Restorative proctocolectomy with ileal pouch-anal anastomosis for refractory or fulminant ulcerative colitis: Functional outcomes

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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Risk Factors for Diseases of Ileal Pouch–Anal Anastomosis After Restorative Proctocolectomy for Ulcerative Colitis

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2005.10.004 ◽

2006 ◽

Vol 4 (1) ◽

pp. 81-89 ◽

Cited By ~ 137

Author(s):

Bo Shen ◽

Victor W. Fazio ◽

Feza H. Remzi ◽

Aaron Brzezinski ◽

Ana E. Bennett ◽

...

Keyword(s):

Risk Factors ◽

Ulcerative Colitis ◽

Restorative Proctocolectomy ◽

Ileal Pouch ◽

Ileal Pouch Anal Anastomosis ◽

Anal Anastomosis

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P567. Functional outcomes and factors influencing quality of life in patients with ulcerative colitis after total proctocolectomy with ileal pouch anal anastomosis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjw019.686 ◽

2016 ◽

Vol 10 (suppl 1) ◽

pp. S387.2-S388

Keyword(s):

Quality Of Life ◽

Ulcerative Colitis ◽

Functional Outcomes ◽

Ileal Pouch ◽

Ileal Pouch Anal Anastomosis ◽

Total Proctocolectomy ◽

Factors Influencing ◽

Anal Anastomosis

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Treatment of Rectal Cuff Inflammation (Cuffitis) in Patients with Ulcerative Colitis Following Restorative Proctocolectomy and Ileal Pouch-Anal Anastomosis

The American Journal of Gastroenterology ◽

10.1111/j.1572-0241.2004.30518.x ◽

2004 ◽

Vol 99 (8) ◽

pp. 1527-1531 ◽

Cited By ~ 117

Author(s):

Bo Shen ◽

Bret A. Lashner ◽

Ana E. Bennett ◽

Feza H. Remzi ◽

Aaron Brzezinski ◽

...

Keyword(s):

Ulcerative Colitis ◽

Restorative Proctocolectomy ◽

Ileal Pouch ◽

Ileal Pouch Anal Anastomosis ◽

Anal Anastomosis

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RESTORATIVE PROCTOCOLECTOMY WITH ILEAL POUCH-ANAL ANASTOMOSIS FOR SEVERE ULCERATIVE COLITIS IN RURAL NEPAL

Journal of Nepal Medical Association ◽

10.31729/jnma.644 ◽

2003 ◽

Vol 42 (150) ◽

pp. 360-363

Author(s):

K P Ghimire ◽

Kenneth Walker

Keyword(s):

Ulcerative Colitis ◽

Medical Therapy ◽

Restorative Proctocolectomy ◽

Ileal Pouch ◽

Elective Surgery ◽

Appropriate Technology ◽

Ileal Pouch Anal Anastomosis ◽

Bowel Habit ◽

Anal Anastomosis ◽

Rural Nepal

For most patients with ulcerative colitis (UC) requiring surgery, restorative proctocolectomy (RP) may bethe operation of choice. By using an ileal pouch-anal anastomosis, it offers a curative operation with no needfor a permanent ileostomy. We present a 16 year-old boy from a remote village with chronic UC whichfailed to respond satisfactorily to maximal medical therapy. We opted for elective surgery because he wasunlikely to comply with long-term medical therapy and surveillance, nor to survive if he came to emergencysurgery in our setting. RP was performed and he recovered well. His bowel habit was better than the 5 or 6motions per day that is typical following this procedure. Where the expertise is available, the operation canbe performed and any complications managed, using only the basic facilities available in most districthospitals. We present this case as an example of the “one-hit medicine” approach that is often required inour context. We suggest that RP may occasionally be indicated for UC in rural Nepal, where the alternativescarry relatively greater disadvantages.Key Words: Restorative proctocolectomy, ileal pouch-anal anastomosis,ulcerative colitis, appropriate technology.

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Association of ileocolic pedicle division with postoperative complications after restorative proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis

BMC Surgery ◽

10.1186/s12893-021-01428-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Emmanouil Tzatzarakis ◽

Florian Herrle ◽

Wolfgang Reindl ◽

Nora Altmayer ◽

Dominik Minas ◽

...

Keyword(s):

Ulcerative Colitis ◽

Postoperative Complications ◽

Restorative Proctocolectomy ◽

Ileal Pouch ◽

Statistical Significance ◽

Ileal Pouch Anal Anastomosis ◽

Abscess Formation ◽

Entire Study ◽

Anastomotic Strictures ◽

Anal Anastomosis

Abstract Background When performing a restorative proctocolectomy (RPC) with an ileal pouch-anal anastomosis (IPAA), it is common practice to divide the ileocolic artery (ICA) if the patient has a tumor or dysplasia, or in order to gain sufficient length to secure a tension-free anastomosis. However, it is unclear whether there is an association between division of the ICA and the rate of postoperative complications. Methods We retrospectively analysed all patients with ulcerative colitis who underwent RPC and IPAA in our department between January 2010 and December 2016. These were divided in two groups, with regard to the ICA being preserved (PRE group) or divided (DIV group). Complications such as stenosis or leakage of the IPAA, perianal fistulas, abscess formation within the lesser pelvis and pouchitis were analysed and compared between both groups. Results We identified 130 patients meeting the study inclusion criteria, 49 patients in the PRE and 81 patients in the DIV group. No statistical significance was observed in IPAA leakages (p = 0.71), anastomotic strictures (p = 0.33), fistulas (p = 0.19) and pouchitis (p = 0.72). Abscess formation frequency was similar in both groups (p > 0.99). Moreover, short-term (p = 0.53) and long-term complications (p = 0.11) were similar in both groups. A higher conversion rate was observed in obese (p = 0.006) and male (p = 0.02) patients. Within the entire study population, fistulas and IPAA leakages were associated with a higher rate of anastomotic strictures (p = 0.008 and p = 0.02 respectively). Conclusion Our data suggest similar IPAA related complications after either division or preservation of the ICA. Further trials are required in order to examine the trends observed in this study.

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