning

confidence: 99%

“…In the absence of these mutations, and in patients with: (1) No rectal cancer or advanced rectal neoplasia ( e.g ., large or high-grade tubulovillous adenoma); (2) Low polyp burden in the rectum (< 20 adenomas); and (3) No colon cancer or profuse colonic polyposis, a rectal sparing colectomy/IRA should be considered as a reasonable alternative[63]. Importantly, however, for rectal sparing surgery to be recommended, a rigorous rectal surveillance program must be adhered to, and if such a program seems impossible, an IPAA should be recommended, irrespective of the polyp burden or genetic profile of the syndrome[24].…”

Section: Indicationsmentioning

confidence: 99%

“…The higher rate in the IC group was largely attributed to the diagnostic conversion of 15% to Crohn’s disease, with sub-analysis indicating that patients with true IC have a similar failure rate to those with UC. It would therefore appear that patients with IC are suitable candidates for pouch surgery[24], but should receive appropriate counselling of the surgical risks and the implications of subsequent conversion to Crohn’s disease.…”

Section: Contraindications To the Ileoanal Pouch Proceduresmentioning

confidence: 99%

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Ileal-anal pouches: A review of its history, indications, and complications

Ng¹,

Gonsalves²,

Sagar³

2019

WJG

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The ileal pouch anal anastomosis (IPAA) has revolutionised the surgical management of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). Despite refinement in surgical technique(s) and patient selection, IPAA can be associated with significant morbidity. As the IPAA celebrated its 40 th anniversary in 2018, this review provides a timely outline of its history, indications, and complications. IPAA has undergone significant modification since 1978. For both UC and FAP, IPAA surgery aims to definitively cure disease and prevent malignant degeneration, while providing adequate continence and avoiding a permanent stoma. The majority of patients experience long-term success, but “early” and “late” complications are recognised. Pelvic sepsis is a common early complication with far-reaching consequences of long-term pouch dysfunction, but prompt intervention (either radiological or surgical) reduces the risk of pouch failure. Even in the absence of sepsis, pouch dysfunction is a long-term complication that may have a myriad of causes. Pouchitis is a common cause that remains incompletely understood and difficult to manage at times. 10% of patients succumb to the diagnosis of pouch failure, which is traditionally associated with the need for pouch excision. This review provides a timely outline of the history, indications, and complications associated with IPAA. Patient selection remains key, and contraindications exist for this surgery. A structured management plan is vital to the successful management of complications following pouch surgery.

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Section: Indicationsmentioning

confidence: 99%

Section: Indicationsmentioning

confidence: 99%

Section: Contraindications To the Ileoanal Pouch Proceduresmentioning

confidence: 99%

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Ileal-anal pouches: A review of its history, indications, and complications

Ng¹,

Gonsalves²,

Sagar³

2019

WJG

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“…108 Ileopouch-anal anastomosis [IPAA] is most commonly performed in UC. Regarding the anastomosis technique: double stapled, hand-sewn, or transanal [109][110][111][112] is reported, as are the type, size, and number of cartridges used. An ileorectal anastomosis [IRA] may also be used, depending on the associated risk-benefit compared with the IPAA.…”

Section: Surgical Indication and Strategymentioning

confidence: 99%

ECCO Topical Review Optimising Reporting in Surgery, Endoscopy, and Histopathology

Adamina

Feakins

Iacucci

et al. 2021

Journal of Crohn's and Colitis

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Background and Aims Diagnosis and management of inflammatory bowel diseases (IBD) requires a lifelong multidisciplinary approach. The quality of medical reporting is essential in this context. The present topical review addresses the need for optimised reporting in endoscopy, surgery, and histopathology. Methods A consensus expert panel consisting of gastroenterologists, surgeons, and pathologists convened by the European Crohn’s and Colitis Organisation performed a systematic literature review. Following topics were covered: In endoscopy: (i) general IBD endoscopy; (ii) disease activity and surveillance; (iii) endoscopy treatment in IBD. In surgery: (iv) medical history with surgical relevance, surgical indication and strategy; (v) operative approach; (vi) intraoperative disease description; (vii) operative steps. In pathology: (viii) macroscopic assessment and interpretation of resection specimens; (ix) IBD histology, including biopsies, surgical resections, and neoplasia; (x) IBD histology conclusion and report. Statements were developed using a Delphi methodology incorporating two consecutive rounds. Current practice positions were set when >80% of participants agreed on a recommendation. Results Thirty practice positions established a standard terminology for optimal reporting in endoscopy, surgery, and histopathology. Assessment of disease activity, surveillance recommendations, advice to surgeons for operative indication and strategies, including margins and extent of resection, and diagnostic criteria of IBD, as well as guidance for the interpretation of dysplasia and cancer were handled. A standardized report including a core set of items to include in each speciality report, was defined. Conclusions Interdisciplinary high-quality care requires thorough and standardised reporting across specialities. This topical review offers an actionable framework and practice recommendations to optimise reporting in endoscopy, surgery, and histopathology.

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“…RPC consists of the removal of the rectum and the colon and the construction of an ileal pouch (reservoir formed with the last 40 cm of the ileum) followed by IPAA [9]. This surgery can be performed in one, two or three stages depending on the colectomy indication.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Risk Factors of Cancer in the Anal Transitional Zone and Ileal Pouch following Surgery for Ulcerative Colitis and Familial Adenomatous Polyposis

Cosquer

Buscail

Gilletta

et al. 2022

Cancers

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Proctocolectomy with ileal pouch-anal anastomosis is the intervention of choice for ulcerative colitis and familial adenomatous polyposis requiring surgery. One of the long-term complications is pouch cancer, having a poor prognosis. The risk of high-grade dysplasia and cancer in the anal transitional zone and ileal pouch after 20 years is estimated to be 2 to 4.5% and 3 to 10% in ulcerative colitis and familial polyposis, respectively. The risk factors for ulcerative colitis are the presence of pre-operative dysplasia or cancer, disease duration > 10 years and severe villous atrophy. For familial polyposis, the risk factors are the number of pre-operative polyps > 1000, surgery with stapled anastomosis and the duration of follow-up. In the case of ulcerative colitis, a pouchoscopy should be performed annually if one of the following is present: dysplasia and cancer at surgery, primary sclerosing cholangitis, villous atrophy and active pouchitis (every 5 years without any of these factors). In the case of familial polyposis, endoscopy is recommended every year including chromoendoscopy. Even if anal transitional zone and ileal pouch cancers seldom occur following proctectomy for ulcerative colitis and familial adenomatous polyposis, the high mortality rate associated with this complication warrants endoscopic monitoring.

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Ileal pouch-anal anastomosis: Points of controversy

Cited by 13 publications

References 48 publications

Ileal-anal pouches: A review of its history, indications, and complications

Ileal-anal pouches: A review of its history, indications, and complications

ECCO Topical Review Optimising Reporting in Surgery, Endoscopy, and Histopathology

Incidence and Risk Factors of Cancer in the Anal Transitional Zone and Ileal Pouch following Surgery for Ulcerative Colitis and Familial Adenomatous Polyposis

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