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

Lian, Lei; Kiran, Ravi P.; Remzi, Feza H.; Lavery, Ian C.; Fazio, Victor W.

doi:10.1007/dcr.0b013e31819ad4f2

Cited by 19 publications

(8 citation statements)

References 28 publications

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“…Although preservation of the ATZ purportedly improves functional results, [16][17][18][19] shortens operative times, 20 and reduces septic complications, 21,22 considerable controversy still exists regarding long-term outcomes as a result of recurrent or persistent disease and the risk of malignant degeneration in the ATZ. In sharp contrast, surgeons who advocate mucosal proctectomy, as we do at our center, emphasize that the complete removal of all rectal mucosa not only confers the highest likelihood of a complete surgical cure but more importantly removes all future risk of malignant transformation.…”

Section: Mucosectomy With Handsewn Versus Double-stapled Anastomosismentioning

confidence: 99%

Completion Mucosectomy for Retained Rectal Mucosa Following Restorative Proctocolectomy with Double-Stapled Ileal Pouch–Anal Anastomosis

Litzendorf

Stucchi

Wishnia

et al. 2010

Journal of Gastrointestinal Surgery

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The clear patient advantage of functional continence has pushed this procedure to the forefront in treating both UC and FAP. As a result, the procedure continues to evolve with recent debate centering on the question of whether to perform a double-stapled technique without rectal mucosectomy or a handsewn anastomosis following transanal mucosectomy. Although continence and complication rates continue to be hotly debated, it is understood that performing the stapled procedure does leave a rectal cuff, which carries with it the possibility of disease persistence or recurrence. As such, if the rectal cuff becomes symptomatic or dysplastic, it must be removed. This is accomplished by performing a transanal completion mucosectomy and reconstructing the ileal pouch-anal anastomosis.

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Section: Mucosectomy With Handsewn Versus Double-stapled Anastomosismentioning

confidence: 99%

Completion Mucosectomy for Retained Rectal Mucosa Following Restorative Proctocolectomy with Double-Stapled Ileal Pouch–Anal Anastomosis

Litzendorf

Stucchi

Wishnia

et al. 2010

Journal of Gastrointestinal Surgery

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“…This is much lower than the rate of pouch-anal anastomotic leaks that occured in 5% (177/3542) of our own IPAAs during the past 25 years. 14 Although pouch leak rates fortunately remain low, they may occur more frequently in the setting of redo pouch surgery. During the same queried period, we performed a total of 410 redo pouch procedures, of which 66 (16.1%) had leaks from the tip of the J-pouch.…”

Section: Discussionmentioning

confidence: 99%

Leaks From the Tip of the J-pouch: Diagnosis, Management, and Long-term Pouch Survival

