Results and Complications after Ileal Pouch Anal Anastomosis: A Meta-Analysis of 43 Observational Studies Comprising 9,317 Patients

Hueting, Willem E.; Buskens, Erik; Tweel, Ingeborg van der; Gooszen, Hein G.; Laarhoven, Cees J. H. M. van

doi:10.1159/000085356

Cited by 265 publications

(186 citation statements)

References 81 publications

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“…Fecundity among women with UC before surgery is comparable to a control population of women without UC, but is only 20 % of fecundity rates of controls aft er IPAA ( 326 ). Approximately 20 % of women will have dyspareunia or fecal incontinence during intercourse during a 3-year follow-up aft er IPAA ( 320 ). A meta-analysis of 43 observational studies found a 4 % risk of sexual dysfunction in men postoperatively ( 320 ).…”

Section: Recommendations For Surgerymentioning

confidence: 99%

“…Nevertheless, there is increasing recognition of the potential complications following IPAA ( 319 ). Besides pouchitis (see below), which may occur in up to 50 % of patients during long-term follow-up, a variety of surgical complications may ensue ( 320 ). A meta-analysis of 17 series of nearly 1,500 patients undergoing IPAA found that when this surgery was performed without a diverting ileostomy, functional outcomes were similar to those of surgery with proximal diversion but there was an increased risk of anastomotic leak.…”

Section: The Patient With Severe Colitis Refractory To Maximal Oral Tmentioning

confidence: 99%

“…Approximately 20 % of women will have dyspareunia or fecal incontinence during intercourse during a 3-year follow-up aft er IPAA ( 320 ). A meta-analysis of 43 observational studies found a 4 % risk of sexual dysfunction in men postoperatively ( 320 ). However, most men note improvement in overall sexual quality of life aft er IPAA, likely due to improvement in general health ( 327 ).…”

Section: Recommendations For Surgerymentioning

confidence: 99%

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Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,145

977

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Guidelines for clinical practice are aimed to indicate preferred approaches to medical problems as established by scientifi cally valid research. Double-blind placebo controlled studies are preferable, but compassionate-use reports and expert review articles are used in a thorough review of the literature conducted through Medline with the National Library of Medicine. When only data that will not withstand objective scrutiny are available, a recommendation is identifi ed as a consensus of experts. Guidelines are applicable to all physicians who address the subject regardless of specialty training or interests and are aimed to indicate the preferable but not necessarily the only acceptable approach to a specifi c problem. Guidelines are intended to be fl exible and must be distinguished from standards of care, which are infl exible and rarely violated. Given the wide range of specifi cs in any healthcare problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the board of trustees. Each has been intensely reviewed and revised by the Committee, other experts in the fi eld, physicians who will use them, and specialists in the science of decision analysis. The recommendations of each guideline are therefore considered valid at the time of composition based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at a time established and indicated at publication to assure continued validity. The recommendations made are based on the level of evidence found. Grade A recommendations imply that there is consistent level 1 evidence (randomized controlled trials), grade B indicates that the evidence would be level 2 or 3, which are cohort studies or case -control studies. Grade C recommendations are based on level 4 studies, meaning case series or poor-quality cohort studies, and grade D recommendations are based on level 5 evidence, meaning expert opinion.

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Section: Recommendations For Surgerymentioning

confidence: 99%

Section: The Patient With Severe Colitis Refractory To Maximal Oral Tmentioning

confidence: 99%

Section: Recommendations For Surgerymentioning

confidence: 99%

See 1 more Smart Citation

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,145

977

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“…However, a poor functional result or pouch-related complications may force permanent faecal diversion with or without pouch excision and therefore, by definition, failure of the pouch. This occurs in approximately 20% of cases depending on the length of follow-up [7]. The most important risk factors for pouch failure are pelvic sepsis [8][9][10][11], Crohn's disease (CD), chronic antibiotic-resistant pouchitis, and 'idiopathic' pouch dysfunction [9,12,13].…”

