Long-term Functional Results and Complications after Stapled Ileal Pouch Anal Canal Anastomosis for Ulcerative Colitis

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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Long-Term Followup with Evaluation of the Surgical and Functional Results of the Ileal Pouch Reservoir in Restorative Proctocolectomy for Ulcerative Colitis

ISRN Gastroenterology ◽

10.5402/2011/625842 ◽

2011 ◽

Vol 2011 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Ola Røkke ◽

Knut Iversen ◽

Torill Olsen ◽

Sølvi-Mai Ristesund ◽

Geir Egil Eide ◽

...

Keyword(s):

Quality Of Life ◽

Ulcerative Colitis ◽

Ileal Pouch ◽

Loop Ileostomy ◽

Operation Time ◽

Functional Results ◽

Late Complications ◽

Initial Time

Aims. Evaluate the early and long term surgical and functional results of the ileal pouch-reservoir (IPAA) in patients with intractable ulcerative colitis. Material and Methods. Followup of 134 consecutive patients with W-or J-ileal pouch by diseases-specific and general health (SF-36) questionnaire. In the first 44 patients, early and late followup was performed. Results. Followup was performed 7.4 years (0.5–17 years) after construction of W () and J () ileal pouch, which had similar results. There were 14.9% early and 43.6% late complications with 12.7% early and 19.5% late reoperations. Protecting loop-ileostomy used in 54 patients (43.9%), did not protect against complications. Thirteen reservoirs (9.8%) were resected () or deactivated () due to functional failure. Operation time, postoperative complications and pouchitis were determinators for reservoir failure and reduced quality of life. The functional results at followup of 44 patients at 2.5 years (0.8–6.7 years) and 11.5 years (8.2–19.2 years) were remarkably similar. Conclusions. IPAA is a good option for most patients when medication fails. 10% experience failure with inferior quality of life. Protective stoma will not reduce failure rates. After an initial time period, reservoir function will not change over time.

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Risk factors for carcinoma of the pelvic ileal pouch (PIP)/Anal canal (AC) in ulcerative colitis (UC)

Gastroenterology ◽

10.1016/s0016-5085(08)82214-7 ◽

2001 ◽

Vol 120 (5) ◽

pp. A446

Author(s):

David Elkowitz ◽

John Procaccino ◽

Joanne Cuomo ◽

Eleanor Boss ◽

Fredric Daum ◽

...

Keyword(s):

Risk Factors ◽

Ulcerative Colitis ◽

Anal Canal ◽

Ileal Pouch

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Long-term outcomes following restorative proctocolectomy ileal pouch-anal anastomosis in pediatric ulcerative colitis patients: Multicenter national study in Japan

Annals of Gastroenterological Surgery ◽

10.1002/ags3.12198 ◽

2018 ◽

Vol 2 (6) ◽

pp. 428-433 ◽

Cited By ~ 1

Author(s):

Hiroki Ikeuchi ◽

Motoi Uchino ◽

Akira Sugita ◽

Kitaro Futami ◽

Kouhei Fukushima ◽

...

Keyword(s):

Ulcerative Colitis ◽

Restorative Proctocolectomy ◽

Ileal Pouch ◽

Ileal Pouch Anal Anastomosis ◽

National Study ◽

Long Term Outcomes ◽

Anal Anastomosis

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Transanal Ileal Pouch-Anal Anastomosis for Ulcerative Colitis has Comparable Long-Term Functional Outcomes to Transabdominal Approach: A Multicentre Comparative Study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz174 ◽

2019 ◽

Vol 14 (6) ◽

pp. 726-733 ◽

Cited By ~ 3

Author(s):

Pramodh Chandrasinghe ◽

Michele Carvello ◽

Karin Wasmann ◽

Caterina Foppa ◽

Pieter Tanis ◽

...

Keyword(s):

Quality Of Life ◽

Ulcerative Colitis ◽

Functional Outcomes ◽

Ileal Pouch ◽

Cohort Analysis ◽

Ileal Pouch Anal Anastomosis ◽

Global Quality Of Life ◽

Anal Anastomosis

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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