Long-Term Results of Salvage Surgery for Septic Complications After Restorative Proctocolectomy

Gorfine, Stephen R.; Fichera, Alessandro; Harris, Michael T.; Bauer, Joel J.

doi:10.1007/s10350-004-6747-2

Cited by 59 publications

(39 citation statements)

References 31 publications

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“…5 Even though acceptable functional results can be achieved in highly motivated patients, multiple procedures are often necessary to achieve complete healing of an IPAA leak. 6 Hence, efforts should be made to reduce such complications and to identify patients at risk for pouch-related sepsis. To decrease the incidence of pouch-related septic complications and to minimize long-term sequelae, a staged surgical approach has been advocated in the management of patients with complex UC.…”

mentioning

confidence: 99%

Minimally Invasive Pouch Surgery for Ulcerative Colitis: Is There a Benefit in Staging?

Pandey

Luther

Umanskiy

et al. 2011

Diseases of the Colon &Amp; Rectum

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mentioning

confidence: 99%

Minimally Invasive Pouch Surgery for Ulcerative Colitis: Is There a Benefit in Staging?

Pandey

Luther

Umanskiy

et al. 2011

Diseases of the Colon &Amp; Rectum

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“…Generally, anastomotic failure after IPAA is associated with a high rate of pouch failure [17]. Although redo-IPAA has been reported a valid alternative for patients with pouch failure due to PRC [7,8,9,10,12,18,19], pouch failure occurs more frequently after redo than after primary IPAA [9].…”

Section: Discussionmentioning

confidence: 99%

“…During adhesiolysis of the original pouches, patients experienced injury to the bilateral ureters and bladder requiring repair by urologists. Although an aggressive surgical approach, including multiple procedures, may be necessary to achieve complete healing [17], some of our patients did not want to have their covering ileostomy closed, in order to preserve their QOL, including stoma without pain or sepsis. Surgeons should also be aware of technical options including the availability of differently designed reconstructed pouches, which may increase the reach of the ileal pouch towards the pelvic floor and facilitate a tension-free anastomosis [20].…”

Section: Discussionmentioning

confidence: 99%

Functional and Manometric Outcomes after Redo-Ileal Pouch Anal Anastomosis in Patients with Ulcerative Colitis

Araki¹,

Okita²,

Fujikawa³

et al. 2014

Dig Surg

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Aim: To retrospectively analyze manometric findings in patients with ulcerative colitis who underwent redo-ileo anal anastomosis for pouch-related complications. Methods: Functional and anal manometric parameters were analyzed before, immediately after, and 6 months after the procedure in 17 patients who underwent redo-ileo anal anastomosis between 2001 and 2012. Results: Of the 17 patients, 13 showed stoma closure and 9 have maintained gastrointestinal continuity with functional pouches. Manometric findings were similar before and immediately after redo-ileo anal anastomosis, including length of high-pressure zone (p = 0.11) and maximum resting and (p = 0.060) squeezing (p = 0.69) pressures, but maximum resting pressure improved significantly 6 months later (p = 0.021). Univariate analysis showed that ulcerative colitis duration <3 years before ileo anal anastomosis (p = 0.0073), interval between pouch-related complications and ileo anal anastomosis <2 years (p = 0.040), and persistent abscess before diversion ileostomy (p = 0.0024) were significant risk factors for pouch failure after redo-ileo anal anastomosis. Conclusions: Although maximum resting pressure was significantly reduced 3 months after redo-ileo anal anastomosis, it returned to preoperative levels after 6 months. The length of the high-pressure zone and the maximum squeezing pressure were not affected by this procedure.

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“…Gorfine et al 29 of the Mount Sinai Hospital, New York, reported on 1185 IPAAs, 51 of which required 85 surgical procedures for septic complications. All four patients receiving abdominal salvage surgery had failure.…”

Section: Septic Complicationsmentioning

confidence: 99%

“…The remaining procedures were carried out transanally, with good results in 40% of patients at a median followup of 5.4 years. 29 Early sepsis may be accompanied by fever, tenesmus and purulent transanal discharge. Antibiotics alone can resolve the infection in a limited number of patients.…”

Section: Septic 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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Long-Term Results of Salvage Surgery for Septic Complications After Restorative Proctocolectomy

Cited by 59 publications

References 31 publications

Minimally Invasive Pouch Surgery for Ulcerative Colitis: Is There a Benefit in Staging?

Minimally Invasive Pouch Surgery for Ulcerative Colitis: Is There a Benefit in Staging?

Functional and Manometric Outcomes after Redo-Ileal Pouch Anal Anastomosis in Patients with Ulcerative Colitis

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

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