809 OPTIMIZATION OF OUTCOMES IN PATIENTS UNDERGOING RE-DO SURGERY FOR A FAILED ILEAL POUCH ANAL ANASTOMOSIS DUE TO PELVIC SEPSIS

AbstractObjectiveWe hypothesized that postoperative oral steroid taper after ileal pouch-anal anastomosis for inflammatory bowel disease would not be associated with pelvic septic complications.BackgroundRecent data has emphasized the possible association between biologic medication use and pelvic sepsis following ileal pouch-anal anastomosis. Limited contemporary data exist examining the effects of steroid use on these complications.MethodsConsecutive patients undergoing ileal pouch-anal anastomosis for inflammatory bowel disease at a single institution from January 2009 to December 2013 were included. Factors associated with anastomotic leak and pelvic sepsis were assessed using univariate and multivariate analysis.ResultsA total of 686 patients were included (mean age 39.5 years, 59% males). Postoperative oral steroid taper was associated with both anastomotic leak and pelvic sepsis on univariate analysis. Stress dose intravenous steroid use was not associated with complications. Multivariate analysis indicated total proctocolectomy (odds ratio [OR] 2.2; confidence interval [CI] 1.01–4.7, P = 0.047), and postoperative oral steroid taper (OR 2.3; CI 1.06–5.1; P = 0.035) as independent factors significantly associated with pelvic sepsis.ConclusionsProlonged postoperative oral steroid taper after ileal pouch-anal anastomosis should be avoided. If preoperative steroid weaning is not possible before a planned total proctocolectomy and ileal pouch-anal anastomosis, patients should undergo an initial total abdominal colectomy.

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Factors associated with failure in managing pelvic sepsis after ileal pouch-anal anastomosis (IPAA) – A multivariate analysis

Surgery ◽

10.1016/j.surg.2006.07.015 ◽

2006 ◽

Vol 140 (4) ◽

pp. 691-704 ◽

Cited By ~ 60

Author(s):

Ismail Sagap ◽

Feza H. Remzi ◽

Jeffrey P. Hammel ◽

Victor W. Fazio

Keyword(s):

Multivariate Analysis ◽

Ileal Pouch ◽

Ileal Pouch Anal Anastomosis ◽

Pelvic Sepsis ◽

Factors Associated ◽

Anal Anastomosis

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Rare complication after ileal pouch-anal anastomosis: Bilateral ureteral obstruction due to pelvic sepsis and retroperitoneal fibrosis

Surgical Practice ◽

10.1111/j.1744-1633.2012.00586.x ◽

2012 ◽

Vol 16 (2) ◽

pp. 81-83 ◽

Cited By ~ 1

Author(s):

Leonardo Maciel da Fonseca ◽

Cristiane de Souza Bechara ◽

Conrado Leonel Menezes ◽

Carlos Eduardo Corradi Fonseca ◽

Rodrigo Gomes da Silva

Keyword(s):

Ureteral Obstruction ◽

Ileal Pouch ◽

Retroperitoneal Fibrosis ◽

Rare Complication ◽

Ileal Pouch Anal Anastomosis ◽

Pelvic Sepsis ◽

Anal Anastomosis

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Ileal pouch-anal anastomosis (IPAA): functional outcome after postoperative pelvic sepsis

International Journal of Colorectal Disease ◽

10.1007/s00384-004-0717-y ◽

2005 ◽

Vol 20 (6) ◽

pp. 529-533 ◽

Cited By ~ 20

Author(s):

Helena Hallberg ◽

Dagny Ståhlberg ◽

Jan-Erik Åkerlund

Keyword(s):

Functional Outcome ◽

Ileal Pouch ◽

Ileal Pouch Anal Anastomosis ◽

Pelvic Sepsis ◽

Anal Anastomosis

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Factors associated with failure in managing pelvic sepsis after ileal pouch-anal anastomosis (IPAA)—A multivariate analysis

Yearbook of Gastroenterology ◽

10.1016/s0739-5930(08)70195-8 ◽

2007 ◽

Vol 2007 ◽

pp. 242-243

Author(s):

