scholarly journals Threefold increased risk of infertility: a meta-analysis of infertility after ileal pouch anal anastomosis in ulcerative colitis

Gut ◽  
2006 ◽  
Vol 55 (11) ◽  
pp. 1575-1580 ◽  
Author(s):  
A Waljee ◽  
J Waljee ◽  
A M Morris ◽  
P D R Higgins
Keyword(s):  
Ulcerative Colitis ◽  
Ileal Pouch ◽  
Meta Analysis ◽  
Ileal Pouch Anal Anastomosis ◽  
Increased Risk ◽  
Anal Anastomosis

Systematic Review and Meta-analysis of Outcomes After Ileal Pouch-anal Anastomosis in Primary Sclerosing Cholangitis and Ulcerative Colitis

2021 ◽  
Author(s):  
Edward L Barnes ◽  
Stefan D Holubar ◽  
Hans H Herfarth
Keyword(s):  
Systematic Review ◽  
Ulcerative Colitis ◽  
Primary Sclerosing Cholangitis ◽  
Sclerosing Cholangitis ◽  
Ileal Pouch ◽  
Meta Analysis ◽  
Ileal Pouch Anal Anastomosis ◽  
Pouch Failure ◽  
Increased Risk ◽  
Anal Anastomosis

Abstract Background The optimal restorative surgical management of patients with concomitant diagnoses of primary sclerosing cholangitis and ulcerative colitis [PSC-UC] who require colectomy is controversial, given that patients may have an increased risk for pouchitis after ileal pouch-anal anastomosis [IPAA]. We aimed to compare rates of pouchitis and pouch failure among patients with and without PSC by performing a systematic review and meta-analysis. Methods A systematic search performed through August 18, 2020, identified 12 studies that compared the rates of pouchitis [n = 11] and/or pouch failure [n = 6] among patients with PSC-UC and UC alone. We then performed a meta-analysis using random effects modelling to estimate the odds of developing any episodes of pouchitis or pouch failure. Results A total of 4108 patients underwent an ileal pouch-anal anastomosis after proctocolectomy for UC. Of these, 3799 [92%] were performed for UC alone and 309 [8%] were performed for PSC-UC. In a meta-analysis of 11 studies, patients with PSC-UC compared with UC alone were significantly more likely to develop any pouchitis (63% vs 30%, odds ratio [OR] 4.21, 95% confidence interval [CI] 2.86–6.18), chronic pouchitis [47% vs 15%, OR 6.37, 95% CI 3.41–11.9], and pouch failure [10% vs 7%, OR 1.85, 95% CI 1.08–3.17]. Conclusions Patients with PSC-UC were more likely to experience pouchitis and pouch failure than patients with UC alone. The risks of inflammatory complications after IPAA must be weighed against the potential complications with other surgical procedures, and future studies comparing outcomes among these procedures may inform decision making in this population.

Restorative Proctocolectomy and Ileal Pouch–Anal Anastomosis for Ulcerative Colitis after Liver Transplant for Primary Sclerosing Cholangitis: Case Report and Review of Literature

2005 ◽  
Vol 71 (4) ◽  
pp. 362-365 ◽  
Author(s):  
Alexis L. Grucela ◽  
Randolph M. Steinhagen
Keyword(s):  
Ulcerative Colitis ◽  
Liver Transplant ◽  
Primary Sclerosing Cholangitis ◽  
Restorative Proctocolectomy ◽  
Sclerosing Cholangitis ◽  
Ileal Pouch ◽  
Ileal Pouch Anal Anastomosis ◽  
Orthotopic Liver Transplant ◽  
Increased Risk ◽  
Anal Anastomosis

Primary sclerosing cholangitis (PSC) is present in 5 per cent of patients with ulcerative colitis (UC). Conversely, as many as 90 per cent of patients with PSC have been found to have UC. The accepted treatment for advanced PSC is orthotopic liver transplant, and the treatment of ulcerative colitis with concomitant PSC is restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA). A small number of studies have shown that there is an increased risk of pouchitis in UC patients with PSC after ileal pouch-anal anastomosis. We report a case of a 45-year-old male who underwent a two-stage restorative proctocolectomy with IPAA after previous orthotopic liver transplant for PSC. We have reviewed the available literature concerning restorative proctocolectomy after liver transplantation, giving special attention to postoperative complications and subsequent development of pouchitis. It is important to be aware of the possibility of increased risk for development of pouchitis and to follow these patients closely to prevent complications.

scholarly journals Inflammatory Pouch Conditions Are Common After Ileal Pouch Anal Anastomosis in Ulcerative Colitis Patients

2019 ◽  
Vol 26 (7) ◽  
pp. 1079-1086 ◽  
Author(s):  
Maia Kayal ◽  
Michael Plietz ◽  
Anam Rizvi ◽  
Marlana Radcliffe ◽  
Alexa Riggs ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Ileal Pouch ◽  
Multivariable Analysis ◽  
Ileal Pouch Anal Anastomosis ◽  
Total Proctocolectomy ◽  
Refractory Disease ◽  
Pouch Failure ◽  
Increased Risk ◽  
Anal Anastomosis

Abstract Background Total proctocolectomy (TPC) with ileal pouch anal anastomosis (IPAA) is the gold standard surgery for ulcerative colitis (UC) patients with medically refractory disease. The aim of this study was to report the rates and risk factors of inflammatory pouch conditions. Methods This was a retrospective review of UC or IBD unspecified (IBDU) patients who underwent TPC with IPAA for refractory disease or dysplasia between 2008 and 2017. Pouchoscopy data were used to calculate rates of inflammatory pouch conditions. Factors associated with outcomes in univariable analysis were investigated in multivariable analysis. Results Of the 621 patients more than 18 years of age who underwent TPC with IPAA between January 2008 and December 2017, pouchoscopy data were available for 386 patients during a median follow-up period of 4 years. Acute pouchitis occurred in 205 patients (53%), 60 of whom (30%) progressed to chronic pouchitis. Cuffitis and Crohn's disease–like condition (CDLC) of the pouch occurred in 119 (30%) patients and 46 (12%) patients, respectively. In multivariable analysis, female sex was associated with a decreased risk of acute pouchitis, and pre-operative steroid use and medically refractory disease were associated with an increased risk; IBDU was associated with chronic pouchitis; rectal cuff length ≥2 cm and medically refractory disease were associated with cuffitis; age 45–54 at colectomy was associated with CDLC. Rates of pouch failure were similar in chronic pouchitis and CDLC patients treated with biologics and those who were not. Conclusions Inflammatory pouch conditions are common. Biologic use for chronic pouchitis and CDLC does not impact the rate of pouch failure.

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