Does technique of anastomosis play any role in developing late perianal abscess or fistula?

Gecim, Ibrahim Ethem; Wolff, B. G.; Pembérton, John H.; Devine, Richard M.; Dozois, Roger R.

doi:10.1007/bf02237428

Cited by 42 publications

(35 citation statements)

References 11 publications

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“…Although some authors showed favorable results toward stapled IPAA,5, 9, 12 others reported no benefit or a trend toward higher complications 13, 14. In the present study, the analysis revealed no significant difference in the rates of overall complications or extra‐pelvic complications between stapled and hand‐sewn IPAA.…”

Section: Discussioncontrasting

confidence: 53%

“…Some studies found higher incidence of septic complications, fistula and anastomotic stricture after hand‐sewn IPAA,5, 9, 12 whereas other studies showed a trend toward higher incidence of overall complications and stricture after stapled IPAA 13, 14. Importantly, most of the previous studies included patients with ulcerative colitis (UC) rather than patients with FAP 5, 8, 14, 15 although the complication rates were different between such patients 5, 8, 14, 15.…”

Section: Introductionmentioning

confidence: 99%

“…Importantly, most of the previous studies included patients with ulcerative colitis (UC) rather than patients with FAP 5, 8, 14, 15 although the complication rates were different between such patients 5, 8, 14, 15. Furthermore, none of the studies used objective criteria such as the Clavien‐Dindo classification for stratifying the complications 5, 8, 9, 12, 13, 14, 15. These limitations could explain inconsistent results in the previous studies, and we need evidence that focuses on patients with FAP with the use of objective criteria for assessing complications.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Postoperative complications after stapled and hand‐sewn ileal pouch‐anal anastomosis for familial adenomatous polyposis: A multicenter study

Konishi

Ishida

Ueno

et al. 2017

Annals of Gastroent Surgery

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Ileal pouch‐anal anastomosis (IPAA) after total proctocolectomy (TPC) can be conducted with either hand‐sewn or stapled anastomosis for patients with familial adenomatous polyposis (FAP). Although stapled IPAA without mucosectomy has a higher risk for developing adenomas in the remnant mucosa, it is the simpler procedure with potential benefit in short‐term outcomes. However, it remains controversial as to whether stapled IPAA has any advantages in reducing postoperative complications. The aim of the present study was to compare the postoperative complications and short‐term outcomes of stapled and hand‐sewn IPAA for patients with FAP, using a multicenter cohort sample in Japan. Data of 143 patients with FAP who underwent TPC with stapled IPAA (n=37) and hand‐sewn IPAA (n=106) at 23 institutions between 2000 and 2012 were collected. Postoperative complications, proportion of ostomy, fecal continence and overall survival were compared. Overall rates of the Clavien‐Dindo grade II‐IV complications were not different between the two groups (19% in stapled vs 25% in hand‐sewn, P=.42), with significantly fewer pouch‐related complications including leakage, pelvic abscess, vaginal fistula and anastomotic stricture in stapled IPAA (none in stapled vs 11% in hand‐sewn, P=.036). There was no mortality. Proportion of ostomy at 12 months was similar (2.7% in stapled vs 4.3% in hand‐sewn, P=.26). Mean Wexner score was similar. (0.47 in stapled vs 2.0 in hand‐sewn, P=.12). Five‐year overall survival excluding Stage IV patients was 96% in both groups. Stapled IPAA is a safe option in patients with FAP with a potential benefit in reducing pouch‐related complications.

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Section: Discussioncontrasting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Postoperative complications after stapled and hand‐sewn ileal pouch‐anal anastomosis for familial adenomatous polyposis: A multicenter study

Konishi

Ishida

Ueno

et al. 2017

Annals of Gastroent Surgery

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“…A presença de fístula, que pode ser vaginal, perianal ou perineal, está mais relacionada à doença de base do que à própria técnica cirúrgica utilizada (10) , ou seja, os doentes com PAF têm baixo risco para esta complicação, quando comparados aos doentes com doença inflamatória intestinal, submetidos a cirurgia do reservatório ileal (31,33,40) . Da mesma maneira, apesar da sepse pélvica estar mais relacionada aos doentes com doença inflamatória intestinal, esta complicação é causa importante de morbidade no pós-operatório da cirurgia do RI na PAF.…”

Section: -Abr/jun 2008unclassified

Complicações imediatas e tardias após cirurgia de reservatório ileal na polipose adenomatosa familiar

Leal

Ayrizono

Coy

et al. 2008

Arq. Gastroenterol.

