Fecal continence outcomes are associated with the type, height, and stage procedure of ileal pouch-anal anastomosis

Jonker, Jara E.; Hofker, H. Sijbrand; Trzpis, Monika; Broens, Paul M. A.

doi:10.1007/s00384-020-03626-7

Cited by 10 publications

(8 citation statements)

References 38 publications

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“…This fits the recommendations of the guidelines [9]. The choice for a three-staged concept in cases with a severe UC and high-dose immunosuppression results in fewer perioperative complications and better longterm outcomes [18][19][20]. We interpreted the higher degree of proctitis in three-staged IPAA as an indicator of the overall higher activity of the disease in those patients, which led to the decision for a three-staged concept.…”

Section: Discussionsupporting

confidence: 58%

Inflammation of the rectal remnant endangers the outcome of ileal pouch-anal anastomosis: a case–control study

Frese

Gröne

Lauscher

et al. 2022

Int J Colorectal Dis

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Background Inflammation of the rectal remnant may affect the postoperative outcome of ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC). We aimed to determine the extent of inflammation in the anastomotic area during IPAA and to investigate the impact of proctitis on postoperative complications and long-term outcomes. Methods Three hundred thirty-four UC patients with primary IPAA were included in this retrospective case–control study. The histopathologic degree of inflammation in the anastomotic area was graded into three stages of no proctitis (“NOP”), mild to medium proctitis (“MIP”), and severe proctitis (“SEP”). Preoperative risk factors, 30-day morbidity, and follow-up data were assessed. Kaplan–Meier analysis was performed in the event of pouch failure. Results The prevalence of proctitis was high (MIP 40.4%, and SEP 42.8%). During follow-up, the incidence of complications was highest among SEP: resulting in re-intervention (n = 40; 28.2%, p = 0.017), pouchitis (n = 36; 25.2%, p < 0.01), and pouch failure (n = 32; 22.4%, p = 0.032). The time interval to pouch failure was 5.0 (4.0–6.9) years among NOP, and 1.2 (0.5–2.3) years in SEP (p = 0.036). ASA 3, pouchitis, and pouch fistula were independent risk factors for pouch failure. Conclusion Proctitis at the time of IPAA is common. A high degree of inflammation is associated with poor long-term outcomes, an effect that declines over time. In addition, a higher degree of proctitis leads to earlier pouch failure.

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Section: Discussionsupporting

confidence: 58%

Inflammation of the rectal remnant endangers the outcome of ileal pouch-anal anastomosis: a case–control study

Frese

Gröne

Lauscher

et al. 2022

Int J Colorectal Dis

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“…In previous studies, CCFFIS has been used as the measurement to compare FI after stapled versus hand‐sewn IPAA; however, it was only analysed at a single time‐point after pouch surgery [11, 12, 17]. In contrast, the present study evaluated CCFFIS at two time‐points after pouch surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In proctocolectomy with IPAA, there have been several reports that investigated postoperative complications [8–10] and functional outcomes, such as faecal incontinence (FI), bowel movement, and quality of life [9–17], by comparing stapled and hand‐sewn IPAA. However, anorectal manometric data analysed before and after pouch surgery are limited.…”

Section: Introductionmentioning

confidence: 99%

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Temporal changes in functional outcomes of stapled and hand‐sewn ileal pouch‐anal anastomosis for ulcerative colitis and familial adenomatous polyposis

