The ileoanal pouch procedure in the long–term perspective: a critical review

Delaini, Gian Gaetano; Scaglia, Marco; Colucci, Gianluca; Hultén, L.

doi:10.1007/s10151-005-0225-2

Cited by 27 publications

(18 citation statements)

References 26 publications

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“…Surveillance flexible pouchoscopy is recommended annually in patients at high risk of neoplastic transformation and every 5 years in others [41]. Delaini et al [73] suggest that intense follow-up and research-based evidence are important in maintaining RPC as the criterion standard procedure for surgical treatment of UC. Although RPC risk surveillance is costly [41], the good news is that the incidence of carcinoma in the ileal pouch or anorectal mucosa appears to be rare during the first 10 years after RPC.…”

Section: Resultsmentioning

confidence: 99%

Pouch-related dysplasia and adenocarcinoma following restorative proctocolectomy for ulcerative colitis

M’Koma

2011

Tech Coloproctol

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Background Restorative proctocolectomy (RPC) is the criterion standard surgical treatment for ulcerative colitis (UC). Restorative proctocolectomy is indicated for UC that is refractory to medical treatment, for emergency conditions, and in case of neoplastic transformation. The procedure substantially reduces the risk of UC-associated dysplasia/neoplasia. However, after RPC surgery, even with mucosectomy, cancers of the pouch and/or the anal-transitional zone (ATZ) have been reported with increasing frequency since the first report in 1984. This review highlights pouch-related dysplastic and neoplastic transformation, prevalence and adverse events, risk factors and surveillance following surgery for UC. Methods Reports in the literature about patients undergoing pouch surgery from different institutions reported through May 2010 were reviewed to identify patients who developed these complications, and an attempt was made to develop a rational follow-up policy based on the data available. Results To date, there are 43 reported cancers of the pouch or inlet after RPC for UC: 16 from retrospective series, 1 from a prospective study, and 26 in case reports. Thirty patients underwent mucosectomy and 13 had stapled anastomoses. To date, the number of 28 patients has been diagnosed with dysplasia after RPC for UC. Mucosectomy was performed in 27 of them and in 1 a stapled anastomosis was constructed without mucosectomy. In all cases reviewed, the time interval from the onset of UC to dysplasia/neoplasia was over 10 years. Conclusion Neoplastic lesions occurring in UC patients after RPC have been shown to be absolutely inevitable. Even mucosectomy does not completely eliminate the risk. There is little evidence to support routine biopsy of the ileal mucosa or the anal-transition zone except in patients with histological type C changes, sclerosing cholangitis, and unremitting pouchitis in the ileal mucosa. Such patients should be selected for endoscopic surveillance to detect dysplasia preceding pouch adenocarcinoma.

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Section: Resultsmentioning

confidence: 99%

Pouch-related dysplasia and adenocarcinoma following restorative proctocolectomy for ulcerative colitis

M’Koma

2011

Tech Coloproctol

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“…These adverse factors will need to be weighed against the alternative outcome of a permanent stoma, which may be high output through loss of a substantial length of ileum originally used to create the pouch. 13 CONCLUSIONS Anastomotic leak after RPC and IPAA often can be managed by conservative or local procedures. For patients who need a laparotomy to control sepsis, the literature indicates that conventional management results in pouch failure in up to half of the patients.…”

Section: Discussionmentioning

confidence: 98%

Parking the Pouch: Pouch Salvage After Anastomotic Leak Following Restorative Proctocolectomy. Report of a Case

Maruthachalam¹,

Kumar²,

Hainsworth³

2008

Diseases of the Colon &Amp; Rectum

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Anastomotic leak is a feared complication after restorative proctocolectomy with formation of an ileal pouch. We describe the use of a technique that is appropriate for profound anastomotic failure in the immediate postoperative period, which will aid in controlling sepsis and may allow salvage of the pouch. A 59-year-old man who failed medical treatment underwent restorative proctocolectomy and ileal pouch-anal anastomosis as a single-stage procedure. The patient developed an anastomotic leak that was not controlled by defunctioning stoma formation. Further surgery was undertaken and the pouch was exteriorized as a mucous fistula. A redo pouch-anal anastomosis was performed 12 months after the original procedure. The patient has good functional outcome with complete continence. Anastomotic leak after restorative proctocolectomy and ileal pouch-anal anastomosis often can be managed by conservative or local procedures. Laparotomy may be required rarely, but this subgroup is associated with pouch failure in up to half of the patients. Awareness that the ileal pouch-anal anastomosis can be taken down and the pouch temporarily parked in the abdominal cavity may persuade surgeons to retain a pouch with the knowledge that the acute pelvic sepsis after an anastomotic leak can be safely treated.