J.L. Rombeau

Keyword(s):

Multivariate Analysis ◽

Ileal Pouch ◽

Ileal Pouch Anal Anastomosis ◽

Pelvic Sepsis ◽

Factors Associated ◽

Anal Anastomosis

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Outcome of Ileal Pouch-anal Anastomosis in Patients With Indeterminate Colitis: A Systematic Review and Meta-analysis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa002 ◽

2020 ◽

Vol 14 (7) ◽

pp. 1010-1020

Author(s):

Sameh Hany Emile ◽

Hayim Gilshtein ◽

Steven D Wexner

Keyword(s):

Systematic Review ◽

Crohn’S Disease ◽

Ileal Pouch ◽

Meta Analysis ◽

Ileal Pouch Anal Anastomosis ◽

Pelvic Sepsis ◽

Indeterminate Colitis ◽

Weighted Mean ◽

Pouch Failure ◽

Anal Anastomosis

Abstract Background Indeterminate colitis [IC] is type of inflammatory bowel disease that exhibits features of both ulcerative colitis [UC] and Crohn’s disease [CD]. The present meta-analysis aimed to assess the outcomes of ileal pouch-anal anastomosis [IPAA] in patients with IC in comparison with patients with UC. Methods A PRISMA-compliant systematic review of the outcome of IPAA in patients with IC was conducted. Electronic databases were searched, and full-text articles were reviewed to extract essential data. Main outcome measures were pouch failure and pouch-related complications. Results A total of 17 studies were included in this meta-analysis. There were 1057 patients with IC and 6511 patients with UC. The weighted mean pouch failure rate in patients with IC was 7.5 (95% confidence interval [CI]: 4.8–10.2) and the weighted mean complication rate was 67 [95% CI: 53.5–80.5]. As compared with patients with UC, patients with IC had significantly higher odds of developing complications after IPAA (odds ratio [OR]: 2.6, p <0.001): pouch fistula [OR:4.98, p <0.001], pelvic sepsis [OR:3.98, p =0.002], pelvic or cuff abscess [OR: 4.5, p <0.001], perineal complications [OR: 5.13, p <0.001], and ultimate diagnosis of CD [OR: 2.57, p <0.001]. Patients with IC and UC had similar odds of pouch failure, pouchitis, anastomotic leak, stricture, and small bowel obstruction. Conclusions Patients with IC had similar pouch failure rates, yet higher overall complication rates than patients with UC. Complications that tend to be higher after IPAA for patients with IC include pouch fistula, pelvic sepsis, abscess, perineal complications, and ultimate diagnosis of Crohn’s disease.

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P268 Ileal Pouch-Anal Anastomosis Complications and Pouch Failure: A Systematic Review and Meta-Analysis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.393 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S303-S303

Author(s):

L Heuthorst ◽

K Wasmann ◽

M Reijntjes ◽

R Hompes ◽

C Buskens ◽

...

Keyword(s):

Systematic Review ◽

Ileal Pouch ◽

Meta Analysis ◽

Ileal Pouch Anal Anastomosis ◽

Fistula Formation ◽

Pelvic Sepsis ◽

Pouch Failure ◽

Anal Anastomosis

Abstract Background Previous studies demonstrated wide variation in postoperative complication rates following ileal pouch-anal anastomosis (IPAA). This systematic review aims to assess the incidence of pouch failure and the correlation between IPAA-related complications and pouch failure. Methods A systematic review was performed by searching the MEDLINE, EMBASE, and Cochrane Library databases for studies reporting on pouch failure published from 1 January 2010 to 6 May 2020. A meta-analysis was performed using a random effects model. 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%CI5.56–10.59) and 10.3% (95%CI7.24–14.30) for studies with a median follow-up of ≥5 years 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). Conclusion 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 increased risk of pouch failure. Pouch survival may be improved through standardized assessment of anastomotic integrity for early identification and adequate management of anastomotic leaks.

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