Functional Outcomes Following Laparoscopic Ileal Pouch-Anal Anastomosis in Patients with Chronic Ulcerative Colitis: Long-Term Follow-up of a Case-Matched Study

Abstract Background The transanal approach to ileal pouch-anal anastomosis [Ta-IPAA] provides better access to the lower pelvis with lower short-term morbidity in ulcerative colitis [UC]. The aim of this study was to assess the long-term functional outcomes after Ta-IPAA vs transabdominal IPAA [Abd-IPAA] in UC. Methods A multicentre cohort analysis was performed between March 2002 and September 2017. Patient characteristics, surgical details and postoperative outcomes were compared. CGQL [Cleveland global quality of life] score at 12 months with a functioning pouch was considered the primary end point. Results A total of 374 patients [100 Ta-IPAA vs 274 Abd-IPAA] were included. Ta-IPAA demonstrated a comparable overall quality of life [CGQL score] to Abd-IPAA [0.75 ± 0.11 vs 0.71 ± 0.14; respectively, p = 0.1]. Quality of life [7.71 ± 1.17 vs 7.30 ± 1.46; p = 0.04] and energy-level items [7.16 ± 1.52 vs 6.66 ± 1.68; p = 0.03] were significantly better after Ta-IPAA, while the quality of health item was comparable [7.68 ± 1.26 vs 7.64 ± 1.44; p = 0.96]. Analysis excluding anastomotic leaks did not change the overall CGQL scores. Stool frequencies [>10/24 h: 22% vs 21%; p = 1.0] and the rate of a single episode of major incontinence during the following 12-month period [27% vs 26%; p = 0.89] were similar. The differences in 30-day morbidity rates [33% vs 41%; p = 0.2] and anastomotic leak rates were not significant [6% vs 13%; p = 0.09]. Conclusions This study provides evidence of comparable long-term functional outcome and quality of life after Ta-IPAA and Abd-IPAA for UC.

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Laparoscopic Ileal Pouch-Anal Anastomosis in Patients with Chronic Ulcerative Colitis and Primary Sclerosing Cholangitis: A Case-Matched Study

Diseases of the Colon & Rectum ◽

10.1007/s10350-008-9250-3 ◽

2008 ◽

Vol 51 (5) ◽

pp. 549-553 ◽

Cited By ~ 7

Author(s):

Luis Benavente-Chenhalls ◽

Kellie L. Mathis ◽

Eric J. Dozois ◽

Robert R. Cima ◽

John H. Pemberton ◽

...

Keyword(s):

Ulcerative Colitis ◽

Primary Sclerosing Cholangitis ◽

Chronic Ulcerative Colitis ◽

Sclerosing Cholangitis ◽

Ileal Pouch ◽

Ileal Pouch Anal Anastomosis ◽

Anal Anastomosis ◽

Matched Study

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Functional Outcomes After Ileal Pouch-Anal Anastomosis for Chronic Ulcerative Colitis

Annals of Surgery ◽

10.1097/00000658-200006000-00017 ◽

2000 ◽

Vol 231 (6) ◽

pp. 919-926 ◽

Cited By ~ 197

Author(s):

Ridzuan Farouk ◽

John H. Pemberton ◽

Bruce G. Wolff ◽

Roger R. Dozois ◽

Scott Browning ◽

...

Keyword(s):

Ulcerative Colitis ◽

Chronic Ulcerative Colitis ◽

Functional Outcomes ◽

Ileal Pouch ◽

Ileal Pouch Anal Anastomosis ◽

Anal Anastomosis

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Comparison of Functional Outcomes of Patients Who Underwent Hand-Sewn or Stapled Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

International Surgery ◽

10.9738/intsurg-d-15-00012.1 ◽

2015 ◽

Vol 100 (7-8) ◽

pp. 1169-1176 ◽

Cited By ~ 11

Author(s):

Hiroaki Ishii ◽

Kazushige Kawai ◽

Keisuke Hata ◽

Yasutaka Shuno ◽

Takeshi Nishikawa ◽

...

Keyword(s):

Ulcerative Colitis ◽

Postoperative Complications ◽

Functional Outcomes ◽

Ileal Pouch ◽

Short Form ◽

Ileal Pouch Anal Anastomosis ◽

Total Proctocolectomy ◽

Sf 36 ◽

Anal Anastomosis

Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for patients with ulcerative colitis (UC). The purpose of this study was to investigate the long-term functional outcomes and quality of life (QOL) associated with hand-sewn and stapled IPAA. Ninety-one patients with UC had undergone IPAA using hand-sewn anastomosis with mucosectomy (32 patients) or stapled anastomosis (59 patients) from January 1988 to May 2010. Patients were evaluated according to patient characteristics, postoperative complications, functional outcomes and QOL. The QOL of patients were evaluated using the Medical Outcomes Study Short Form 36 (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ). Numbers of patients with colorectal cancer or dysplasia were significantly greater in the hand-sewn IPAA group (P < 0.01). These patients had longer disease durations and were older (both P < 0.01). There was no difference in the incidence of complications between the groups, except for a greater incidence of postoperative anal fistula in the stapled group (P = 0.03). In the early postsurgery period, both the frequency of bowel movements and the rate of soiling were significantly higher in the hand-sewn group, but in a later period, there was no difference in these events >3 years after surgery. The SF-36 and IBDQ results were similar in the two groups, indicating that hand-sewn and stapled IPAA result in similar QOL in the late postoperative period. Postoperative complications, functional outcomes, and long-term QOL were similar in patients who had received hand-sewn or stapled IPAA.