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“…Dans une série de 204 AIA pour maladie de Crohn (diagnostic connu en préopératoire ou découverte à la suite de l'intervention), le taux global de conservation du réservoir était de 71 %. Les meilleurs résultats (taux élevé de conservation du réservoir et résultats fonctionnels) étaient observés chez les patients dont le diagnostic était connu avant l'intervention [28] ; le risque de laisser en place un reste de muqueuse au niveau du canal anal en cas d'anastomose mécanique [29] ; les techniques chirurgicales pour descendre le réservoir dans le pelvis [30] ; le risque de stérilité chez les femmes en rapport probablement avec les adhérences tubaires et l'apport de la laparoscopie [31][32][33][34]. Les premiers travaux avaient montré une réduction majeure de la fertilité des femmes après AIA [35].…”

Section: Discussionunclassified

Proctocolectomy and ileal pouch-anal anastomosis

Lefèvre

2009

Colon Rectum

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Une technique de coloproctectomie évitant la confection d'une iléostomie définitive a été développée pour les patients atteints d'une rectocolite hémorragique ou d'une polypose adénomateuse familiale. Après l'exérèse de l'intégralité des organes malades, un réservoir utilisant l'iléon terminal est confectionné et descendu au travers du canal anal après mucosectomie, et une anastomose iléo-anale est alors réalisée. Vingt et un patients (17 rectocolites hémorragiques et quatre polyposes) ont été traités, et 20 ont été suivis entre 2 et 34 mois (délai moyen 13,5 mois). La mortalité fut nulle, et neuf patients ont présenté une complication précoce. Tous les patients sont, actuellement, en bon état général sans retentissement sexuel ou urinaire. La continence diurne aux selles était parfaite, et un patient avait des épisodes d'incontinence la nuit. Le nombre moyen de selles était de 3,8 par 24 heures. Dix patients avaient des exonérations sans manoeuvres. Tous les patients avaient un régime alimentaire normal, et seulement deux prenaient un ralentisseur du transit. Cette intervention semble être une alternative à la coloproctectomie associée à une iléostomie définitive.Mots clés Côlon · Rectum · Coloproctectomie · Anastomose iléo-anale · Rectocolite hémorragique · Polypose adénomateuse familiale Abstract A technique of proctocolectomy avoiding an ileostomy has been developed for patients with chronic ulcerative colitis or polyposis coli. After excision of all diseased tissue a reservoir of terminal ileum is constructed and brought up through the anal canal after performing a mucosectomy; an ileo-anal anastomosis is then carried out.Twenty one patients (17 chronic ulcerative colitis, 4 polyposis) were treated and 20 followed for between 2 to 34 months (average 13.5 months). There was no mortality but early complications occurred in 9 patients. All patients are currently well, with no disturbance of urinary or sexual function. Continence of faeces was perfect in all patients during the day, and 1 patient has episodic nocturnal incontinence. The average frequency of evacuation is 3.8 times in 24 hours. Ten patients void spontaneously. All patients tolerate a full diet and only 2 use peristalsis slowdown medication. This operation appears to be a satisfactory alternative to proctocolectomy with a permanent ileostomy.

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The ileoanal pouch procedure in the long–term perspective: a critical review

Cited by 27 publications

References 26 publications

Pouch-related dysplasia and adenocarcinoma following restorative proctocolectomy for ulcerative colitis

Pouch-related dysplasia and adenocarcinoma following restorative proctocolectomy for ulcerative colitis

Parking the Pouch: Pouch Salvage After Anastomotic Leak Following Restorative Proctocolectomy. Report of a Case

Proctocolectomy and ileal pouch-anal anastomosis

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