Outcome after ileal pouch‐anal anastomosis in ulcerative colitis patients: experience during a 27‐year period

Abstract

Technical improvements changed the IPAA technique. Stapled IPAA is characterized by better functional outcome than handsewn IPAA. DS Endo-GIA and Contour IPAA are followed by lower risk of cuffitis.

Long‐term outcome after ileal pouch‐anal anastomosis for ulcerative colitis

“…Some authors have championed threestaged IPAA if patients are severely immunocompromised and have been on multiple courses of biologic medication. 14 This report by Tonelli et al 1 in this issue of ANZ Journal of Surgery is further evidence of the long-term viability of IPAA in patients with CUC. The goal of IPAA surgery is to protect the patient from malignant transformation of the colon, to achieve an excellent quality of life with excellent pouch function and faecal control and confer normal fertility, all by ensuring a high pouch success rate exceeding 95%.…”

“…Despite considerable advancements in the management of metastatic disease, only 50% will be candidates for curative surgery. 1 Emergency surgery for malignant bowel obstruction is associated with a mortality rate of up to 30%, significantly greater than elective colorectal cancer resection. It also results in considerable morbidity with prolonged hospital stay, delay in initiation of chemotherapy and frequent stoma formation, with impairment of quality of life.…”

“…These stapled anastomoses preserve a short segment of ATZ which in turn facilitates better discrimination and continence. Stapled anastomoses also reduce the high stricture rates of hand-sewn anastomoses as shown by Tonelli et al 1 Today, the ATZ should be kept not longer than 1 cm to avoid cuffitis. 6 If cuffitis does occur and does not respond to 5-ASA and/or steroid treatment (48% in a cohort of 120 patients with cuffitis), Crohn's disease needs to be ruled out.…”

“…In this issue of ANZ Journal of Surgery, Tonelli et al 1 report on a 27-year experience with ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis (CUC) using different types of pouches and various anastomotic techniques. Hand-sewn anastomosis was associated with a significantly higher rate of late complications, especially strictures (10%) and worse function including impaired continence and a higher incidence of loss of discrimination compared with double-stapled anastomoses.…”

THE MAIN PROBLEMS AND PERSPECTIVES OF ULCERATIVE COLITIS SIRGICAL TREATMENT (review)

“…У 31,6 % пациентов в группе с ручным анастомозом против 14,4 % пациентов в группе с двухрядным степлерным анастомозом были зарегистрированы явления проктита. Таким образом, был сделан вывод, что функциональные результаты степлерного РИАА лучше, чем ручного, и что в случае формирования двухрядного степлерного анастомоза Endo-GIA и Contour риск проктита снижается [16] [17]. В 1999 году группа авторов из Оксфорда (Великобритания) исследовали явление воспаления в культе прямой кишки после степлерного РИАА.…”