Conditional Survival After IPAA for Ulcerative and Indeterminate Colitis

Feinberg, Adina; Lavryk, Olga; Aiello, Alexandra; Hull, Tracy L.; Steele, Scott R.; Stocchi, Luca; Holubar, Stefan D.

doi:10.1097/dcr.0000000000001629

Cited by 8 publications

(16 citation statements)

References 17 publications

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“…However, Feinberg et al reported that the conditional survival improves as time from the pouch construction passes. 30 A higher rate of pouch failure in our cohort could be explained by detection bias, as patients with <20 years of follow-up were not included, which may have falsely increased the pouch failure rates. Similarly, by only including patients who have at least 20 years of follow-up with our group, we may have skewed our population toward those who were having trouble with their pouch and thus continued to follow-up, whereas those whose pouches are functioning very well may have stopped returning for routine follow-up visits.…”

Section: Discussionmentioning

confidence: 89%

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What Can an Aging Pouch Tell Us? Outcomes of Ileoanal Pouches Over 20 Years Old

Beresneva

Jabri

Breen

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND:Little is known about the long-term functional outcomes of restorative proctocolectomy. OBJECTIVE:The aim of this study was to examine ileoanal pouch outcomes 20 and 30 years postoperatively.DESIGN: This is a retrospective case series. SETTING:This study was conducted at a tertiary care referral center. PATIENTS:Patients who underwent restorative proctocolectomy between 1980 and 1994 were identified.Those with ≥20 years of in-person follow-up were included. MAIN OUTCOMES MEASURES:Pouch function, pouchitis, anal stricture, and pouch failure rates were analyzed.RESULTS: A total of 203 patients had ≥20 years of follow-up. Of those, 71 had ≥30 years of follow-up. Initial diagnoses included ulcerative colitis (83%), indeterminate colitis (9%), familial adenomatous polyposis (4%), and Crohn's disease (3%). Twenty-one percent of those with ulcerative or indeterminate colitis later transitioned to Crohn's disease. Mean daily stool frequency was 7 (IQR 6-8), 38% experienced seepage, 31% had anal stenosis, 47% experienced pouchitis, and 18% had pouch failure. Over time, stool frequency increased in 41% of patients, stayed the same in 43%, and decreased in 16%.Patients older than 50 years at the time of construction had more daily bowel movements (median 8 vs 6; p = 0.02) and more seepage (77% vs 35%; p = 0.005) than those younger than 50 years. Patients with Crohn's disease had higher stool frequency (median 8 vs 6; p < 0.001) and higher rates of anal stenosis (44% vs 26%; p = 0.02), pouchitis (70% vs 40%; p < 0.001), and pouch failure (38% vs 12%; p < 0.001) compared to non-Crohn's patients. Patients with ≥30 years of follow-up had similar function as those with 20-30 years of follow-up.LIMITATIONS: This was a retrospective, single-institution study. Only 35% of pouches created during the study period had >20 years of follow-up. CONCLUSIONS:Most patients maintain reasonably good function and retain their pouches after 20 years. Over time, stool frequency and seepage increase. Older age and Crohn's disease are associated with worse outcomes. See Video Abstract at http://links.lww.com/DCR/B801. ¿QUÉ NOS DICE UN RESERVORIO A LARGO PLAZO? RESULTADOS DE LOS RESERVORIOS ILEOANALES MAYORES DE 20 AÑOSANTECEDENTES: se sabe poco sobre los resultados funcionales a largo plazo de la proctocolectomía restauradora.OBJETIVO: El objetivo de este estudio fue examinar los resultados del reservorio ileoanal 20 y 30 años después de la operación.DISEÑO: Serie de casos retrospectiva.ENTORNO CLÍNICO: Centro de referencia de atención terciaria PACIENTES: Se identificaron pacientes que se sometieron a proctocolectomía restauradora entre 1980 y 1994. Se incluyeron aquellos con ≥20 años de seguimiento en persona.

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Section: Discussionmentioning

confidence: 89%

“…However, Feinberg et al reported that the conditional survival improves as time from the pouch construction passes. 30…”

Section: Discussionmentioning

confidence: 99%

What Can an Aging Pouch Tell Us? Outcomes of Ileoanal Pouches Over 20 Years Old

Beresneva

Jabri

Breen

et al. 2022

Diseases of the Colon &Amp; Rectum

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“…16,25 Fortunately, with appropriate surgical intervention in experienced centers such as ours, the pouch salvage rate may reach 86.5%. [26][27][28][29] Despite being the largest series to date, our study has several limitations worth mentioning. As a high-volume quaternary IBD and pouch referral center with expertise in redo pouch procedures, referral bias may limit the Copyright © The American Society of Colon & Rectal Surgeons, Inc.…”

Section: Discussionmentioning

confidence: 94%

“…16,25 Fortunately, with appropriate surgical intervention in experienced centers such as ours, the pouch salvage rate may reach 86.5%. 26–29…”

