Management of early pouch‐related septic complications in ulcerative colitis: a systematic review

Worley, Guy; Segal, Jonathan; Warusavitarne, J; Clark, Sue; Faiz, Omar

doi:10.1111/codi.14266

Cited by 9 publications

(12 citation statements)

References 30 publications

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“…Leakage was found to be an independent risk factor for pouch failure OR 3.65 (95%CI 1.21-1.83) p = 0.022. This has been reported in several reports before and the prompt diagnose and treatment of leakage cannot be stressed enough [17].…”

Section: Discussionmentioning

confidence: 90%

Pouch failures following restorative proctocolectomy in ulcerative colitis

Helavirta

Lehto

Hyöty

et al. 2020

Int J Colorectal Dis

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Purpose Restorative proctocolectomy (RPC) is the most common operation in ulcerative colitis. Nevertheless, permanent ileostomy will sometimes be unavoidable. The aim was to evaluate the reasons for pouch failure and early morbidity after pouch excision. Methods The number and the reasons for pouch failures were analysed in patients undergoing RPC 1985-2016. Results Out of 491 RPC patients, 53 experienced pouch failure (10 women, 43 men); 52 out of 53 underwent pouch excision. The cumulative risk for excision at 5, 10 and 20 years was 5.6, 9.4 and 15.5%, respectively. The reasons for failure included septic events such as fistula in 12 (23%), chronic pouchitis in 11 (21%) and leakage in 8 (15%) patients. Functional reasons for pouch failure were recorded as poor function in 16 (30%), incontinence in 12 (23%) and stricture in 12 (23%) patients. Multiple causes for pouch failure were recorded for individual patients. Seven cases of Crohn’s disease were found among the failure cases: two before pouch excision and five after. Altogether, 15 Crohn’s disease diagnoses were set in the RPC cohort, giving a percentage of 47% of pouch failure in this disorder. A complication occurred in 23 (44%) patients within 30 days after surgery; 16 were mild (Clavien-Dindo grades I–II). Conclusions Eleven percent of RPC patients suffered pouch failure: more men than women. The reasons were multiple. Crohn’s disease created a risk of failure, but a half of these patients maintained the pouch. Morbidity after pouch excision was moderate, but in most cases slight.

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Section: Discussionmentioning

confidence: 90%

Pouch failures following restorative proctocolectomy in ulcerative colitis

Helavirta

Lehto

Hyöty

et al. 2020

Int J Colorectal Dis

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“…If possible (and appropriate), a transanal approach is usually preferred, during which a Depezer or Malecot catheter is placed through the anastomosis to drain peripouch collections/abscesses[87]. Due to the potential risk of fistulation along the drain tract, trans-gluteal drainage should be avoided if possible[91].…”

Section: Complicationsmentioning

confidence: 99%

“…Several attempts may be needed to eradicate sepsis. Recently, endo-cavitational vacuum therapy (Endo-SPONGE ® ) has been embraced for the treatment of low pelvic leaks (Figure 2); first described for the treatment of anastomotic leak following anterior resection[92], its use has been borrowed for the treatment of anastomotic dehiscence post-IPAA, with encouraging results[91]. Rarely, an abdominal approach (re-laparotomy) is needed.…”

Section: Complicationsmentioning

confidence: 99%

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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“…Relaparotomy or relaparoscopy is reserved for those cases in which CT-guided drainage or minor surgery has failed to control sepsis [64,131]. The rate of successful salvage ranges between 75 and 85% [132]. Bleeding of the staple line is rare (1.5%) [133] and it can be controlled in 80% of patients by EUA and local irrigation with 1:200,000 adrenaline solution injected through a Foley catheter.…”

Section: Item 14mentioning

confidence: 99%

Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): ulcerative colitis

et al. 2020

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The Italian Society of Colorectal Surgery (SICCR) promoted the project reported here, which consists of a Position Statement of Italian colorectal surgeons to address the surgical aspects of ulcerative colitis management. Members of the society were invited to express their opinions on several items proposed by the writing committee, based on evidence available in the literature. The results are presented, focusing on relevant points. The present paper is not an alternative to available guidelines; rather, it offers a snapshot of the attitudes of SICCR surgeons about the surgical treatment of ulcerative colitis. The committee was able to identify some points of major disagreement and suggested strategies to improve the quality of available data and acceptance of guidelines.

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Management of early pouch‐related septic complications in ulcerative colitis: a systematic review

Cited by 9 publications

References 30 publications

Pouch failures following restorative proctocolectomy in ulcerative colitis

Pouch failures following restorative proctocolectomy in ulcerative colitis

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

Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): ulcerative colitis

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