Improved Outcome Due to Increased Experience and Individualized Management of Leaks After Ileal Pouch-Anal Anastomosis

Abstract

A high rate of ileal pouch salvage can be achieved after leaks associated with the IPAA procedure if management is individualized. Improved salvage rate over time is likely a reflection of increased experience with the management of complications as well as the strategy of individualized management.

Sepsis is a Major Predictor of Failure After Ileal Pouch-Anal Anastomosis

“…Anastomotic leaks were shown to occur in as many as 19% of patients with pouches created between 1981 and 1984, whereas only 4% of patients experienced such a complication between 1997 and 2003. 13 An individualized approach to patients with anastomotic leaks has also led to a significant improvement in pouch salvage rates: up to 93% in recent years compared with 67% when IPAA surgery was first introduced. 13 This includes a tailored approach to the application of nonoperative interventions such as radiologically placed drains, to more aggressive therapy, c Because of small cell sizes, "Other" diagnosis, W-pouch configuration, and I stage pouches had to be excluded from multivariate analysis d I, one-stage IPAA construction; IIn, total proctocolectomy, IPAA construction, and loop ileostomy, followed by ileostomy closure; IIi, subtotal colectomy and ileostomy, followed by IPAA construction; III, subtotal colectomy and ileostomy, followed by IPAA with loop ileostomy, followed by closure of ileostomy.…”

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

“…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].…”

Outcomes for Patients Developing Anastomotic Leak After Ileal Pouch-Anal Anastomosis

“…Anastomotic leak can be associated with anastomotic tension, local ischemia, nutritional status, and anastomotic technique. 3 Previous studies described the association of an anastomotic leak with preoperative use of steroids 4 and the diagnosis of Crohn's disease. 5 Anastomotic leak can result in anastomotic stenosis, and is associated with other septic complications such as pelvic abscess formation and fistula.…”