Section: Introductionmentioning

confidence: 99%

Pouch failures following ileal pouch–anal anastomosis for ulcerative colitis

et al. 2018

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Aim Ileal pouch-anal anastomosis is a procedure offered to patients with ulcerative colitis who opt for restoration of bowel continuity. The aim of this study was to determine the risk of pouch failure and ascertain the risk factors associated with failure. MethodThe study included 1991 patients with ulcerative colitis who underwent ileal pouch-anal anastomosis in Denmark in the period 1980-2013. Pouch failure was defined as excision of the pouch or presence of an unreversed stoma within 1 year after its creation. We used Cox proportional hazards regression to explore the association between pouch failure and age, gender, synchronous colectomy, primary faecal diversion, annual hospital volume (very low, 1-5 cases per year; low, 6-10; intermediate 11-20; high > 20), calendar year, laparoscopy and primary sclerosing cholangitis.Results Over a median 11.4 years, 295 failures occurred, corresponding to 5-, 10-and 20-year cumulative risks of 9.1%, 12.1% and 18.2%, respectively. The risk of failure was higher for women [adjusted hazard ratio (aHR) 1.39, 95% CI 1.10-1.75]. Primary nondiversion (aHR 1.63, 95% CI 1.11-2.41) and a low hospital volume (aHR, very low volume vs high volume 2.30, 95% CI 1.26-4.20) were also associated with a higher risk of failure. The risk of failure was not associated with calendar year, primary sclerosing cholangitis, synchronous colectomy or laparoscopy.Conclusion In a cohort of patients from Denmark (where pouch surgery is centralized) with ulcerative colitis and ileal pouch-anal anastomosis, women had a higher risk of pouch failure. Of modifiable factors, low hospital volume and non-diversion were associated with a higher risk of pouch failure.

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“…1 There are several reasons for failure: septic complications, anastomotic complications, irritable pouch syndrome (IPS) and pouchitis, being the most frequent. 4,5 Data on health-related quality of life (HQoL) also show satisfactory results for a majority of pouch-operated patients. 6,7 However, reported results regarding sexual function, i.e.…”

Section: Introductionmentioning

confidence: 99%

Sexual function after failed ileal pouch-anal anastomosis

Bengtsson¹,

Lindholm²,

Nordgren³

et al. 2011

Journal of Crohn's and Colitis

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Background and Aims: Failure of ileal pouch-anal anastomosis (IPAA) occurs in around 10% of the patients. Compared to patients with functioning pouches, health related quality of life is deteriorated after failure. Sexual function in patients with pouch failure is however poorly studied. The aim was to study sexual function in patients with pelvic pouch failure; patients with functioning pouches were used as controls. The hypothesis was that patients with pouch failure have worse sexual function. Methods: 36 patients with pouch failure were compared with 72 age and sex-matched controls with ulcerative colitis and functioning pouches. The patients answered a set of questionnaires concerning sexual function (Female Sexual Function Index [FSFI] and International Index of Erectile Function [IIEF]), body image (BIS-scale) and health-related quality of life (SF-36). Results: Both women and men with pouch failure scored lower than controls in the FSFI and IIEF questionnaires. However, none of the observations were statistically significant. The scores in the failure group (for both sexes) were below the cut-off level for sexual dysfunction. Scores for the BIS instrument were significantly lower for both sexes in the failure group. Women and men in the failure group scored lower than the controls in all domains of the SF-36, however statistically significant only for the social function domain in men. Conclusions: The hypothesis, that a failed IPAA is associated with worse sexual function, was not confirmed. Compared to patients with functioning pouches, patients with pouch failure have inferior body image.

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Results and Complications after Ileal Pouch Anal Anastomosis: A Meta-Analysis of 43 Observational Studies Comprising 9,317 Patients

Cited by 265 publications

References 81 publications

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Pouch failures following ileal pouch–anal anastomosis for ulcerative colitis

Sexual function after failed ileal pouch-anal anastomosis

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