Case‐Matched Comparison of Long‐Term Functional and Quality of Life Outcomes Following Laparoscopic Versus Open Ileal Pouch‐Anal Anastomosis

Lavryk, Olga; Stocchi, Luca; Ashburn, Jean; Costedio, Meagan; Görgün, Emre; Hull, Tracy L.; Keßler, Hermann; Delaney, Conor P.

doi:10.1007/s00268-018-4602-1

Cited by 9 publications

(5 citation statements)

References 34 publications

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“…Only four (21%) patients required surgery after 3 months of vedolizumab, three (16%) had ileostomy and one (5%) had pouch-revision surgery. The pouch-failure rate after initial IPAA creation at our institute is ∼2%, and ∼3% of the patients with chronic pouchitis require pouch-redo surgery [23, 24].…”

Section: Discussionmentioning

confidence: 99%

Vedolizumab for chronic antibiotic-refractory pouchitis

Singh

Khan

López

et al. 2019

Gastroenterology Report

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Background Chronic antibiotic-refractory pouchitis (CARP) is a complication of ileal pouch-anal anastomosis (IPAA), which poses a therapeutic challenge. Vedolizumab, a gut-selective monoclonal antibody to the α4β7 of integrin, has been used in such patients, but data on its efficacy are limited. Our aim was to assess the efficacy and safety of vedolizumab as induction therapy in CARP patients. Methods In this single-center, historic cohort, patients with CARP who received vedolizumab between January 2015 to June 2017 were identified and analysed. Patients were included if they had active pouchitis with a total of modified pouch disease activity index (mPDAI) score ≥5 or if unavailable clinician diagnosis of active pouchitis. Pre-treatment and at 3-month post-therapy pouchoscopy and clinical visits were used to calculate mPDAI. Results A total of 19 patients were included in the study. The mean age was 26.7 ± 12.8 years, with 10 (53%) males. Nine (47%) patients had been treated with anti-tumor necrosis factor (TNF) agents before colectomy and 10 (53%) had anti-TNFs after colectomy and IPAA. Six (32%) patients had improvement in the mPDAI symptom subscores ( P = 0.031) and 14 (74%) had improvement in both endoscopic and total mPDAI scores with a median change of –2 units (both P = 0.031). Adverse events were noted only in two (11%) patients and four (21%) required surgery for CARP. Conclusions Our study suggests that vedolizumab has efficacy and can be safely used for CARP patients. Larger studies with a higher number of patients are required to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Vedolizumab for chronic antibiotic-refractory pouchitis

Singh

Khan

López

et al. 2019

Gastroenterology Report

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“…The laparoscopic group had a higher incidence of stapled anastomosis, but a subgroup analysis suggested that the difference between laparoscopic and open functional outcomes was not attributable to only the anastomotic technique. Lavryk et al, 50 in an analysis of 404 patients undergoing laparoscopic IPAA matched 1:1 with open IPAA, found similar long-term functional outcomes and quality of life between the 2 groups.…”

Section: Open Versus Mi-ipaamentioning

confidence: 92%

State of the Art: Pouch Surgery in the 21st Century

Maspero,

Hull

2024

Diseases of the Colon &Amp; Rectum

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BACKGROUND: An ileoanal pouch with ileal pouch-anal anastomosis is the preferred method to restore intestinal continuity in patients who require a total proctocolectomy. Pouch surgery has evolved during the past decades thanks to increased experience and research, changes in the medical management of patients who require an ileal pouch, and technological innovations. OBJECTIVE: To review the main changes in pouch surgery during the last two decades, with focus on staging, minimally invasive and transanal approaches, pouch design, and anastomotic configuration. RESULTS: The decision on the number of stages depends on the patient’s conditions, their indication for surgery, and the risk of anastomotic leak. A minimally invasive approach should be performed whenever feasible, but open surgery still has a role in this technically demanding operation. Transanal IPAA may be performed in experienced centers and may reduce conversion to open in the hostile pelvis. The J pouch is the easiest, fastest, and most commonly performed design, but other designs may be used when a J-pouch is not feasible. A stapled anastomosis without mucosectomy can be safely performed in the majority of cases, with low incidence of rectal cuff neoplasia and better functional outcomes than handsewn. Finally, Crohn’s disease is not an absolute contraindication to an ileoanal pouch, but pouch failure may be higher compared to other indications. CONCLUSIONS: Many technical nuances contribute to the success of an ileoanal pouch. The current standard of care is a laparoscopic J pouch with double-stapled anastomosis, but this should not be seen as a dogma, and the optimal approach and design should be tailored to each individual patient. See video from symposium.

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“…180,181 Regardless of the particular staged approach utilized, laparoscopic or robotic approaches for IPAA are preferred when expertise is available due to reported improved short-term outcomes, including shorter length of hospital stay, reduced intraoperative blood loss, decreased wound infection rates, improved cosmesis, and equivalent long-term functional outcomes and overall pouch failure rates. [184][185][186][187][188][189][190] In terms of other minimally invasive techniques, the recently introduced transanal approach to restorative proctectomy has been shown to be safe and feasible in early studies and has demonstrated long-term functional outcomes and quality-of-life scores equivalent to conventional approaches in 2 multicenter comparative series. [191][192][193][194] 10.…”

Section: Technical and Postoperative Considerationsmentioning

confidence: 99%

“…[195][196][197][198][199][200][201][202][203] When appropriate, a minimally invasive approach should typically be considered because of the associated reduced length of hospital stay and improved short-term outcomes, cosmesis, and fertility. 185,187,[204][205][206][207][208][209][210][211][212][213][214] Pouch surgery often utilizes a J-type configuration because of its ease of construction and relatively predictable emptying. J pouches are associated with fewer evacuation difficulties compared with S-type pouches (especially an S pouch with a longer spout), but an S-pouch construction may be particularly useful when additional length is needed for a tension-free IPAA.…”

Section: Technical and Postoperative Considerationsmentioning

confidence: 99%

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surgical Management of Ulcerative Colitis

Holubar

Lightner

Poylin

et al. 2021

Diseases of the Colon &Amp; Rectum

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Ulcerative colitis (UC) is an idiopathic chronic inflammatory condition that affects the mucosa lining the colon and rectum that, for unknown reasons, continues to increase in incidence with nearly 3.1 million people affected in the United States alone. 1 Patients most often present in 2 general age categories, between about ages 15 and 30 or 55 and 65, with rectal bleeding, urgency, and/or tenesmus from proctitis. 2,3 The degree of symptomatology is variable over

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Case‐Matched Comparison of Long‐Term Functional and Quality of Life Outcomes Following Laparoscopic Versus Open Ileal Pouch‐Anal Anastomosis

Abstract: Laparoscopic and open IPAA are associated with equivalent long-term functional outcomes, quality of life and pouch survival rates. Laparoscopic technique is associated with temporary benefits lasting 1 or 2 years.

Cited by 9 publications

References 34 publications

Vedolizumab for chronic antibiotic-refractory pouchitis

Vedolizumab for chronic antibiotic-refractory pouchitis

State of the Art: Pouch Surgery in the 21st Century

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surgical Management of Ulcerative Colitis

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