scholarly journals Safety of transanal ileal pouch-anal anastomosis for ulcerative colitis: a retrospective observational cohort study

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Aina Lask ◽  
Matthias Biebl ◽  
Luca Dittrich ◽  
Andreas Fischer ◽  
Andreas Adler ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Anastomotic Leakage ◽  
Ileal Pouch ◽  
Colorectal Disease ◽  
Pouch Function ◽  
Long Term Follow Up ◽  
Benign Colorectal Disease ◽  
Short And Long Term

Abstract Background Colectomy with transanal ileal pouch-anal anastomosis (taIPAA) is a surgical technique that can be used to treat benign colorectal disease. Ulcerative colitis is the most frequent inflammatory bowel disease (IBD) and although pharmacological therapy has improved, colectomy rates reach up to 15%. The objective of this study was to determine anastomotic leakage rates and treatment after taIPAA as well as short- and long-term pouch function. Methods We conducted a retrospective analysis of a prospective database of all patients undergoing taIPAA at an academic tertiary referral center in Germany, between 01/03/2015 and 31/08/2019. Patients with indications other than ulcerative colitis or with adjuvant chemotherapy following colectomy for colorectal carcinoma were excluded for short- and long-term follow up due to diverging postoperative care yet considered for evaluation of anastomotic leakage. Results A total of 22 patients undergoing taIPAA during the study time-window were included in analysis. Median age at the time of surgery was 32 ± 12.5 (14–54) years. Two patients developed an anastomotic leakage at 11 days (early anastomotic leakage) and 9 months (late anastomotic leakage) after surgery, respectively. In both patients, pouches could be preserved with a multimodal approach. Twenty patients out of 22 met the inclusion criteria for short and long term follow-up. Data on short-term pouch function could be obtained in 14 patients and showed satisfactory pouch function with only four patients reporting intermittent incontinence at a median stool frequency of 9–10 times per day. In the long-term we observed an inflammation or “pouchitis” in 11 patients and a pouch failure in one patient. Conclusion Postoperative complication rates in patients with benign colorectal disease remain an area of concern for surgical patient safety. In this pilot study on 22 selected patients, taIPAA was associated with two patients developing anastomotic leakage. Future large-scale validation studies are required to determine the safety and feasibility of taIPAA in patients with ulcerative colitis.

scholarly journals Transanal Ileal Pouch-Anal Anastomosis for Ulcerative Colitis - A Retrospective Single-Center Study Regarding Anastomotic Leakage and Episodes of Pouchitis in the Long-Term

2021 ◽  
Author(s):  
Aina Lask ◽  
Matthias Biebl ◽  
Luca Dittrich ◽  
Andreas Fischer ◽  
Andreas Adler ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Anastomotic Leakage ◽  
Ileal Pouch ◽  
Pharmacological Therapy ◽  
Ileal Pouch Anal Anastomosis ◽  
Colorectal Disease ◽  
Safe Procedure ◽  
Pouch Function ◽  
Anal Anastomosis

Abstract Introduction:Colectomy with transanal ileal pouch-anal anastomosis (taIPAA) is a surgical technique that can be used to treat benign colorectal disease. Ulcerative colitis (UC) is the most frequent inflammatory bowel disease (IBD) and although pharmacological therapy has improved, colectomy rates reach up to 15%. Objective of this study was to determine anastomotic leakage (AL) rates and treatment after taIPAA as well as short- and long-term pouch function. Patients and Methods:Data from a prospectively collected database of all patients undergoing taIPAA in our center between March 2015 and August 2019 was analyzed retrospectively. Patients with indications other than UC or with adjuvant chemotherapy following colectomy for colorectal carcinoma were excluded. Results:Of 23 patients undergoing taIPAA in our center 20 patients met the inclusion criteria, with a median age of 36 years at the time of pouch formation. Overall prevalence of AL was 10% with one early (11 days after operation) and one late AL (19 months after operation). In both patients pouches could be preserved with a multimodal approach based on endosponge therapy. Data on short-term pouch function could be obtained in 11 (55.8%) patients and was satisfactory in all cases. In the long-term we observed a pouchitis rate of 57.9% and a pouch failure rate of 5.3%.Conclusion:In our study, taIPAA surgery is a safe procedure and results in good patient outcome. The rate of AL is comparable to transabdominal IPAA. In order to fully evaluate the risks and benefits of taIPAA further studies with larger cohorts of patients are required.

Granulocyte and monocyte selective apheresis for the treatment of refractory ulcerative colitis, short and long term follow-up

2006 ◽  
Vol 38 ◽  
pp. S118-S119
Author(s):  
R. Testa ◽  
M.R. Ruzzenente ◽  
E. Testa ◽  
S. Milazzo ◽  
L. Isola ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Long Term Follow Up ◽  
Short And Long Term

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

2016 ◽  
Vol 82 (10) ◽  
pp. 977-981 ◽  
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.

scholarly journals Endo-sponge Assisted Early Surgical Closure of Ileal Pouch-anal Anastomotic Leakage Preserves Long-term Function: A Cohort Study

2019 ◽  
Vol 13 (12) ◽  
pp. 1537-1545
Author(s):  
Karin A Wasmann ◽  
Maud A Reijntjes ◽  
Merel E Stellingwerf ◽  
Cyriel Y Ponsioen ◽  
Christianne J Buskens ◽  
...  
Keyword(s):  
Cohort Study ◽  
Effective Treatment ◽  
Anastomotic Leakage ◽  
Ileal Pouch ◽  
Pelvic Sepsis ◽  
Surgical Closure ◽  
Pouch Failure ◽  
Pouch Function ◽  
And Control

Abstract Background and Aims Endo-sponge [Braun Medical] assisted early surgical closure [ESC] is an effective treatment to control pelvic sepsis after ileal pouch-anal anastomosis [IPAA] leakage, and became standard treatment in our centre from 2010 onwards. The aim of this cohort study was to assess the long-term pouch function of ulcerative colitis [UC] patients treated with ESC or conventional management [CM] for anastomotic leakage after IPAA. Methods Consecutive patients who underwent an IPAA for UC between 2002 and 2017 were included. Patients treated with ESC [2010–2017] or CM [2002–2009] for anastomotic leakage were compared with control patients without anastomotic leakage of the corresponding time period. Main endpoints were long-term pouch function on a 3-point scale and pouch failure, as measured with the validated pouch dysfunction score questionnaire. Results Some 280 of 334 patients [84%] returned the pouch dysfunction questionnaire, of whom 18 were treated with ESC and 22 with CM for anastomotic leakage. Control cohorts included 133 [2010–2017] and 107 patients [2002–2009]. Between ESC-treated patients and control patients, pouch function [p = 0.647] and pouch failure rates [0/18 versus 5/133, p >0.99] were similar. CM resulted in worse pouch function [p = 0.016] and a higher pouch failure rate [5/22 versus 5/107, p = 0.013] compared with control patients. Conclusions ESC, in contrast to CM, for IPAA leakage in UC patients is associated with preservation of pouch function and preclusion of pouch failure, probably due to early and effective treatment of pelvic sepsis.

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