Are radiologic pouchogram and pouchoscopy useful before ileostomy closure in asymptomatic patients operated for ulcerative colitis?

Exarchos, Georgios; Metaxa, Linda; Gklavas, Antonios; Koutoulidis, Vassilis; Papaconstantinou, Ioannis

doi:10.1007/s00330-018-5760-0

Cited by 5 publications

(4 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, to date there is no standardized definition or grading for an AL of the pouch, which suggests that there are significant differences in its detection. A considerable occurrence of asymptomatic ALs of the pouch masked by the presence of an ileostomy has already been described in the literature [ 39 , 40 ]. In a previous meta-analysis, only a limited number of included studies assessed the J-pouch, despite it being the current gold-standard in restorative proctocolectomy [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Perfusion Visualization during Ileal J-Pouch Formation—A Proposal for the Standardization of Intraoperative Imaging with Indocyanine Green Near-Infrared Fluorescence and a Postoperative Follow-Up in IBD Surgery

Lobbes

Berns

Warschkow

et al. 2022

Life

View full text Add to dashboard Cite

Background: An anastomotic leak (AL) after a restorative proctocolectomy and an ileal J-pouch increases morbidity and the risk of pouch failure. Thus, a perfusion assessment during J-pouch formation is crucial. While indocyanine green near-infrared fluorescence (ICG-NIRF) has shown potential to reduce ALs, its suitability in a restorative proctocolectomy remains unclear. We aimed to develop a standardized approach for investigating ICG-NIRF and ALs in pouch surgery. Methods: Patients undergoing a restorative proctocolectomy with an ileal J-pouch for ulcerative colitis at an IBD-referral-center were included in a prospective study in which an AL within 30 postoperative days was the primary outcome. Intraoperatively, standardized perfusion visualization with ICG-NIRF was performed and video recorded for postoperative analysis at three time points. Quantitative clinical and technical variables (secondary outcome) were correlated with the primary outcome by descriptive analysis and logistic regression. A novel definition and grading of AL of the J-pouch was applied. A postoperative pouchoscopy was routinely performed to screen for AL. Results: Intraoperative ICG-NIRF-visualization and its postoperative visual analysis in 25 patients did not indicate an AL. The anastomotic site after pouch formation appeared completely fluorescent with a strong fluorescence signal (category 2) in all cases of ALs (4 of 25). Anastomotic site was not changed. ICG-NIRF visualization was reproducible and standardized. Logistic regression identified a two-stage approach vs. a three-stage approach (Odds ratio (OR) = 20.00, 95% confidence interval [CI] = 1.37–580.18, p = 0.029) as a risk factor for ALs. Conclusion: We present a standardized, comparable approach of ICG-NIRF visualization in pouch surgery. Our data indicate that the visual interpretation of ICG-NIRF alone may not detect ALs of the pouch in all cases—quantifiable, objective methods of interpretation may be required in the future.

show abstract

Section: Discussionmentioning

confidence: 99%

Perfusion Visualization during Ileal J-Pouch Formation—A Proposal for the Standardization of Intraoperative Imaging with Indocyanine Green Near-Infrared Fluorescence and a Postoperative Follow-Up in IBD Surgery

Lobbes

Berns

Warschkow

et al. 2022

Life

View full text Add to dashboard Cite

show abstract

“…In this study, 1 asymptomatic patient (2%) had an anastomotic leak demonstrated on contrast study, which was subsequently confirmed at EUA‚ and 2 patients (3%) with a normal pouchogram, 1 symptomatic and 1 asymptomatic, subsequently had an anastomotic leak demonstrated at EUA. 147 Another study evaluated 61 patients following IPAA before ileostomy closure 148 with a pouchogram and pouchoscopy. Preoperatively, both pouchogram and pouchoscopy were negative for leakage in all 61 patients, and subsequently, the ileostomies were reversed.…”

Section: Routine Water-soluble Contrast Studies In the Absence Of A C...mentioning

confidence: 99%

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery

Davis

Valente

Goldberg

et al. 2022

Diseases of the Colon &Amp; Rectum

View full text Add to dashboard Cite

“…[24][25][26][27] Pouchoscopy has also not been shown to improve the accuracy of pouchograms prior to reversal. 28 Another presentation of an anastomotic leak may be as a pouch sinus. When adjacent to the IPAA, they are likely due to an anastomotic leak that caused a blind-ending track.…”

Section: Identifying Ipaa Leaksmentioning

confidence: 99%

“…24 25 26 27 Pouchoscopy has also not been shown to improve the accuracy of pouchograms prior to reversal. 28…”

Section: Identifying Ipaa Leaksmentioning

confidence: 99%

Management of Anastomotic Leaks in Ileal Pouch Anal Anastomosis for Ulcerative Colitis

Huang

Plietz

Greenstein

et al. 2022

Clin Colon Rectal Surg

View full text Add to dashboard Cite

Anastomotic leaks remain a dreaded complication after ileal pouch anal anastomosis (IPAA). Their impacts can be devastating, ranging from an acute leak leading to postoperative sepsis to chronic leaks and sinus tracts resulting in long-term pouch dysfunction and subsequent pouch failure. The management of acute leaks is intricate. Initial management is important to resolve acute sepsis, but the type of acute intervention impacts long-term pouch function. Aggressive management in the postoperative period, including the use of IV fluids, broad-spectrum antibiotics, and operative interventions may be necessary to preserve pouch structure and function. Early identification and knowledge of the most common areas of leak, such as at the IPAA anastomosis, are important for guiding management. Long-term complications, such as pouch sinuses, pouch-vaginal fistulas, and diminished IPAA function complicate the overall survival and functionality of the pouch. Knowledge and awareness of the identification and management of leaks is crucial for optimizing IPAA success.

show abstract

Are radiologic pouchogram and pouchoscopy useful before ileostomy closure in asymptomatic patients operated for ulcerative colitis?

Cited by 5 publications

References 30 publications

Perfusion Visualization during Ileal J-Pouch Formation—A Proposal for the Standardization of Intraoperative Imaging with Indocyanine Green Near-Infrared Fluorescence and a Postoperative Follow-Up in IBD Surgery

Perfusion Visualization during Ileal J-Pouch Formation—A Proposal for the Standardization of Intraoperative Imaging with Indocyanine Green Near-Infrared Fluorescence and a Postoperative Follow-Up in IBD Surgery

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery

Management of Anastomotic Leaks in Ileal Pouch Anal Anastomosis for Ulcerative Colitis

Contact Info

Product

Resources

About