Long-Term Failure After Restorative Proctocolectomy for Ulcerative Colitis

Tulchinsky, Hagit; Hawley, P. R.; Nicholls, R. J.

doi:10.1097/01.sla.0000082121.84763.4c

Cited by 245 publications

(188 citation statements)

References 29 publications

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“…The ultimate consequence of pouch dysfunction is the creation of a diverting ileostomy with or without excision of the pouch itself, and with this study we found that the risk of failure in Denmark over the past three decades at 5 and 10 years was 9.1% and 12.1%, respectively, comparable with results from highvolume specialist centres [5,12].…”

Section: Discussionsupporting

confidence: 76%

“…The fourth period covered the years 2010 to 2013. 1757 patients identified from previous study [26] 67 with missing data 34 with data found Based on the between-hospital differences in average annual pouch procedures performed, we categorized hospital volume as very low (1-5 cases/year), low (6-10 cases/year), intermediate (11)(12)(13)(14)(15)(16)(17)(18)(19)(20) cases/year) and high (> 20 cases/year). For this categorization, we divided the total number of procedures performed at a department by the total number of calendar years in which pouch procedures were performed.…”

Section: Covariatesmentioning

confidence: 99%

“…This occurs in approximately 20% of cases depending on the length of follow-up [7]. The most important risk factors for pouch failure are pelvic sepsis [8][9][10][11], Crohn's disease (CD), chronic antibiotic-resistant pouchitis, and 'idiopathic' pouch dysfunction [9,12,13]. Currently, controversy exists as to the importance of timing of the restorative pouch procedure in relation to the colectomy [14] and the merits of temporary faecal diversion to reduce the risk of failure of the pouch are debated [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Pouch failures following ileal pouch–anal anastomosis for ulcerative colitis

et al. 2018

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Aim Ileal pouch-anal anastomosis is a procedure offered to patients with ulcerative colitis who opt for restoration of bowel continuity. The aim of this study was to determine the risk of pouch failure and ascertain the risk factors associated with failure. MethodThe study included 1991 patients with ulcerative colitis who underwent ileal pouch-anal anastomosis in Denmark in the period 1980-2013. Pouch failure was defined as excision of the pouch or presence of an unreversed stoma within 1 year after its creation. We used Cox proportional hazards regression to explore the association between pouch failure and age, gender, synchronous colectomy, primary faecal diversion, annual hospital volume (very low, 1-5 cases per year; low, 6-10; intermediate 11-20; high > 20), calendar year, laparoscopy and primary sclerosing cholangitis.Results Over a median 11.4 years, 295 failures occurred, corresponding to 5-, 10-and 20-year cumulative risks of 9.1%, 12.1% and 18.2%, respectively. The risk of failure was higher for women [adjusted hazard ratio (aHR) 1.39, 95% CI 1.10-1.75]. Primary nondiversion (aHR 1.63, 95% CI 1.11-2.41) and a low hospital volume (aHR, very low volume vs high volume 2.30, 95% CI 1.26-4.20) were also associated with a higher risk of failure. The risk of failure was not associated with calendar year, primary sclerosing cholangitis, synchronous colectomy or laparoscopy.Conclusion In a cohort of patients from Denmark (where pouch surgery is centralized) with ulcerative colitis and ileal pouch-anal anastomosis, women had a higher risk of pouch failure. Of modifiable factors, low hospital volume and non-diversion were associated with a higher risk of pouch failure.

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Section: Discussionsupporting

confidence: 76%

Section: Covariatesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pouch failures following ileal pouch–anal anastomosis for ulcerative colitis

et al. 2018

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“…5,6,8,9,30,31 The identification of possible predictors of CD in these patients is therefore important for proper surgical management and prognostication for these patients. We identified two independently significant predictors of postoperative CD: a family history of Crohn's disease and seroreactivity to ASCA IgA.…”

Section: Discussionmentioning

confidence: 99%

Family History and Serology Predict Crohn's Disease after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Melmed¹,

Fleshner²,

Bardakcioglu³

et al. 2008

Diseases of the Colon &Amp; Rectum

108

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Purpose-About 5 to 10 percent of patients undergoing ileal pouch-anal anastomosis with a diagnosis of ulcerative colitis are subsequently diagnosed with Crohn's disease. Preoperative predictors for Crohn's disease post-ileal pouch anal-anastomosis have not been prospectively defined.Methods-Two hundred thirty-eight consecutive patients with ulcerative colitis or indeterminate colitis undergoing ileal pouch anal-anastomosis were prospectively enrolled into a longitudinal database. Clinical factors were assessed perioperatively. Serum drawn pre-operatively was assayed for anti-Saccharomyces-cerevisiae, anti-outer membrane porin-C, anti-CBir1, and perinuclear antineutrophil cytoplasmic antibody using enzyme-linked immunosorbent assay. Crohn's disease was defined by small-bowel inflammation proximal to the ileal pouch or a perianal fistula identified at least 3 months after ileostomy closure. Predictors were assessed in a multivariate Cox proportional hazards model to predict the rate of Crohn's disease after ileostomy closure.

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“…Despite excellent functional results and high patient satisfaction (1,2), approximately 5-10% of patients develop Crohn's disease (CD) of the pouch (3)(4)(5)(6)(7)(8). While some authors assume the above-described situation to be CD (9), others accept this as a phenotype of UC mimicking CD (10).…”

Section: Introductionmentioning

confidence: 99%