Ileal reservoir with ileo-anal anastomosis: Long-term complications

Béliard, Anne-Sophie; Prudhomme, Michel

doi:10.1016/j.jviscsurg.2010.07.001

Cited by 23 publications

(4 citation statements)

References 81 publications

(100 reference statements)

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“…Perianal fistula after IPAA has been reported to arise from the anastomotic site or anal glands, 15,16 and Araki et al 17 proposed that the total removal of the rectal mucosa might reduce the risk of postoperative perianal fistulae. Although several reports have described the development of dysplasia or cancer after IPAA, 14,18 we found no neoplasms in either group, during the postoperative surveillance. The incidence of postoperative pouchitis was not different between groups, and both groups maintained good pouch function, with no difference in the rate of pouch failure.…”

Section: Discussioncontrasting

confidence: 72%

Comparison of Functional Outcomes of Patients Who Underwent Hand-Sewn or Stapled Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Ishii

Kawai

Hata

et al. 2015

International Surgery

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Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for patients with ulcerative colitis (UC). The purpose of this study was to investigate the long-term functional outcomes and quality of life (QOL) associated with hand-sewn and stapled IPAA. Ninety-one patients with UC had undergone IPAA using hand-sewn anastomosis with mucosectomy (32 patients) or stapled anastomosis (59 patients) from January 1988 to May 2010. Patients were evaluated according to patient characteristics, postoperative complications, functional outcomes and QOL. The QOL of patients were evaluated using the Medical Outcomes Study Short Form 36 (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ). Numbers of patients with colorectal cancer or dysplasia were significantly greater in the hand-sewn IPAA group (P , 0.01). These patients had longer disease durations and were older (both P , 0.01). There was no difference in the incidence of complications between the groups, except for a greater incidence of postoperative anal fistula in the stapled group (P ¼ 0.03). In the early postsurgery period, both the frequency of bowel movements and the rate of soiling were significantly higher in the hand-sewn group, but in a later period, there was no difference in these events .3 years after surgery. The SF-36 and IBDQ results were similar in the two groups, indicating that hand-sewn and stapled IPAA result in similar QOL in the late postoperative Corresponding author: Hiroaki Ishii, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. Total proctocolectomy with ileal pouch-anal anastomosis (IPAA), which was first described in 1978 by Parks and Nicholls, 4 has become established as the standard surgical treatment for patients with UC. The problems with IPAA are that the excision close to the anal sphincter may result in impaired anal function that may cause neurologic damage to the rectum, in turn resulting in urinary and sexual dysfunction. The anastomosis of ileal pouch leads to diarrhea and frequent bowel movements that may adversely affect patients' quality of life (QOL). Two different anastomotic techniques are generally used in IPAA: handsewn anastomosis with mucosectomy, which removes all rectal mucosa to the dentate line, and stapled anastomosis (Fig. 1). Patients who undergo hand-sewn anastomosis are thought to develop impaired anal function and QOL more than that in patients who underwent stapled anastomosis.Although some reports have suggested that the stapled anastomosis provides a better functional outcome than the hand-sewn anastomosis, 5-7 no report has investigated the difference between a hand-sewn IPAA and a stapled IPAA with regard to QOL using validated questionnaires.We reviewed postoperative complications and evaluated postoperative function both objectively and subjectively. We compared long-term functional outcomes and QOL between these two techniques, using the Medical Outcomes Study Short Form 36 (SF-36), 8 which is a validated generic QOL instrument, and the inflammatory bowel di...

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Section: Discussioncontrasting

confidence: 72%

Comparison of Functional Outcomes of Patients Who Underwent Hand-Sewn or Stapled Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Ishii

Kawai

Hata

et al. 2015

International Surgery

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“…Pouchitis is an inflammatory condition characterized by increased frequency of bowel movements, diarrhea, tenesmus, malaise, and arthralgias that can affect between 15% to 70% of patients depending on definition and duration of follow-up. 2 CD-like complications include the development of fistulas, strictures, and granulomatous inflammation that can affect up to 13% of patients. 3 Mild pouchitis (MP), a phenomenon that commonly occurs in the IPAA patient, is an acceptable complication because it can be effectively treated with a short course of antibiotics.…”

mentioning

confidence: 99%

Genetic Risk Profiling and Gene Signature Modeling to Predict Risk of Complications After IPAA

Sehgal

Berg

Polinski

et al. 2012

Diseases of the Colon &Amp; Rectum

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“…Pouchitis is an inflammatory condition of the ileal reservoir that is formed during IPAA [9]. It occurs as a single acute episode in a third of cases but most have recurrent acute episodes or a chronic course of disease [10]. Acutely, it can be distressing with symptoms of increased stool frequency, urgency, nocturnal incontinence and abdomino-pelvic pain, often accompanied by fever, weight-loss and bloody stools [5].…”

Section: Introductionmentioning

confidence: 99%

The pathogenesis of primary pouchitis following ileal pouch-anal anastomosis: a review of current hypotheses

Bath¹,

Selinger²,

Leong³

2011

OJGas

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Primary pouchitis is a common complication of ileal pouch-anal anastomosis following proctocolectomy in patients treated for ulcerative colitis (UC), but is un-usual for those treated for familial adenomatous polyposis (FAP). While a number of theories as to the pathogenesis of this inflammatory condition have been proposed, no single one has been wholly satis-factory. Much research has been devoted to investi-gating a link between the pathogenic factors involved in UC, but not FAP, and those underlying pouchitis. The contribution of sulfate-producing bacteria has also been explored. The role of other intraluminal factors, such as short chain fatty acids and unconju-gated bile salts, has also been investigated. A unifying theory of a multi-step process might explain the pathogenesis of pouchitis, but further research is re-quired to proof causation. It is likely that pouchitis develops as a result of a combination of genetic, im-munological, microbial and metabolic factors. Future insight into the causes of pouchitis may eventually allow for the development of more effective treat-ments

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Ileal reservoir with ileo-anal anastomosis: Long-term complications

Cited by 23 publications

References 81 publications

Comparison of Functional Outcomes of Patients Who Underwent Hand-Sewn or Stapled Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Comparison of Functional Outcomes of Patients Who Underwent Hand-Sewn or Stapled Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Genetic Risk Profiling and Gene Signature Modeling to Predict Risk of Complications After IPAA

The pathogenesis of primary pouchitis following ileal pouch-anal anastomosis: a review of current hypotheses

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