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

Abstract

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.

Ileal pouch–anal anastomosis—a personal experience reevaluating complications, pouch survival, and quality of life

“…The occasional generous referral to IPAA as the gold standard for proctocolectomy [26] suggests that strategic and technical questions pertaining to the surgical procedure have been conclusively answered and that the results, including QOL, leave no room for doubting this assessment. In fact, while the literature consistently reports very satisfactory surgical outcomes, it also recognizes not inconsiderable rates of complications and pouch failure [9,15,24]. This apparentcontradictionruns like a thread through the literature and needs to be resolved.…”

“…Irrespective of the ultimate answers to open questions, the outcomes-measured in terms of surgical results and quality of life (QOL)-are consistently considered to be satisfactory by both surgeons and patients [9]. Sur-prisingly, this is not diminished by the fact that perioperative morbidity associated with this demanding operation is not negligible, and that numerous complications, including those with drastic surgical consequences, occur in the longterm course [15]. As a consequence of one or even multiple complications, definitive pouch failure may result in the long term [24].…”

Biologic Therapies for the Treatment of Post Ileal Pouch Anal Anastomosis Surgery Chronic Inflammatory Disorders: Systematic Review and Meta-analysis

“…38 In addition, patients with Crohn's disease of the pouch (CD) were found to require early biologic therapy soon after IPAA to prevent further complications. 39 This emphasizes the importance of understanding the effectiveness of the different biologic therapies in inducing complete response or remission in these patients.…”

Immune Microenvironment: New Insight for Familial Adenomatous Polyposis

“…Colectomy with IRA and proctocolectomy with IPAA are the two main surgical options, and both have their merits and shortcomings ( 10 , 11 ). While after surgery, there are some complications such as hemorrhage, acute pelvic sepsis, portal vein thrombus in the early postoperative period, chronic pelvic sepsis, small bowel obstruction pouch dysfunction, and pouchitis ( 12 – 14 ). Moreover, most adult FAP patients will progress to malignant tumors if they are not diagnosed and treated early enough ( 10 ).…”