Pouch excision: indications and outcomes

Lightner, Amy L.; Dattani, Sheev; Dozois, Eric J.; Moncrief, Sara B.; Pembérton, John H.; Mathis, Kellie L.

doi:10.1111/codi.13673

Cited by 49 publications

(27 citation statements)

References 18 publications

(37 reference statements)

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“…The reported rate of pelvic sepsis has decreased to 4.6% in the past 5 years from 11.1% before 2013, and pouch failure rates have fallen to 1.1% in the same period from 6.0% before 2013 [15][16][17][18][19][20]. The proportion of cases with no complication recorded has increased from 74.3% before 2013 to 83.8% after (Table 4).…”

Section: Postoperative Complicationsmentioning

confidence: 99%

Review of current practice and outcomes following ileoanal pouch surgery: lessons learned from the Ileoanal Pouch Registry and the 2017 Ileoanal Pouch Report

et al. 2018

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Section: Postoperative Complicationsmentioning

confidence: 99%

Review of current practice and outcomes following ileoanal pouch surgery: lessons learned from the Ileoanal Pouch Registry and the 2017 Ileoanal Pouch Report

et al. 2018

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“…The literature on ileoanal pouch excision is even more limited than that on re-do, with a total of just under 400 cases described from five centres [454,[700][701][702][703][704][705]. Two publications each from two of these institutions report patients from the same cohort.…”

Section: Pouch Excisionmentioning

confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

et al. 2018

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Aim There is a requirement of an expansive and up to date review of surgical management of inflammatory bowel disease (IBD) that can dovetail with the medical guidelines produced by the British Society of Gastroenterology. Methods Surgeons who are members of the ACPGBI with a recognised interest in IBD were invited to contribute various sections of the guidelines. They were directed to produce a procedure based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. An editorial board was convened to ensure consistency of style, presentation and quality. Each author was asked to provide a set of recommendations which were evidence based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after 2 votes were included in the guidelines. Results All aspects of surgical care for IBD have been included along with 157 recommendations for management. Conclusion These guidelines provide an up to date and evidence based summary of the current surgical knowledge in the management of IBD and will serve as a useful practical text for clinicians performing this type of surgery.

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“…IPAA revisions are technically demanding procedures that require significant expertise, may necessitate referral to a specialty centre and may have long-term function consequences, while accepting an excision and permanent ileostomy can have a profound impact on the patient's perceived quality of life [13][14][15][16][17][18]. Currently, only data from single institution series performed in highly specialized centres are available to inform surgical decision-making surrounding these uncommon reoperative pouch procedures [11,16,[19][20][21][22][23][24][25][26]. No multi-institutional data from a broad range of hospitals are available to inform surgeons and patients about what to expect in the perioperative period in terms of short-term surgical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Ileal pouch revision vs excision: short‐term (30‐day) outcomes from the National Surgical Quality Improvement Program

et al. 2018

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Aim Ileal pouch–anal anastomosis (IPAA) failure occurs in approximately 5%–10% of patients. We aimed to compare short‐term (30‐day) postoperative outcomes associated with pouch revision and pouch excision using a large international database. Our null hypothesis was that there is no statistically significant difference in overall postoperative complications between patients selected for pouch revision vs pouch excision. Methods Using the American College of Surgeons National Surgical Quality Improvement Program Participant User File from 2005 to 2016 we identified patients who underwent either IPAA revision via the combined abdominoperineal approach [Current Procedural Terminology (CPT) 46712] or IPAA excision (CPT 45136). Differences in baseline characteristics and short‐term outcomes between groups were assessed with univariate and matched analyses. Results We identified 593 reoperative IPAA procedures: revision group 78 (13%) and excision group 515 (86%). The groups had similar age and body mass index (kg/m2), but the revision group had more women (65.4% vs 51.8%, P = 0.02) and fewer were on chronic steroids (3.9% vs 17.9%, P = 0.0008) relative to the excision group. Revision IPAA patients were more likely to have received a preoperative transfusion (5.1% vs 0.97%, P = 0.02). Revision and excision were associated with similar postoperative length of stay (9.3 vs 8.6 days, 0.44), mortality (nil vs 0.58%, respectively; P = 0.99) and short‐term morbidity (34.6% vs 40.2%, respectively; P = 0.88) at 30 days. Conclusions Pouch revision and excision have comparable short‐term postoperative outcomes, but pouch excision appears to be more commonly utilized. Increased awareness of the indications for pouch revision or referral to specialized centres may improve pouch revision rates.

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Pouch excision: indications and outcomes

Cited by 49 publications

References 18 publications

Review of current practice and outcomes following ileoanal pouch surgery: lessons learned from the Ileoanal Pouch Registry and the 2017 Ileoanal Pouch Report

Review of current practice and outcomes following ileoanal pouch surgery: lessons learned from the Ileoanal Pouch Registry and the 2017 Ileoanal Pouch Report

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

Ileal pouch revision vs excision: short‐term (30‐day) outcomes from the National Surgical Quality Improvement Program

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