Severity of inflammation as a risk factor for ileo-anal anastomotic leak after a pouch procedure in ulcerative colitis

Zerhouni, Siham; Kirsch, Richard; Bakonyi, April; O’Connor, Brenda I.; Huang, Harden; Cohen, Zane

doi:10.1007/s00384-015-2290-y

Cited by 5 publications

(1 citation statement)

References 28 publications

(40 reference statements)

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“…The majority of studies had small sample sizes, with CIs overlapping one, which reduces statistical confidence in the findings. In the adult literature, anastomotic leak rates range from 5% to 19%, [42][43][44] and there seems to be a trend towards decreased clinically detectable leak rates in the diverted versus undiverted group. 23 This finding does not align with previous literature reporting higher incidence of anastomotic leakage in the undiverted than diverted populations.…”

Section: Discussionmentioning

confidence: 98%

Postoperative complications of colectomy and J-pouch with ileostomy versus without ileostomy in children with inflammatory bowel diseases: a systematic review and meta-analysis

Oltean

Travis

Kaur

et al. 2022

World Jnl Ped Surgery

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BackgroundThe efficacy of performing a restorative proctocolectomy and J-pouch ileoanal anastomosis without diverting ileostomy in children with inflammatory bowel disease has been a longstanding debate. A systematic review and meta-analysis is presented comparing the occurrence of postoperative complications in children who underwent either the pouch-anal anastomosis (IPAA) with ileostomy (diverted) versus the undiverted procedure.MethodsRecords were sourced from CINAHL, CENTRAL, EMBASE and MEDLINE databases. Studies followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and compared postoperative complications in pediatric patients diagnosed with inflammatory diseases aged less than 18 years who underwent J-pouch with ileostomy versus without ileostomy. The primary outcome was the occurrence of postoperative leaks, and the secondary outcomes were presence of postoperative small bowel obstruction (SBO), pouchitis, stricture and fistula complications. A random-effects meta-analysis was used.ResultsTwenty-three observational studies in the systematic review were included with 658 patients (83% diverted, 17% undiverted). Pooled estimates showed no difference in occurrence of leaks in children who underwent J-pouch/IPAA with ileostomy versus without (odds ratio (OR) 0.54, 95% confidence interval (CI) 0.17 to 1.64, I2=16%). There was no difference in the occurrence of SBO, pouchitis or strictures in children who underwent J-pouch/IPAA with ileostomy versus without (SBO: OR 2.27, 95% CI 0.52 to 9.92, I2=0%, pouchitis: OR 1.76, 95% CI 0.95 to 3.24, I2=0%, strictures: OR 2.72, 95% CI 0.44 to 16.69, I2=66%).ConclusionThe meta-analysis did not find differences in the occurrence of complications in pediatric patients who underwent the IPAA with ileostomy procedure versus without ileostomy.

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Section: Discussionmentioning

confidence: 98%

Postoperative complications of colectomy and J-pouch with ileostomy versus without ileostomy in children with inflammatory bowel diseases: a systematic review and meta-analysis

Oltean

Travis

Kaur

et al. 2022

World Jnl Ped Surgery

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Is fecal diversion necessary during ileal pouch creation after initial subtotal colectomy in pediatric ulcerative colitis?

et al. 2019

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Colectomy with ileostomy for severe ulcerative colitis-postoperative complications and risk factors

Schineis

Lehmann

Lauscher

et al. 2019

Int J Colorectal Dis

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Severity of inflammation as a risk factor for ileo-anal anastomotic leak after a pouch procedure in ulcerative colitis

Abstract: Studies with greater power will be required to evaluate the association (if any) between histological severity of UC at the distal margin of a PPP procedure and IAA leak rate. This risk factor could influence preoperative management and post-operative outcome in patients requiring the PPP.

Cited by 5 publications

References 28 publications

Postoperative complications of colectomy and J-pouch with ileostomy versus without ileostomy in children with inflammatory bowel diseases: a systematic review and meta-analysis

Postoperative complications of colectomy and J-pouch with ileostomy versus without ileostomy in children with inflammatory bowel diseases: a systematic review and meta-analysis

Is fecal diversion necessary during ileal pouch creation after initial subtotal colectomy in pediatric ulcerative colitis?

Colectomy with ileostomy for severe ulcerative colitis-postoperative complications and risk factors

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