et al. 2022

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Aim Little is known about how ileal pouch‐anal anastomosis (IPAA) influences anorectal manometric data. This study aimed to clarify temporal changes in anorectal manometric data and faecal incontinence in IPAA. Methods We examined 32 patients with ulcerative colitis (UC) or familial adenomatous polyposis (FAP) undergoing restorative proctocolectomy with stapled or hand‐sewn IPAA. Maximum resting pressure (MRP) and maximum squeezing pressure (MSP) were analysed before and 1–3, 6–9, and 12–24 months after IPAA. Cleveland Clinic Florida‐Faecal Incontinence Score (CCF‐FIS) was measured 6–9 and 12–24 months after IPAA. Results Fourteen patients underwent stapled IPAA and 18 patients underwent hand‐sewn IPAA. MRP decreased 1–3 months after stapled IPAA (median: 42.3 mmHg vs. 60.0 mmHg at preoperative value, p = 0.039), but recovered afterwards. In hand‐sewn IPAA, the median MRP decreased to 29.5 mmHg at 1–3 months after IPAA (baseline: 64.8 mmHg, p < 0.0001), and remained unchanged thereafter. Stapled IPAA did not affect MSP; however, hand‐sewn IPAA caused a reduction in the median MSP from 191.3 mmHg to 141.3 mmHg at 1–3 months (p = 0.035), which gradually increased afterwards. The median CCFFIS was 5.5 points at 6–9 months and 2 points at 12–24 months after stapled IPAA. The score was high (11 points) at 6–9 months but decreased to 5 points at 12–24 months after hand‐sewn IPAA (p = 0.022). Conclusion We present time trends in functional outcomes of IPAA. MRP showed a transient decrease after stapled IPAA, whereas it remained low after hand‐sewn IPAA. CCFFIS was high only at 6–9 months after hand‐sewn IPAA.

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“…The radical stage of surgical interventions for non-neoplastic colonic diseases, which include ulcerative colitis, Crohn's disease, familial adenomatous polyposis, chronic colonic or coloproctogenic stasis, diverticular colon disease, plays an extremely important role. A specified radical stage is important due to the fact that its insufficient extent poses a risk of the disease recurrence, thus, significantly negatively affects the functional outcomes of surgical treatment, social and occupational rehabilitation [1][2][3].…”

mentioning

confidence: 99%

Radical surgery for non-neoplastic colonic diseases

Melnyk¹

2023

ZMJ

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Aim. To improve the results of surgical treatment for patients with non-neoplastic colonic diseases by optimizing the choice of radical surgery extent. Materials and methods. The study material was the analysis of radical surgical interventions performed in 87 patients with non-neoplastic colonic diseases: ulcerative colitis, Crohn’s disease, familial adenomatous polyposis, chronic colonic and coloproctogenic stasis, diverticular colon disease. The age of the operated patients was 20–72 years. There were 49 (56.3 %) men and 38 (43.7 %) women. The criteria for choosing the radical surgery extent for these diseases were defined and substantiated. Results. There were 3 postoperative mortalities (3.4 %) among patients operated on absolute indications for acute complications of ulcerative colitis and Crohn’s disease. Recurrences of ulcerative colitis, Crohn’s disease and familial adenomatous polyposis occurred in 16 (18.4 %) operated patients in the area of the retained rectal stump and terminal ileum. Malignant transformation of the rectal stump occurred in 5 (5.7 %) patients with these recurrences. The extent of radical surgery in non-neoplastic colonic diseases depended on the diagnosis of the underlying disease, the presence of complications, the depth of wall lesions and the extent of the pathological process, the risk of recurrence in the anatomical parts of the small and large intestine. Conclusions. Deciding on the extent of the radical stage of surgical intervention depended on the diagnosis, features of the clinical course of non-neoplastic colorectal diseases, recurrences, the general condition of a patient, the pathological process extent and severity. Performing the optimal extent of radical surgery for non-neoplastic colonic diseases helped reduce the number of recurrences in the terminal part of the small intestine to 4 (4.6 %), in the area of the rectal stump to 7 (8.1 %), improved functional outcomes and quality of life in 76 (87.3 %) operated patients.

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Fecal continence outcomes are associated with the type, height, and stage procedure of ileal pouch-anal anastomosis

Cited by 10 publications

References 38 publications

Inflammation of the rectal remnant endangers the outcome of ileal pouch-anal anastomosis: a case–control study

Inflammation of the rectal remnant endangers the outcome of ileal pouch-anal anastomosis: a case–control study

Temporal changes in functional outcomes of stapled and hand‐sewn ileal pouch‐anal anastomosis for ulcerative colitis and familial adenomatous polyposis

Radical surgery for non-neoplastic colonic diseases

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