Impact of ileal pouch-anal anastomosis on female fertility: meta-analysis and systematic review

Rajaratnam, Siraj; Eglinton, Timothy; Hider, Phil; Fearnhead, Nicola

doi:10.1007/s00384-011-1274-9

Cited by 170 publications

(115 citation statements)

References 44 publications

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“…This subgroup of elective colorectal operations from a prospective cohort study of 755 all types elective abdominal operations was chosen because colorectal surgery involves a large patient group and this type of surgery has been associated with adhesion-related complications [4,[20][21][22] . Almost two-third of patients had baseline adhesions, mostly originating from previous surgery, harboring the highest risk of surgical complications when lysed.…”

Section: Discussionmentioning

confidence: 99%

Impact of Adhesiolysis on Outcome of Colorectal Surgery

et al. 2015

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Background/Aims: Adhesiolysis is a frequent part of colorectal surgery, potentially impeding the operation and causing inadvertent bowel injury. Such difficulties might compromise convalescence and oncological quality of resection. The aim of this prospective cohort study was to assess the impact of adhesiolysis on clinical outcomes and histopathological results in colorectal surgery. Methods: Colorectal procedures were selected from a prospective cohort study of adhesiolysis-related problems. We compared the incidence of bowel injury, morbidity, costs, and the histopathology between patients undergoing elective colorectal surgery with or without adhesiolysis. Results: Two hundred and forty nine colorectal surgeries were analysed. Adhesiolysis was required in 59.0%. The mean adhesiolysis time was 28 min. In the adhesiolysis group, enterotomies occurred in 6.1% and seromuscular injuries in 27.2% compared to 0 and 6.9% respectively in the non-adhesiolysis group (p = 0.012 and p < 0.001). In patients requiring adhesiolysis, 29.9% had major surgery-related complications (MSRC) compared to 15.7% without adhesiolysis (p = 0.007). There were no statistically significant differences regarding inpatient costs and resection margin or number of harvested lymph nodes. Conclusions: Adhesiolysis during colorectal surgery is related to an increased incidence of iatrogenic bowel injuries and MSRC. Despite the technical challenges associated with adhesiolysis, good histopathological results were obtained in oncological resections.

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Section: Discussionmentioning

confidence: 99%

Impact of Adhesiolysis on Outcome of Colorectal Surgery

et al. 2015

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“…A meta-analysis evaluating IPAA in UC patients suggested that the risk of infertility increased 3-fold post-IPAA [23] . PCL [24] with IPAA has a more pronounced effect on fertility compared to the laparoscopic approach, which produces fewer adhesions [18,19,[23][24][25][26] . Studies involving laparoscopic IPAA indicate that women undergoing these procedures have significantly higher pregnancy rates as compared to open field IPAA [27] .…”

Section: Fertilitymentioning

confidence: 99%

Pregnancy and inflammatory bowel diseases: Current perspectives, risks and patient management

Hosseini‐Carroll¹,

Mutyala²,

Seth³

et al. 2015

WJGPT

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Manas K made critical revisions of the manuscript; Becker F and Alexander JS contributed equally as senior authors. Conflict-of-interest statement:There are no known conflicts of interest. The authors (Pegah Hosseini-Carroll, Monica Mutyala, Abhishek Seth, Shaheen Nageeb, Demiana Soliman, Moheb Boktor, Ankur Sheth, Jonathon Chapman, James Morris, Paul Jordan, Kenneth Manas, Felix Becker, and J Steven Alexander) have no relevant financial considerations related to this proposal, and the study was not supported by any corporate entity. There is no known intellectual property associated with this report. AbstractInflammatory bowel diseases (IBD) are chronic idiopathic inflammatory conditions characterized by relapsing and remitting episodes of inflammation which can affect several different regions of the gastrointestinal tract, but also shows extra-intestinal manifestations. IBD is most frequently diagnosed during peak female reproductive years, with 25% of women with IBD conceiving after their diagnosis. While IBD therapy has improved dramatically with enhanced surveillance and more abundant and powerful treatment options, IBD disease can have important effects on pregnancy and presents several challenges for maintaining optimal outcomes for mothers with IBD and the developing fetus/neonate. Women with IBD, the medical team treating them (both gastroenterologists and obstetricians/gynecologists) must often make highly complicated choices regarding conception, pregnancy, and post-natal care (particularly breastfeeding) related to their choice of treatment options at different phases of pregnancy as well as post-partum. This current review discusses current concerns and recommendations for pregnancy during 157November 6, 2015|Volume 6|Issue 4| WJGPT|www.wjgnet.com Hosseini-Carroll P et al . Pregnancy and inflammatory bowel diseases IBD and is intended for gastroenterologists, general practitioners and IBD patients intending to become, (or already) pregnant, and their families. We have addressed patterns of IBD inheritance, effects of IBD on fertility and conception (in both men and women), the effects of IBD disease activity on maintenance of pregnancy and outcomes, risks of diagnostic procedures during pregnancy and potential risks and complications associated with different classes of IBD therapeutics. We also have evaluated the clinical experience using "top-down" care with biologics, which is currently the standard care at our institution. Post-partum care and breastfeeding recommendations are also addressed. Core tip: Inflammatory bowel diseases (IBD) are chronic inflammatory conditions characterized by relapsing and remitting episodes of intestinal inflammation. IBD is most frequently diagnosed during peak female reproductive years, with 25% of women with IBD conceiving after their diagnosis. While therapies have improved dramatically, IBDs have important effects on pregnancy and present challenges for maintaining optimal outcomes for mothers and their developing fetus/ neonate. Women with IBD and physician...

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“…Women who have undergone pelvic surgery have increased rates of infertility, particularly those who have had proctocolectomy with ileal pouch anal anastomosis (IPAA) [14][15][16]. A recent meta-analysis by Rajaratnam et al looking at female fertility in familial adenomatous polyposis patients post-IPAA found a 3.91-fold increased risk of infertility (95% CI: 2.06-7.44) [17]. It is suspected that the major reason for this is pelvic scarring and adhesions from surgery resulting in tubal infertility.…”

Section: Fertilitymentioning

confidence: 99%