Rectal eversion: safe and effective way to achieve low transaction in minimally invasive Ileal pouch-anal anastomosis surgery, short- and long-term outcomes

Cataneo, Jose L.; Mowschenson, Peter; Cataldo, Thomas E.; Poylin, Vitaliy

doi:10.1007/s00464-019-06896-7

Cited by 2 publications

(1 citation statement)

References 12 publications

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“… 19 , 46 , 49 , 54 Anastomotic leak was defined as any defect at the anastomotic site confirmed by imaging or during surgical reintervention in 7 studies 16 , 20 , 23 , 24 , 55 , 56 and was undefined in 9 studies. 21 , 32 , 33 , 36 , 41 , 48 , 49 , 52 , 53 Pelvic sepsis included pelvic abscesses with or without anastomotic leak 20 , 23 , 31 , 32 , 36 , 39 , 41 , 43 , 46 , 52 in 10 studies; included anastomotic leaks, pelvic abscesses, and fistulas in 2 studies 21 , 45 ; and was undefined in 4 studies. 34 , 37 , 47 , 53 Fistula was defined as a fistula originating from anywhere in the pouch in 10 studies 16 , 20 , 23 , 31 , 33 , 34 , 39 , 44 , 50 , 53 ; originating from the anastomosis only in 1 study 48 ; and was undefined in 7 studies.…”

Section: Resultsmentioning

confidence: 99%

Ileal Pouch-anal Anastomosis Complications and Pouch Failure

Heuthorst

Wasmann

Reijntjes

et al. 2021

Annals of Surgery Open

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Objective: This systematic review aims to assess the incidence of pouch failure and the correlation between ileal pouch-anal anastomosis (IPAA)-related complications and pouch failure. Background: Previous studies demonstrated wide variation in postoperative complication rates following IPAA. Methods: A systematic review was performed by searching the MEDLINE, EMBASE, and Cochrane Library databases for studies reporting on pouch failure published from January 1, 2010, to May 6, 2020. A meta-analysis was performed using a random-effects model, and the relationship between pouch-related complications and pouch failure was assessed using Spearman’s correlations. Results: Thirty studies comprising 22,978 patients were included. Included studies contained heterogenic patient populations, different procedural stages, varying definitions for IPAA-related complications, and different follow-up periods. The pooled pouch failure rate was 7.7% (95% confidence intervals: 5.56–10.59) and 10.3% (95% confidence intervals: 7.24–14.30) for studies with a median follow-up of ≥5 and ≥10 years, respectively. Observed IPAA-related complications were anastomotic leakage (1–17%), pelvic sepsis (2–18%), fistula (1–30%), stricture (1–34%), pouchitis (11–61%), and Crohn’s disease of the pouch (0–18%). Pelvic sepsis (r = 0.51, P < 0.05) and fistula (r = 0.63, P < 0.01) were correlated with pouch failure. A sensitivity analysis including studies with a median follow-up of ≥5 years indicated that only fistula was significantly correlated with pouch failure (r = 0.77, P < 0.01). Conclusions: The single long-term determinant of pouch failure was pouch fistula, which is a manifestation of a chronic leak. Therefore, all effort should be taken to prevent an acute leak from becoming a chronic leak by early diagnosis and proactive management of the leak. Mini abstract: This systematic review aims to assess the incidence of pouch failure and the correlation between IPAA-related complications and pouch failure. Long-term pouch failure was correlated with fistula, suggesting that early septic complications may result in fistula formation during long-term follow-up, leading to an increased risk of pouch failure.

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