Anastomotic Leak after Ileal Pouch–Anal Anastomosis

Guyton, Kristina; Kearney, David E.; Holubar, Stefan D.

doi:10.1055/s-0041-1735274

Cited by 8 publications

(2 citation statements)

References 73 publications

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“…Up to 15% of ileoanal pouches will develop a symptomatic leak [ 6 ]. The clinical presentation is driven by the timing of the leak.…”

Section: Methodsmentioning

confidence: 99%

Assessment of the ileoanal pouch for the colorectal surgeon

Celentano,

Manzo

2023

Langenbecks Arch Surg

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Introduction Many pouch complications following ileoanal pouch surgery have an inflammatory or mechanical nature, and specialist colorectal surgeons are required to assess the anatomy of the ileoanal pouch in multiple settings. In this study, we report our stepwise clinical and endoscopic assessment of the patient with an ileoanal pouch. Methods The most common configuration of the ileoanal pouch is a J-pouch, and the stapled anastomosis is more frequently performed than a handsewn post-mucosectomy. A structured clinical and endoscopic assessment of the ileoanal pouch must provide information on 7 critical areas: anus and perineum, rectal cuff, pouch anal anastomosis, pouch body, blind end of the pouch, pouch inlet and pre-pouch ileum. Results We have developed a structured pro forma for step-wise assessment of the ileoanal pouch, according to 7 essential areas to be evaluated, biopsied and reported. The structured assessment of the ileoanal pouch in 102 patients allowed reporting of abnormal findings in 63 (61.7%). Strictures were diagnosed in 27 patients (26.4%), 3 pouch inlet strictures, 21 pouch anal anastomosis strictures, and 3 pre-pouch ileum strictures. Chronic, recurrent pouchitis was diagnosed in 9 patients, whilst 1 patient had Crohn’s disease of the pouch. Conclusions Detailed clinical history, assessment of symptoms and multidisciplinary input are all essential for the care of patients with an ileoanal pouch. We present a comprehensive reporting pro forma for initial clinical assessment of the patient with an ileoanal pouch, with the aim to guide further investigations and inform multidisciplinary decision-making.

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“…Up to 15% of ileoanal pouches will develop a symptomatic leak [ 6 ]. The clinical presentation is driven by the timing of the leak.…”

Section: Methodsmentioning

confidence: 99%

Assessment of the ileoanal pouch for the colorectal surgeon

Celentano,

Manzo

2023

Langenbecks Arch Surg

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“…According to Guyton et al, the reported rates of anastomotic leak following ileal pouch-anal anastomosis (IPAA) vary widely from 5% to 19%, with the majority of this contributing data coming from single institution case series [ 1 ]. Following an uncontrolled leak discovery, the goals of treatment are patient resuscitation and infection source control.…”

Section: Introductionmentioning

confidence: 99%

Creation of a Custom Endoluminal Vacuum-Assisted Device for Salvage of Ileal Pouch-Anal Anastomotic Leak

Kiko,

Nehring,

2023

Cureus

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Endoluminal vacuum-assisted devices have become increasingly popular solutions for low-colorectal injuries and anastomotic defects in recent years. We present a case of a 23-year-old male who underwent salvage of an ileal pouch-anal anastomosis (IPAA) anastomotic leak with a customized endoluminal vacuum sponge and cavity marsupialization. This case highlights the easy-to-follow steps to create a customized endoluminal vacuum (endo-vac) sponge with readily available materials for the treatment of low colorectal anastomotic leaks. Included are step-by-step photos and instructions for successful endoluminal vacuum device construction.

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