Comparison of Outcomes After Restorative Proctocolectomy With or Without Defunctioning Ileostomy

Weston-Petrides, Gina; Lovegrove, Richard E.; Tilney, H. S.; Heriot, Alexander G.; Nicholls, R. J.; Mortensen, Neil; Fazio, Victor W.; Tekkis, Paris

doi:10.1001/archsurg.143.4.406

Cited by 161 publications

(104 citation statements)

References 46 publications

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“…All agree, however, that any clinical, laboratory, or radiologic deterioration on medical therapy mandates immediate colectomy. Th ere are no prospective randomized trials comparing medical treatment to surgery for any indication in UC, but three situations are absolute indications for surgery because continued medical bowel obstruction; the time intervals during which reoperations for complications were performed were not specifi ed ( 321 ). A large database analysis of privately insured UC patients undergoing IPAA found a 20 % rate of postoperative complications resulting in an unexpected reoperation.…”

Section: The Patient With Severe Colitis Refractory To Maximal Oral Tmentioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,154

977

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Guidelines for clinical practice are aimed to indicate preferred approaches to medical problems as established by scientifi cally valid research. Double-blind placebo controlled studies are preferable, but compassionate-use reports and expert review articles are used in a thorough review of the literature conducted through Medline with the National Library of Medicine. When only data that will not withstand objective scrutiny are available, a recommendation is identifi ed as a consensus of experts. Guidelines are applicable to all physicians who address the subject regardless of specialty training or interests and are aimed to indicate the preferable but not necessarily the only acceptable approach to a specifi c problem. Guidelines are intended to be fl exible and must be distinguished from standards of care, which are infl exible and rarely violated. Given the wide range of specifi cs in any healthcare problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the board of trustees. Each has been intensely reviewed and revised by the Committee, other experts in the fi eld, physicians who will use them, and specialists in the science of decision analysis. The recommendations of each guideline are therefore considered valid at the time of composition based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at a time established and indicated at publication to assure continued validity. The recommendations made are based on the level of evidence found. Grade A recommendations imply that there is consistent level 1 evidence (randomized controlled trials), grade B indicates that the evidence would be level 2 or 3, which are cohort studies or case -control studies. Grade C recommendations are based on level 4 studies, meaning case series or poor-quality cohort studies, and grade D recommendations are based on level 5 evidence, meaning expert opinion.

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Section: The Patient With Severe Colitis Refractory To Maximal Oral Tmentioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,154

977

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“…While the only randomized controlled trial of loop ileostomy omission in IPAA surgery (with only 45 patients) found no difference in the occurrence of complications [17], a meta-analysis of high-quality observational studies found an increased risk of anastomotic leakage associated with ileostomy omission. This risk, however, was not mirrored in an increased risk of pouch failure, presumably because of a small sample size with just 11 failures in 347 cases combined [31]. The risk of pouch failure illustrated in Fig.…”

Section: Discussionmentioning

confidence: 93%

Pouch failures following ileal pouch–anal anastomosis for ulcerative colitis

et al. 2018

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Aim Ileal pouch-anal anastomosis is a procedure offered to patients with ulcerative colitis who opt for restoration of bowel continuity. The aim of this study was to determine the risk of pouch failure and ascertain the risk factors associated with failure. MethodThe study included 1991 patients with ulcerative colitis who underwent ileal pouch-anal anastomosis in Denmark in the period 1980-2013. Pouch failure was defined as excision of the pouch or presence of an unreversed stoma within 1 year after its creation. We used Cox proportional hazards regression to explore the association between pouch failure and age, gender, synchronous colectomy, primary faecal diversion, annual hospital volume (very low, 1-5 cases per year; low, 6-10; intermediate 11-20; high > 20), calendar year, laparoscopy and primary sclerosing cholangitis.Results Over a median 11.4 years, 295 failures occurred, corresponding to 5-, 10-and 20-year cumulative risks of 9.1%, 12.1% and 18.2%, respectively. The risk of failure was higher for women [adjusted hazard ratio (aHR) 1.39, 95% CI 1.10-1.75]. Primary nondiversion (aHR 1.63, 95% CI 1.11-2.41) and a low hospital volume (aHR, very low volume vs high volume 2.30, 95% CI 1.26-4.20) were also associated with a higher risk of failure. The risk of failure was not associated with calendar year, primary sclerosing cholangitis, synchronous colectomy or laparoscopy.Conclusion In a cohort of patients from Denmark (where pouch surgery is centralized) with ulcerative colitis and ileal pouch-anal anastomosis, women had a higher risk of pouch failure. Of modifiable factors, low hospital volume and non-diversion were associated with a higher risk of pouch failure.

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“…Based on literature [as well as clinical practice], the factors Crohn's disease, handsewn anastomosis, laparoscopic approach, and defunctioning ileostomy were considered as clinically important , possibly influencing the outcome, and were therefore also entered in the logistic regression. 18,19,20 With the use of a forward and backward selection regression method, factors were identified and included in our model. Variables with a p-value ≥ 0.05 at each step of regression analysis were rejected.…”

Section: Discussionmentioning

confidence: 99%

A Multicentre Evaluation of Risk Factors for Anastomotic Leakage After Restorative Proctocolectomy with Ileal Pouch-Anal Anastomosis for Inflammatory Bowel Disease

Sahami

Bartels

D’Hoore³

et al. 2015

ECCOJC

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Background: Anastomotic leakage is a major complication after restorative proctocolectomy with ileal pouch-anal anastomosis [IPAA]. Identification of patients at high risk of leakage may influence surgical decision making. The aim of this study was to identify risk factors associated with anastomotic leakage after restorative proctocolectomy with IPAA. Methods: Between September 1990 and January 2015, patients who underwent IPAA for inflammatory bowel disease [IBD] were identified from prospectively maintained databases of three tertiary referral centres. Retrospective chart review identified additional data on demographic and surgical variables. Multivariable regression models were developed to identify risk factors for anastomotic leakage. Separate analyses were performed for type of procedure. [OR 6.40; were independent risk factors for anastomotic leakage in patients who underwent a proctocolectomy and IPAA. Conclusions: Independent risk factors for anastomotic leakage in IBD patients undergoing IPAA are BMI >25, ASA score >2, disease course > 5 years, and concurrent steroid and anti-TNF treatment, with a different risk profile for one-stage proctocolectomy and completion proctectomy procedures.

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Comparison of Outcomes After Restorative Proctocolectomy With or Without Defunctioning Ileostomy

Abstract: To evaluate postoperative adverse events and functional outcomes of patients undergoing restorative proctocolectomy with or without proximal diversion.

Cited by 161 publications

References 46 publications

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Pouch failures following ileal pouch–anal anastomosis for ulcerative colitis

A Multicentre Evaluation of Risk Factors for Anastomotic Leakage After Restorative Proctocolectomy with Ileal Pouch-Anal Anastomosis for Inflammatory Bowel Disease

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