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Short- and long-term outcomes of ileal pouch-anal anastomosis for ulcerative colitis

Revista do Hospital das Clínicas ◽

10.1590/s0041-87812003000400002 ◽

2003 ◽

Vol 58 (4) ◽

pp. 193-198 ◽

Cited By ~ 3

Author(s):

Magaly Gemio Teixeira ◽

Adauto C. Abreu da Ponte ◽

Manuela Sousa ◽

Maristela G. de Almeida ◽

Edésio Silva Filho ◽

...

Keyword(s):

Ulcerative Colitis ◽

Ileal Pouch ◽

Severe Disease ◽

Functional Results ◽

Late Complications ◽

Ileal Pouch Anal Anastomosis ◽

Early Complications ◽

Anal Anastomosis

Ileal pouch-anal anastomosis was an important advancement in the treatment of ulcerative colitis. The aim of this study was to determine whether early complications of ileal pouch-anal anastomosis in patients with ulcerative colitis are associated with poor late functional results. PATIENTS AND METHODS: Eighty patients were operated on from 1986 to 2000, 62 patients with ileostomy and 18 without. The early and late complications were recorded. Specific emphasis has been placed on the incidence of pouchitis with prolonged follow-up. RESULTS: The ileostomy was closed an average of 9.2 months after the first operation. Fourteen patients were excluded from the long-term evaluation; 6 patients were lost to regular follow-up, 4 died, and 4 patients still have the ileostomy. Of the 4 patients that died, 1 died from surgical complications. Early complications after operation (41) occurred in 34 patients (42.5%). Late complications (29) occurred in 25 patients as follows: 16 had pouchitis, 3 associated with stenosis and 1 with sexual dysfunction; 5 had stenosis; and there was 1 case each of incisional hernia, ileoanal fistula, hepatic cancer, and endometriosis. Pouchitis occurred in 6 patients (9.8%) 1 year after ileal pouch-anal anastomosis, 9 (14.8%) after 3 years, 13 (21.3%) after 5 years, and 16 (26.2%) after more than 6 years. The mean daily stool frequency was 12 before and 5.8 after operation. One pouch was removed because of fistulas that appeared 2 years later. CONCLUSIONS: Ileal pouch-anal anastomosis is associated with a considerable number of early complications. There was no correlation between pouchitis and severe disease, operation with or without ileostomy, or early postoperative complications. The incidence of pouchitis was directly proportional to duration of time of follow-up.

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De novo Crohn's Disease after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis and Inflammatory Bowel Disease Unclassified: Long-Term Follow-Up of a Prospective Inflammatory Bowel Disease Registry

The American Surgeon ◽

10.1177/000313481608201026 ◽

2016 ◽

Vol 82 (10) ◽

pp. 977-981 ◽

Cited By ~ 9

Author(s):

Karen Zaghiyan ◽

Jan P. Kaminski ◽

Galinos Barmparas ◽

Phillip Fleshner

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Ileal Pouch ◽

De Novo ◽

Anal Anastomosis ◽

Long Term Follow Up ◽

Inflammatory Bowel

The risk of de novo Crohn's disease (CD) after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) versus inflammatory bowel disease unclassified (IBDU) or indeterminate colitis (IC) remains debatable. Here, we present updated results after long-term follow-up of a previously studied cohort of 334 patients with UC, IBDU, or IC who underwent IPAA during a 10-year period ending 2007. Of 334 study patients, 56 per cent were male and median age was 38 years (range: 8–81). Patients were classified as UC (n = 237) or IBDU (n = 97) preoperatively and UC (n = 236) or IC (n = 98) postoperatively. After a median follow-up of 76 months (range: 3–236), 63 patients (19%) developed CD within a median of 22 months (range: 1–213) from ileostomy closure compared with the previously published 40 patients (12%) with 26-month follow-up ( P = 0.01). The development of de novo CD was similar for patients undergoing IPAA for UC (n = 40; 17%), IBDU (n = 21; 22%) or those classified as having UC (n = 42; 18%) or IC (n = 19; 19%) postoperatively; P > 0.05. Thus, patients with IBDU and IC can expect equivalent long-term outcome to patients with UC after IPAA. Pouch failure occurred in 13 (4%) study patients and was equal among all four groups.

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