Ileal Pouch Prolapse: Prevalence, Management, and Outcomes

Joyce, Myles R.; Fazio, Victor W.; Hull, Tracy; Church, James M.; Kiran, Ravi P.; Mor, Isabella; Lian, Lei; Shen, Bo; Remzi, Feza H.

doi:10.1007/s11605-010-1194-y

Cited by 57 publications

(49 citation statements)

References 9 publications

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“…As reported from Joyce et al [3] it is also our experience that the suture rectopexy has higher recurrence rates, and that the complication-and recurrence rates with biological meshes are low. The biological meshes are immunological intent and can be left in place in case of infection.…”

Section: Discussionsupporting

confidence: 69%

“…Due to the high recurrence rate, the seventh patient underwent transabdominal pouchopexy with a biological mesh. At nine months follow-up there was no recurrence [3].…”

Section: Discussionmentioning

confidence: 82%

“…Therefore the experience with management of the complication is very limited. The surgical treatments reported include transanal repair, transabdominal pouchopexy and transabdominal revision or removal [3,4]. A single case-report describes a successful robotic-assisted laparoscopic pouchopexy [5].…”

Section: Introductionmentioning

confidence: 99%

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Ileoanal J-Pouch Prolapse: Successful Laparoscopic Pouchopexy with a Biological Mesh

Steinthorsdottir

Bulut

2017

GHOA

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Background and aims: Prolapse of ileal pouch is uncommon complication and the surgical treatment of this entity is very challenging. Only a few reports in the literature describe the repair of pouch prolapse with synthetic material, and there is no report describing the use of a biological mesh. Methods: Case reportResults: A 34-year old female was diagnosed with colitis ulcerosa at the age of 29. One year after she had a subtotal colectomy and two years later, she underwent completion proctectomy with an ileo-anal J pouch (IPAA). Both procedures were performed by open approach. The patient developed a recurrent full-thickness prolapse of the pouch that failed the initial nonoperative management and she was successfully treated with laparoscopic pouchopexy, using a biological mesh. Conclusion:Laparoscopic pouchopexy with a biological mesh appears to be a reasonable option in the surgical management of a full-thickness prolapse of ileoanal J-pouch prolapse.

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Section: Discussionsupporting

confidence: 69%

“…Due to the high recurrence rate, the seventh patient underwent transabdominal pouchopexy with a biological mesh. At nine months follow-up there was no recurrence [3].…”

Section: Discussionmentioning

confidence: 82%

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Ileoanal J-Pouch Prolapse: Successful Laparoscopic Pouchopexy with a Biological Mesh

Steinthorsdottir

Bulut

2017

GHOA

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“…It can be either a mucosal or full prolapse, and is observed in approximately 0.3% of patients. 50 Conservative measures include stool-bulking agents and biofeedback, whereas transanal excision of the prolapsed mucosa is a viable choice. 50 Full-thickness pouch prolapse needs abdominal salvage with pouchopexy.…”

Section: Structural and Mechanical Complicationsmentioning

confidence: 99%

Outcomes of Salvage Surgery for Ileal Pouch Complications and Dysfunctions. The Experience of a Referral Centre and Review of Literature

Pellino¹,

Selvaggi²

2015

ECCOJC

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Background and Aims: Failure rates of restorative proctocolectomy with ileo pouch-anal anastomosis (IPAA) range between 3.5 and 15%. Salvage surgery aims to preserve the pouch and transanal evacuation. We report our experience with salvage, review the outcomes of revisional pouch surgery, and propose a classification of pouch dysfunction. Methods: We collected data on patients undergoing pouch salvage surgery between 1987 and 2014 at our hospital. Pre-and post-salvage functional data were assessed. Function at the 3-year follow-up was compared with that of matched IPAA controls (study patients:controls, 1:3). Results: Considering only patients who underwent primary IPAA at our centre (n = 31), 5-year failure was higher after salvage compared with primary IPAA (28.8 vs 5.7% log rank test, p = 0.005). Overall, we included 39 patients, with eight additional patients who received primary IPAA elsewhere, undergoing 46 procedures. Most patients had a J-pouch (74.4%) and needed salvage for septic complications. A transperineal approach was used in 22 patients, whereas 17 underwent abdominal salvage, with 77.3 and 64.7% success rates, respectively. Minor surgery was effective but required repeated procedures. Overall failure was 28.2% at a median follow-up of 42 (1-153) months. A significant decrease in bowel frequency (p = 0.021) and rate of urgency (p = 0.009) was observed at the 3-year follow-up after salvage in 25 patients available for comparison. Functional results after major salvage procedures were poorer compared with healthy IPAA controls (p = 0.003). Conclusions: Salvage surgery is effective and safe in experienced teams, but the 5-year failure rate is higher after salvage than after successful primary pouch surgery. Sepsis brings about a higher risk of failure compared with mechanical causes of dysfunction.

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“…One study reported 83 patients with pouch prolapse when a survey of colorectal surgeons in North America was conducted, whereas an article from Cleveland clinic identified a rate of 0.3%, 11 patients of 3176. 43,44 In the Cleveland clinic study, both full thickness and mucosal prolapse are seen, and diagnosis were made on physical examiantion alone while 1 patient needed pouchoscopy. 44 Because pouch prolapse is such rare event, recommendations for treatment are based on case reports and case series only.…”

Section: Rare Complications Prolpasementioning

confidence: 99%

Ileal J Pouch Complications and Surgical Solutions

Sherman

Greenstein

2014

Inflammatory Bowel Diseases

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Ileal pouch-anal anastomosis is currently accepted as the standard method to restore continence after total proctocolectomy for medically refractory ulcerative colitis and familial adenomatous polyposis. Ileal pouches offer improved quality of life and high patient satisfaction; however, there are many pouch-related complications due to the original disease process and change in anatomy. This is a review article of the common and some rare surgical complications after J pouches, which can be subdivided into the septic and nonseptic categories. Septic-related complications include anastomotic leak, abscess, and fistulas, whereas common nonseptic-related complications include small bowel obstruction, strictures, Crohn's disease, pouchitis, and cuffitis. Rare nonseptic complications to be discussed are prolapse, volvulus, and neoplasia.

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Ileal Pouch Prolapse: Prevalence, Management, and Outcomes

Abstract: Pouch prolapse is rare, and there are no obvious predisposing factors. Mucosal prolapse may be treated by stool bulking or a local perineal procedure. Full thickness prolapse requires definitive surgery and is associated with risk of pouch loss.

Cited by 57 publications

References 9 publications

Ileoanal J-Pouch Prolapse: Successful Laparoscopic Pouchopexy with a Biological Mesh

Ileoanal J-Pouch Prolapse: Successful Laparoscopic Pouchopexy with a Biological Mesh

Outcomes of Salvage Surgery for Ileal Pouch Complications and Dysfunctions. The Experience of a Referral Centre and Review of Literature

Ileal J Pouch Complications and Surgical Solutions

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