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RESUMO -Racional -A retocolectomia total com confecção de reservatório ileal é cirurgia ideal para o tratamento do cólon e reto dos doentes com polipose adenomatosa familiar, no entanto pode estar associada a complicações no pós-operatório imediato e tardio. Objetivo -Estudar as complicações pós-operatórias da cirurgia do reservatório ileal na polipose adenomatosa familiar. e sepse pélvica (10,1%). Outras complicações foram isquemia aguda do reservatório ileal (4,3%), ileíte do reservatório ("pouchitis") (2,9%) e fístulas relacionadas ao reservatório (2,9%). Conclusões -A morbimortalidade foi semelhante à da literatura e aceitável para uma cirurgia complexa como é a do reservatório ileal, realizada em dois tempos operatórios. A obstrução intestinal foi a complicação mais freqüente. Entretanto, isquemia do reservatório, "pouchitis" e sepse pélvica constituíram importantes complicações relacionadas à perda do reservatório ileal. DESCRITORES -Polipose adenomatosa do colo, cirurgia. Íleo, cirurgia. Reto, cirurgia. Bolsas do colo. Colectomia, complicações.A polipose adenomatosa familiar (PAF) é uma doença hereditária de caráter autossômico dominante, igualmente distribuída entre os sexos. Origina-se, principalmente, a partir da mutação na linhagem de células germinativas no gene da polipose adenomatosa coli (PAC), resultando em formação de centenas de pólipos colorretais. A principal característica clínica é a evolução para câncer colorretal em quase 100% dos casos, geralmente antes dos 40 anos de idade, se a cirurgia não for realizada. A incidência é de 1/7.000 nascimentos, no entanto, esta estimativa é incerta, uma vez que a doença não é óbvia ao nascimento e algumas vezes pode se manifestar na 4ª ou 5ª décadas de vida, nas formas atenuadas da doença (2,3,4,29) .A retocolectomia total com confecção de reservatório ileal (RI) é a cirurgia de escolha para a PAF. Desde o seu advento, no final da década de 70 (27,30,42) , o RI tem sido a reconstrução cirúrgica ideal nesses doentes, uma vez que possibilita a retirada de toda a mucosa do cólon e do reto com potencial de formação de pólipos, como também evita a ileostomia definitiva (18,21,42) .Este procedimento está indicado nos doentes com PAF que possuem muitos pólipos retais, em geral mais do que 20, ou presença de pólipos com displasia de alto grau no epitélio, condições predisponentes para desenvolvimento de câncer retal (17) .Por ser cirurgia de maior complexidade, os doentes submetidos ao RI estão sujeitos a maior ocorrência de possíveis complicações tanto no pós-operatório imediato quanto tardio, quando comparados àqueles nos quais se faz apenas colectomia total e anastomose ileorretal. No entanto, de maneira geral, a retocolectomia total com RI apresenta aceitável morbidade e baixa mortalidade nos doentes portadores de PAF (9,18,21,24) .Este estudo teve como objetivo demonstrar as complicações pós-operatórias da cirurgia do RI em doentes com PAF que possuíam acometimento colorretal, acompanhados no Ambulatório de Coloproctologia de hospital universitário e compa...

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“…The prevalence of perianal fistulae varies between 3.6 and 12.7% [23,24,25]. Patients with a diagnosis of chronic UC have a significantly higher risk of developing perianal sepsis during in the long term following IPAA compared with those with familial adenomatous polyposis [26]. Although it is difficult to determine if perianal sepsis after IPAA arises from anastomotic dehiscence or the anal gland, except for patients who are clearly diagnosed with cuff abscess, these complications may cause pouch failures regardless of their origins [27].…”

Section: Discussionmentioning

confidence: 99%

Full Mucosal Proctectomy Initiated below the Dentate Line May Prevent the Development of a Perianal Fistula after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Araki

Okita²,

Fujikawa³

et al. 2013

Dig Surg

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Background: Long-term functional results of ileal pouch-anal anastomosis (IPAA) with mucosal proctectomy (MP) for ulcerative colitis (UC) are satisfactory but may be compromised by perianal fistulae. Methods: We analyzed the effect of the level of MP (above or below the dentate line) on the risk of perianal fistulae in 151 patients undergoing IPAA for UC. Results: A postoperative perianal fistula occurred in 12 patients (10 with MP from the level above the dentate line and 2 below). Patients developing perianal fistulae after IPAA were significantly younger at IPAA (23 vs. 32 years, p = 0.015). Age <25 years at UC onset (hazard ratio, HR, 3.5, p = 0.041), age <30 years at IPAA (HR 4.3, p = 0.015) and MP above the dentate line (HR 4.7, p = 0.010) were significant risk factors for perianal fistulae after IPAA. Multivariate analysis showed that age <30 years at IPAA (HR 4.4, p = 0.018) and MP above the dentate line (HR 6.0, p = 0.012) were significant risk factors. Conclusion: IPAA with MP below the dentate line for UC might reduce the risk of postoperative perianal fistulae.

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Does technique of anastomosis play any role in developing late perianal abscess or fistula?

Cited by 42 publications

References 11 publications

Postoperative complications after stapled and hand‐sewn ileal pouch‐anal anastomosis for familial adenomatous polyposis: A multicenter study

Postoperative complications after stapled and hand‐sewn ileal pouch‐anal anastomosis for familial adenomatous polyposis: A multicenter study

Complicações imediatas e tardias após cirurgia de reservatório ileal na polipose adenomatosa familiar

Full Mucosal Proctectomy Initiated below the Dentate Line May Prevent the Development of a Perianal Fistula after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

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