Cumulative Failure Rate of Ileal Pouch-Anal Anastomosis and Quality of Life After Failure

Lepistö, Anna; Luukkonen, Pekka; Järvinen, Heikki

doi:10.1007/s10350-004-6412-9

Cited by 134 publications

(101 citation statements)

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“…A isquemia pode ser também lenta e tardia e, neste caso, poderá ocorrer disfuncionalização progressiva com fibrose do RI e até necessidade de remoção do mesmo. LOVEGROVE et al (24) mencionaram 4,5% e LEPISTÖ et al (22) , 5,3% de falência do reservatório por isquemia, próximo ao encontrado neste estudo, de 4,3%. Mesmo assim, em dois dos três casos que evoluíram com isquemia do RI, esta poderia ter sido atribuída a não preservação da arcada do cólon direito, pois foram operados no início da casuística, quando não se realizava esta técnica (13) .…”

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Complicações imediatas e tardias após cirurgia de reservatório ileal na polipose adenomatosa familiar

Leal

Ayrizono

Coy

et al. 2008

Arq. Gastroenterol.

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RESUMO -Racional -A retocolectomia total com confecção de reservatório ileal é cirurgia ideal para o tratamento do cólon e reto dos doentes com polipose adenomatosa familiar, no entanto pode estar associada a complicações no pós-operatório imediato e tardio. Objetivo -Estudar as complicações pós-operatórias da cirurgia do reservatório ileal na polipose adenomatosa familiar. e sepse pélvica (10,1%). Outras complicações foram isquemia aguda do reservatório ileal (4,3%), ileíte do reservatório ("pouchitis") (2,9%) e fístulas relacionadas ao reservatório (2,9%). Conclusões -A morbimortalidade foi semelhante à da literatura e aceitável para uma cirurgia complexa como é a do reservatório ileal, realizada em dois tempos operatórios. A obstrução intestinal foi a complicação mais freqüente. Entretanto, isquemia do reservatório, "pouchitis" e sepse pélvica constituíram importantes complicações relacionadas à perda do reservatório ileal. DESCRITORES -Polipose adenomatosa do colo, cirurgia. Íleo, cirurgia. Reto, cirurgia. Bolsas do colo. Colectomia, complicações.A polipose adenomatosa familiar (PAF) é uma doença hereditária de caráter autossômico dominante, igualmente distribuída entre os sexos. Origina-se, principalmente, a partir da mutação na linhagem de células germinativas no gene da polipose adenomatosa coli (PAC), resultando em formação de centenas de pólipos colorretais. A principal característica clínica é a evolução para câncer colorretal em quase 100% dos casos, geralmente antes dos 40 anos de idade, se a cirurgia não for realizada. A incidência é de 1/7.000 nascimentos, no entanto, esta estimativa é incerta, uma vez que a doença não é óbvia ao nascimento e algumas vezes pode se manifestar na 4ª ou 5ª décadas de vida, nas formas atenuadas da doença (2,3,4,29) .A retocolectomia total com confecção de reservatório ileal (RI) é a cirurgia de escolha para a PAF. Desde o seu advento, no final da década de 70 (27,30,42) , o RI tem sido a reconstrução cirúrgica ideal nesses doentes, uma vez que possibilita a retirada de toda a mucosa do cólon e do reto com potencial de formação de pólipos, como também evita a ileostomia definitiva (18,21,42) .Este procedimento está indicado nos doentes com PAF que possuem muitos pólipos retais, em geral mais do que 20, ou presença de pólipos com displasia de alto grau no epitélio, condições predisponentes para desenvolvimento de câncer retal (17) .Por ser cirurgia de maior complexidade, os doentes submetidos ao RI estão sujeitos a maior ocorrência de possíveis complicações tanto no pós-operatório imediato quanto tardio, quando comparados àqueles nos quais se faz apenas colectomia total e anastomose ileorretal. No entanto, de maneira geral, a retocolectomia total com RI apresenta aceitável morbidade e baixa mortalidade nos doentes portadores de PAF (9,18,21,24) .Este estudo teve como objetivo demonstrar as complicações pós-operatórias da cirurgia do RI em doentes com PAF que possuíam acometimento colorretal, acompanhados no Ambulatório de Coloproctologia de hospital universitário e compa...

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Complicações imediatas e tardias após cirurgia de reservatório ileal na polipose adenomatosa familiar

Leal

Ayrizono

Coy

et al. 2008

Arq. Gastroenterol.

