Comparison of outcomes after hand-sewn versus stapled ileal pouch-anal anastomosis in 3,109 patients

Kirat, Hasan T.; Remzi, Feza H.; Kiran, Ravi P.; Fazio, Victor W.

doi:10.1016/j.surg.2009.06.041

Cited by 139 publications

(95 citation statements)

References 22 publications

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“…Hand‐sewn IPAA with mucosectomy is generally accepted as a time‐consuming and complicated procedure 25. Hence, in Western countries, this technique has been increasingly replaced by stapled IPAA without mucosectomy 3, 4, 5, 6. In a recent case‐matched study from Germany which focused on FAP patients,13 anastomotic technique was switched from hand‐sewn IPAA to stapled IPAA in 2001, and stapled IPAA during 2001‐2006 was compared with hand‐sewn IPAA during 1984‐2001.…”

Section: Discussionmentioning

confidence: 99%

“…Since the first report by Parks and Nicholls in 1978,2 IPAA was originally conducted by hand‐sewn technique with mucosectomy down to the dentate line to eliminate all mucosa at risk. With the development of staple devices in the 1980s, stapled IPAA without mucosectomy has been increasingly conducted 3, 4, 5, 6. Previous studies have reported several pros and cons on these two anastomotic techniques.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have reported several pros and cons on these two anastomotic techniques. Stapled IPAA is the simpler type of anastomosis with shorter length of operation and better fecal continence possibly as a result of omission of mucosectomy and preservation of the anal transitional zone (ATZ) 5, 7, 8, 9, 10. In contrast, hand‐sewn IPAA with mucosectomy can reduce a substantial risk for developing adenomas at the anastomotic site 11…”

Section: Introductionmentioning

confidence: 99%

“…Some studies found higher incidence of septic complications, fistula and anastomotic stricture after hand‐sewn IPAA,5, 9, 12 whereas other studies showed a trend toward higher incidence of overall complications and stricture after stapled IPAA 13, 14. Importantly, most of the previous studies included patients with ulcerative colitis (UC) rather than patients with FAP 5, 8, 14, 15 although the complication rates were different between such patients 5, 8, 14, 15. Furthermore, none of the studies used objective criteria such as the Clavien‐Dindo classification for stratifying the complications 5, 8, 9, 12, 13, 14, 15.…”

Section: Introductionmentioning

confidence: 99%

“…Importantly, most of the previous studies included patients with ulcerative colitis (UC) rather than patients with FAP 5, 8, 14, 15 although the complication rates were different between such patients 5, 8, 14, 15. Furthermore, none of the studies used objective criteria such as the Clavien‐Dindo classification for stratifying the complications 5, 8, 9, 12, 13, 14, 15. These limitations could explain inconsistent results in the previous studies, and we need evidence that focuses on patients with FAP with the use of objective criteria for assessing complications.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Postoperative complications after stapled and hand‐sewn ileal pouch‐anal anastomosis for familial adenomatous polyposis: A multicenter study

Konishi

Ishida

Ueno

et al. 2017

Annals of Gastroent Surgery

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Ileal pouch‐anal anastomosis (IPAA) after total proctocolectomy (TPC) can be conducted with either hand‐sewn or stapled anastomosis for patients with familial adenomatous polyposis (FAP). Although stapled IPAA without mucosectomy has a higher risk for developing adenomas in the remnant mucosa, it is the simpler procedure with potential benefit in short‐term outcomes. However, it remains controversial as to whether stapled IPAA has any advantages in reducing postoperative complications. The aim of the present study was to compare the postoperative complications and short‐term outcomes of stapled and hand‐sewn IPAA for patients with FAP, using a multicenter cohort sample in Japan. Data of 143 patients with FAP who underwent TPC with stapled IPAA (n=37) and hand‐sewn IPAA (n=106) at 23 institutions between 2000 and 2012 were collected. Postoperative complications, proportion of ostomy, fecal continence and overall survival were compared. Overall rates of the Clavien‐Dindo grade II‐IV complications were not different between the two groups (19% in stapled vs 25% in hand‐sewn, P=.42), with significantly fewer pouch‐related complications including leakage, pelvic abscess, vaginal fistula and anastomotic stricture in stapled IPAA (none in stapled vs 11% in hand‐sewn, P=.036). There was no mortality. Proportion of ostomy at 12 months was similar (2.7% in stapled vs 4.3% in hand‐sewn, P=.26). Mean Wexner score was similar. (0.47 in stapled vs 2.0 in hand‐sewn, P=.12). Five‐year overall survival excluding Stage IV patients was 96% in both groups. Stapled IPAA is a safe option in patients with FAP with a potential benefit in reducing pouch‐related complications.

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