Complications associated with heal pouch‐anal anastomosis

Abstract

Seventy-three patients underwent total colectomy, rectal mucosectomy, creation of J or S ileal reservoir, and ileal pouch-anal anastomosis from 1982 to 1989. Mean follow-up was 38 months, with a minimum of 3 months in 15 patients being followed long-term at another institution. Forty-eight (66%) patients had histologically proven ulcerative colitis and 25 (34%) patients had familial polyposis. Thirty-eight J reservoirs and 35 S reservoirs were constructed. There were no perioperative deaths. The failure rate (loss of pouch) was 3%. Thirty-six complications in 34 (47%) patients were reported, 14 (19%) patients required surgery. Bowel obstruction was the most common postoperative complication (16%), followed by pouchitis (15%), and cuff infection (5%). Seventy-eight percent of the complications were associated with the J pouch. Average stool frequency at 1 year was 4 per 24-hour period. Other complications included postoperative pneumonia (1), peroneal nerve palsy (1), and temporary sexual dysfunction (1). Seven of 15 complications requiring surgical intervention occurred in the first 2 years of the study period, illustrating the learning curve associated with the procedure. Blood loss, transfusion requirements, and length of operation were not associated with higher complication rates. Use of the J pouch and experience of the individual surgeon affected morbidity.

Risk Factors for Ileoanal J Pouch-Related Septic Complications in Ulcerative Colitis and Familial Adenomatous Polyposis

“…A surgeon's experience has been shown to have an effect on the outcome of IPAA 8,24,25 and was therefore analyzed as a potential factor for PRSC in our study. We defined operations as being performed by an experienced surgeon if the surgeon had done at least 30 IPAAs.…”

Anastomoses colônicas após mucosectomia química, em ratos

“…O processo da cicatrização de alças intestinais processase de maneira única no organismo, com características diferentes da pele e outros tecidos orgânicos, tanto pelas características da síntese do colágeno como da migração de fibroblatos (9). A síntese do colágeno, mediada pela presença dos fibroblastos na anastomose, é um dos fatores responsáveis pela aquisição da força tênsil capaz de tornar as cicatrizes mais fortes com o tempo e, aparentemente, essa ativação dos fibroblastos ocorre não somente na linha de sutura, mas ao longo de todo o trato digestivo (10,11), caracterizando a importância da submucosa na cicatrização das anastomoses intestinais (8).…”

“…Entretanto, existem controvérsias quanto ao mérito de se realizar a mucosectomia, sendo que alguns estudos sugerem que a mucosectomia seguida de anastomose manual se associaria com pior resultado funcional do que quando realizada a anastomose mecânica sem a mucosectomia (6,7). Na cicatrização de segmentos do tubo digestivo, é conhecida a importância da submucosa como principal responsável pela aquisição de força tênsil (8), devido à presença de grande quantidade de células inflamatórias e fibroblastos, (9) sendo essas as células responsáveis pela síntese do colágeno (10,11). Após uma mucosectomia, teoricamente essas superfícies estariam mais expostas e, portanto, a área sujeita à reação inflamatória seria mais extensa, podendo resultar não só em uma cicatriz mais forte, como também favorecer ao aumento na incidência de estenoses.…”

Refractory Distal Ulcerative Colitis: Is Proctocolectomy Always Necessary?

“…When nonpouch- and pouch-related morbidities are included, the overall incidence of complications can range from 13 to 62%. These usually include small bowel obstruction, pulmonary infection, myocardial events, infection of the urinary tract, deep venous thrombosis, incisional hernia, pouch hemorrhage and dehydration secondary to high stoma output [33,48,49,50,51,52,53,54]. Despite the morbidity rate cited above, tertiary referral centers have shown a significant reduction in complication rates over two decades of case series [32,37].…”