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“…When it was first introduced, complication rates of 60-70% and failure rates of up to 30% were reported. The complication rate has decreased dramatically, so overall the failure rate now is less than 5% at large centers [48][49][50]. This is due to modifications in technique as well as increased experience both with the technical aspects of the procedure as well as the management of complications.…”

Section: The Pelvic Pouch Proceduresmentioning

confidence: 98%

“…Lepisto et al [50] reported an overall failure rate of 5.3%. The cumulative probability of pouch failure was 1% at 1 year, 5% at 5 years and 7% at 10 years.…”

Section: Pouch Failurementioning

confidence: 99%

Surgery for Inflammatory Bowel Diseases

McLeod¹

2003

Dig Dis

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Surgery is required in many patients with inflammatory bowel disease at some point in their disease. In patients with ulcerative colitis, surgery is potentially curative whereas recurrence of Crohn’s disease following surgery is a common occurrence. As a result, the indications and surgical management of the two diseases may be quite different. Surgery is usually reserved for the management of complications or failure of medical treatment in Crohn’s disease. Resection of the diseased segment is the usual procedure performed. While surgery usually results in an improvement in quality of life, recurrence of disease occurs frequently with reported rates of 5–90% at 1 year, depending on the criteria used. To date, there have been no surgical maneuvers which have been shown to decrease the risk of recurrence. Over the past few decades, several advances have been made in the surgical management of Crohn’s disease: use of strictureplasty for extensive disease; use of laparoscopic techniques to perform surgery and the performance of the ileal pouch procedure in very selected patients. Significant advances in the surgical management of ulcerative colitis have been made in the past 50 years. Although there are several options available to patients, the preferred option now is the ileal pouch procedure. With technical modifications and with experience, this procedure can now be performed with a low complication rate, with good functional results and quality of life and excellent long-term outcome.

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“…2,8,13,14 Failure occurs in 3-15% of patients. [2][3][4][6][7][8]11,[14][15][16] Data from the UK National Pouch Registry, comparing function and failure of 2364 patients undergoing IPAA with those of 127 who required subsequent abdominal salvage surgery, showed that functional results were poorer in the latter, with higher failure rates (7.7 vs 27.5%, p < 0.001). 15 Pouch retention rates after reconstructive surgery range between 0 and 50%.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Salvage Surgery for Ileal Pouch Complications and Dysfunctions. The Experience of a Referral Centre and Review of Literature

Pellino¹,

Selvaggi²

2015

ECCOJC

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Background and Aims: Failure rates of restorative proctocolectomy with ileo pouch-anal anastomosis (IPAA) range between 3.5 and 15%. Salvage surgery aims to preserve the pouch and transanal evacuation. We report our experience with salvage, review the outcomes of revisional pouch surgery, and propose a classification of pouch dysfunction. Methods: We collected data on patients undergoing pouch salvage surgery between 1987 and 2014 at our hospital. Pre-and post-salvage functional data were assessed. Function at the 3-year follow-up was compared with that of matched IPAA controls (study patients:controls, 1:3). Results: Considering only patients who underwent primary IPAA at our centre (n = 31), 5-year failure was higher after salvage compared with primary IPAA (28.8 vs 5.7% log rank test, p = 0.005). Overall, we included 39 patients, with eight additional patients who received primary IPAA elsewhere, undergoing 46 procedures. Most patients had a J-pouch (74.4%) and needed salvage for septic complications. A transperineal approach was used in 22 patients, whereas 17 underwent abdominal salvage, with 77.3 and 64.7% success rates, respectively. Minor surgery was effective but required repeated procedures. Overall failure was 28.2% at a median follow-up of 42 (1-153) months. A significant decrease in bowel frequency (p = 0.021) and rate of urgency (p = 0.009) was observed at the 3-year follow-up after salvage in 25 patients available for comparison. Functional results after major salvage procedures were poorer compared with healthy IPAA controls (p = 0.003). Conclusions: Salvage surgery is effective and safe in experienced teams, but the 5-year failure rate is higher after salvage than after successful primary pouch surgery. Sepsis brings about a higher risk of failure compared with mechanical causes of dysfunction.

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Cumulative Failure Rate of Ileal Pouch-Anal Anastomosis and Quality of Life After Failure

Abstract: The most common cause of pouch failure is fistula, whereas pouch excision is rarely caused by pouchitis. The impaired quality of life of patients in the failure group was caused by impairment of physical function and restrictions in social life.

Cited by 134 publications

References 18 publications

Complicações imediatas e tardias após cirurgia de reservatório ileal na polipose adenomatosa familiar

Complicações imediatas e tardias após cirurgia de reservatório ileal na polipose adenomatosa familiar

Surgery for Inflammatory Bowel Diseases

Outcomes of Salvage Surgery for Ileal Pouch Complications and Dysfunctions. The Experience of a Referral Centre and Review of Literature

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