Holubar¹,

Rajamanickam²,

Görgün³

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: The standard of care for surgical treatment of ulcerative colitis is restorative proctocolectomy with ileal J-pouch. Leaks from the tip of the J-pouch are a known complication, but there is a paucity of literature regarding this type of leak. OBJECTIVE: We aimed to describe the diagnosis, management, and long-term clinical outcomes of leaks from the tip of the J-pouch at our institution. DESIGN: This was a retrospective study of a prospectively maintained pouch registry. SETTING: This study was conducted at a quaternary IBD referral center. PATIENTS: Patients included those with ileal J-pouches diagnosed with leaks from the tip of the J-pouch. MAIN OUTCOME MEASURES: The main measures of outcomes were pouch salvage rate, type of salvage procedures, and long-term Kaplan-Meier pouch survival. RESULTS: We identified 74 patients with leaks from the tip of the J-pouch. Pain (68.9%) and pelvic abscess (40.9%) were the most common presentations, whereas 10.8% of patients presented with an acute abdomen. The leak was diagnosed by imaging and/or endoscopy in 74.3% of patients but only discovered during surgical exploration in 25.6% of patients. Some 63.5% of patients were diagnosed only after loop ileostomy closure, whereas 32.4% of patients were diagnosed before ileostomy closure. The most common methods used for diagnosis were pouchoscopy (31.1%) and gastrograffin enema (28.4%). A definitive nonoperative approach was attempted in 48.6% of patients but was successful in only 10.8% of patients overall. Surgical repair was attempted in 89.2% of patients, whereas 4.5% of patients had pouch excision. Salvage operations (n = 63) included sutured or stapled repair of the tip of the J (65%), pouch excision with neo-pouch (25.4%), and pouch disconnection, repair, and reanastomosis (9.5%). Ultimately‚ 10 patients (13.5%) required pouch excision, yielding an overall 5-year pouch survival rate of 86.3%. LIMITATIONS: This was a retrospective review; referral bias may limit the generalizability. CONCLUSIONS: Leaks from the tip of the J-pouch have variable clinical presentations and require a high index of suspicion. Pouch salvage surgery is required in the majority of patients and is associated with a high pouch salvage rate. See Video Abstract at http://links.lww.com/DCR/C50. FUGAS DEL EXTREMO DE LA BOLSA EN J: DIAGNÓSTICO, MANEJO Y SUPERVIVENCIA A LARGO PLAZO DE LA BOLSA ANTECEDENTES: El estándar de atención para el tratamiento quirúrgico de la colitis ulcerosa es la proctocolectomía restauradora con bolsa ileal en J. Las fugas del extremo de la bolsa en J son una complicación conocida, pero hay escasez de literatura sobre este tipo de fuga. OBJETIVO: Describir el diagnóstico, manejo y resultados clínicos a largo plazo de las fugas del extremo de la bolsa en J en nuestra institución. DISEÑO: Estudio retrospectivo de registro de bolsa mantenido prospectivamente. ENTORNO CLINICO: Centro de referencia de enfermedad inflamatoria intestinal cuaternaria. PACIENTES: Pacientes con bolsas ileales en J diagnosti...

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“…Lian et al evaluated 1,965 IPAA procedures and found an AL rate of 5% and fistula formation of 7%. 3 In another large series from Germany with 494 patients, the overall incidence of pouch-related septic complications (PRSCs) was 19.2%. In a 24-year analysis of pediatric patients with FAP undergoing IPAA, Kennedy et al found a low rate of AL or pelvic abscess in their patient cohort (7.4%).…”

Section: Epidemiologymentioning

confidence: 98%

“…Interestingly, they found that functional results at 5 years were better after a leak from a stapled anastomosis compared with an HS anastomosis, specifically with a lower incontinence rate and lower nocturnal seepage rates, likely owing to the height of the anastomosis. 3…”

Section: Sutured Versus Stapled Ileal Pouch-anal Anastomosismentioning

confidence: 99%

Anastomotic Leak after Ileal Pouch–Anal Anastomosis

Guyton

Kearney

Holubar

2021

Clin Colon Rectal Surg

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There are special considerations when treating anastomotic leak after restorative proctocolectomy and ileal pouch–anal anastomosis. The epidemiology, risk factors, anatomic considerations, diagnosis and management, as well as the short- and long-term consequences to the patient are unique to this patent population. Additionally, there are specific concerns such as “tip of the J” leaks, transanal management of anastomotic leak/presacral sinus, functional outcomes after leak, and considerations of redo pouch procedures.

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

Abstract: Outcomes including functional results and pouch failure rates for patients developing a leak after stapled anastomosis at ileal pouch-anal anastomosis were significantly better than outcomes for patients who develop a leak after handsewn anastomosis.

Cited by 19 publications

References 28 publications

Completion Mucosectomy for Retained Rectal Mucosa Following Restorative Proctocolectomy with Double-Stapled Ileal Pouch–Anal Anastomosis

Completion Mucosectomy for Retained Rectal Mucosa Following Restorative Proctocolectomy with Double-Stapled Ileal Pouch–Anal Anastomosis

Leaks From the Tip of the J-pouch: Diagnosis, Management, and Long-term Pouch Survival

Anastomotic Leak after Ileal Pouch–Anal Anastomosis

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