Section: Discussionmentioning

confidence: 99%

Tip of the J-pouch Leaks: Diagnosis, Management, and Long-term Pouch Survival

Holubar¹,

Rajamanickam²,

Görgün³

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: The standard of care for surgical treatment of ulcerative colitis is restorative proctocolectomy with ileal J-pouch. Leaks from the tip of the J-pouch are a known complication, but there is a paucity of literature regarding this type of leak. OBJECTIVE: We aimed to describe the diagnosis, management, and long-term clinical outcomes of leaks from the tip of the J-pouch at our institution. DESIGN: This was a retrospective study of a prospectively maintained pouch registry. SETTING: This study was conducted at a quaternary IBD referral center. PATIENTS: Patients included those with ileal J-pouches diagnosed with leaks from the tip of the J-pouch. MAIN OUTCOME MEASURES: The main measures of outcomes were pouch salvage rate, type of salvage procedures, and long-term Kaplan-Meier pouch survival. RESULTS: We identified 74 patients with leaks from the tip of the J-pouch. Pain (68.9%) and pelvic abscess (40.9%) were the most common presentations, whereas 10.8% of patients presented with an acute abdomen. The leak was diagnosed by imaging and/or endoscopy in 74.3% of patients but only discovered during surgical exploration in 25.6% of patients. Some 63.5% of patients were diagnosed only after loop ileostomy closure, whereas 32.4% of patients were diagnosed before ileostomy closure. The most common methods used for diagnosis were pouchoscopy (31.1%) and gastrograffin enema (28.4%). A definitive nonoperative approach was attempted in 48.6% of patients but was successful in only 10.8% of patients overall. Surgical repair was attempted in 89.2% of patients, whereas 4.5% of patients had pouch excision. Salvage operations (n = 63) included sutured or stapled repair of the tip of the J (65%), pouch excision with neo-pouch (25.4%), and pouch disconnection, repair, and reanastomosis (9.5%). Ultimately‚ 10 patients (13.5%) required pouch excision, yielding an overall 5-year pouch survival rate of 86.3%. LIMITATIONS: This was a retrospective review; referral bias may limit the generalizability. CONCLUSIONS: Leaks from the tip of the J-pouch have variable clinical presentations and require a high index of suspicion. Pouch salvage surgery is required in the majority of patients and is associated with a high pouch salvage rate. See Video Abstract at http://links.lww.com/DCR/C50. FUGAS DEL EXTREMO DE LA BOLSA EN J: DIAGNÓSTICO, MANEJO Y SUPERVIVENCIA A LARGO PLAZO DE LA BOLSA ANTECEDENTES: El estándar de atención para el tratamiento quirúrgico de la colitis ulcerosa es la proctocolectomía restauradora con bolsa ileal en J. Las fugas del extremo de la bolsa en J son una complicación conocida, pero hay escasez de literatura sobre este tipo de fuga. OBJETIVO: Describir el diagnóstico, manejo y resultados clínicos a largo plazo de las fugas del extremo de la bolsa en J en nuestra institución. DISEÑO: Estudio retrospectivo de registro de bolsa mantenido prospectivamente. ENTORNO CLINICO: Centro de referencia de enfermedad inflamatoria intestinal cuaternaria. PACIENTES: Pacientes con bolsas ileales en J diagnosti...

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“…When it comes to failure-free pouch survival, studies comparing long-term results subdivided by pouch design did not report major differences between S and J pouches [ 4 ]. An overall 10-year survival of pouches between 94–96% [ 9 , 10 ] was reported with a 20-year survival rate of 93% [ 10 ]. The objective of this study was to assess pouch failure (PF) in different pouch designs compared according to volume, with a follow up exceeding 20 years.…”

Section: Introductionmentioning

confidence: 99%

Incidence and causes of failure in various anatomical pouch designs 20 years after surgical primary ileal-pouch anal anastomosis construction

Reijntjes

Bocharewicz

Hompes

et al. 2022

Int J Colorectal Dis

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Purpose Since the introduction of ileo-pouch anal anastomosis (IPAA) surgery, various pouch designs have been applied. Recently, there has been renewed interest in creating larger pouch designs to reduce defecation frequency after pouch surgery. The aim of this study was to assess chronic pouch failure (PF) rates and causes in alternative S or septated (SP) pouches when compared to J pouches and B- shaped adaptations. Methods This retrospective cohort study included patients that underwent primary IPAA construction surgery from 1978–2000. Pouch designs were subdivided in J and B (J/B), and larger pouches (S/SP). PF included need for a pouch excision, redo pouch procedure, revisional pouch surgery, or permanent ileostomy surgery. Outcomes of this study were incidence and causes for PF per pouch design group. Results Out of 200 patients who underwent IPAA surgery, 19 had an S/SP design and 181 had a J/B design. After a follow-up of 27.0 (IQR 23.3 – 29.0) years, 45/200 (22.5%) patients who underwent IPAA surgery between 1975–2000 developed PF. Some 78.9% of patients with an S/SP pouch developed PF, compared to 16.7% of patients with a J/B pouch (p < 0.01). Mechanical outlet issues occurred more often in S/SP pouches when compared to J/B (42.1% vs. 1.1%, p < 0.01), and were predominantly caused by septal- or pouch wall intussusception and efferent loop kinking (S-pouch). Conclusion Despite an inevitable proportion of bias, the current study revealed that S/SP pouches were characterized by an increased PF incidence due to emptying problems after long-term follow-up when compared to J/B pouches. Constructing an S pouch or large septated reservoir at index surgery should therefore be questioned because of a shorter longevity.

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Conditional Survival After IPAA for Ulcerative and Indeterminate Colitis

Cited by 8 publications

References 17 publications

What Can an Aging Pouch Tell Us? Outcomes of Ileoanal Pouches Over 20 Years Old

What Can an Aging Pouch Tell Us? Outcomes of Ileoanal Pouches Over 20 Years Old

Tip of the J-pouch Leaks: Diagnosis, Management, and Long-term Pouch Survival

Incidence and causes of failure in various anatomical pouch designs 20 years after surgical primary ileal-pouch anal anastomosis construction

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