Functional outcome of stapled ileal pouch-anal canal anastomosis versus handsewn pouch-anal anastomosis

Saigusa, Naoto; Kurahashi, Takayuki; Nakamura, Takamitsu; Sugimura, Haruhiko; Baba, Shigeaki; Konno, Hiroyuki; Nakamura, Satoshi

doi:10.1007/s005950070095

Cited by 46 publications

(22 citation statements)

References 34 publications

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“…Our finding of better functional outcome in stapled pouch-anal anastomosis has been confirmed by several studies [38][39][40][41][42][43] but has also been contradicted by others including a large meta-analysis [19,44].…”

Section: Discussionsupporting

confidence: 68%

Functional Outcome and Quality of Life after Ileal Pouch-Anal Anastomosis within a Defined Population in Sweden

Dafnis¹

2018

Dig Dis

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Objective: The purpose of this population-based study was to present prospectively recorded functional data and health-related quality of life (HRQOL) questionnaire data to assess the long-term results of the first 100 consecutive ileal pouch-anal anastomosis (IPAA) performed chronologically by 3 surgeons in a single referral centre. Methods: During 1993–2008, 100 patients underwent IPAA. The 90 patients still alive with an intact pouch were included (response rate = 92%). Function was evaluated using St Mark’s incontinence score, and HRQOL with SF-36. Results: At 18 months after loop ileostomy closure, 63 patients (76%) had 4–6 day-time and 47 patients (57%) had no night-time bowel movements. A stapled IPAA resulted in better St Mark’s (p = 0.0064) and Wexner scores (p = 0.0019) than did a hand-sewn anastomosis. The younger the patients were at the onset of ulcerative colitis (UC) the better St Mark’s (p = 0.0037) and Wexner scores (p = 0.011) were. The patients scored significantly higher than did the general Swedish population adjusted by age-group and sex in 6 out of 7 SF-36 subscales. Conclusions: In the hands of experienced high-volume surgeons, IPAA is a safe procedure associated with good functional results that are stable over time. Stapled IPAA and younger age at onset of UC were correlated with better functional results. The HRQOL scores were high.

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Section: Discussionsupporting

confidence: 68%

Functional Outcome and Quality of Life after Ileal Pouch-Anal Anastomosis within a Defined Population in Sweden

Dafnis¹

2018

Dig Dis

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“…15 IACA is not a specific bowel reconstruction for patients undergoing total colectomy for fulminant AC, although this procedure is currently the standard for patients with ulcerative colitis and familial adenomatous polyposis, with better functional outcomes than ileal pouch anal anastotmosis with mucosectomy. 16,17 In this case, we selected IACA because (1) dissecting the lower rectum was mandatory for safe bowel anastomosis, and (2) anal function was considered intact even after severe inflammation caused rectal stricture. Pathological changes around the perirectal tissue below the stenotic part should be noted when surgeons schedule bowel reconstruction after total colectomy for AC.…”

Section: Discussionmentioning

confidence: 99%

Fulminant amoebic colitis with perforation successfully treated by staged surgery: a case report

Ishida

Inokuma

Murata

et al. 2003

Journal of Gastroenterology

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Radical surgery for fulminant amoebic colitis leads to extremely high mortality; however, resective surgery is mandatory if a patient develops massive fecal peritonitis. We herein report an extremely rare case of fulminant amoebic colitis with multiple perforations, which was successfully treated by staged surgical procedures. A 48-year-old man who had been treated with predonisolone under a diagnosis of ulcerative colitis was admitted. Biopsy specimens from the colonic mucosa revealed Entamoeba histolytica. On the day of diagnosis, he developed severe abdominal pain and underwent emergency laparoptomy, showing total colonic gangrene with multiple perforations associated with massive fecal peritonitis. Subtotal colectomy, mucous fistula of the rectosigmoid, and ileostomy were performed. He recovered well although disseminated intravascular coagulopathy developed postoperatively. As the middle and upper part of rectum was found to be severely stenotic 4 months after surgery, we performed proctectomy, ileal pouch anal canal anastomosis, and diverting ileostomy, which was reversed 6 months later. The patient has been well with satisfactory anal function 37 months after the initial surgery. This case suggests that (1). early and accurate diagnosis of amoebiasis is important to avoid surgical intervention, and (2). staged surgery including total colectomy should be considered as one of the treatment choices even in patients with total necrotizing amoebic colitis.

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“…Some surgeons have abandoned the step of endoanal mucosectomy in order to simplify the procedure and improve functional outcome [23,[39][40][41][42][43][44][45], preferring instead a technique of double stapling of the anastomosis, transection with a linear stapler of the very distal rectum or proximal anal canal, thereby avoiding a mucosectomy, and anastomosing the pouch by means of a circular end-to-end stapler (Figure 3b) [23].…”

Section: Endoanal Mucosectomy Vs Double-stapled Anastomosismentioning

confidence: 99%

Restorative proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis revisited

et al. 2006

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Since restorative proctocolectomy (RPC) with ileal-pouch anal anastomosis (IPAA) removes the entire diseased mucosa, it has become firmly established as the standard operative procedure of choice for familial adenomatous polyposis (FAP). Many technical controversies still persist, such as mesenteric lengthening techniques, close rectal wall proctectomy, endoanal mucosectomy vs. double stapled anastomosis, loop ileostomy omission and a laparoscopic approach. Despite the complexity of the operation, IPAA is safe (mortality: 0.5-1%), it carries an acceptable risk of non-life-threatening complications (10-25%), and it achieves good long-term functional outcome with excellent patient satisfaction (over 95%). In contrast to the high incidence in patients operated for ulcerative colitis (UC) (15-20%), the occurrence of pouchitis after IPAA seems to be rare in FAP patients (0-11%). Even after IPAA, FAP patients are still at risk of developing adenomas (and occasional adenocarcinomas), either in the anal canal (10-31%) or in the ileal pouch itself (8-62%), thus requiring lifelong endoscopic monitoring. IPAA operation does not jeopardise pregnancy and childbirth, but it does impair female fecundity and has a low risk of impairment of erection and ejaculation in young males. The latter can almost completely be avoided by a careful "close rectal wall" proctectomy technique. Some argue that low risk patients (e.g. <5 rectal polyps) can be identified where ileorectal anastomosis (IRA) might be reasonable. We feel that the risk of rectal cancer after IRA means that IPAA should be recommended for the vast majority of FAP patients. We accept that in some very selected cases, based on clinical and genetics data (and perhaps influenced by patient choice regarding female fecundity), a stepwise surgical strategy with a primary IPA followed at a later age by a secondary proctectomy with IPAA could be proposed.

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Functional outcome of stapled ileal pouch-anal canal anastomosis versus handsewn pouch-anal anastomosis

Cited by 46 publications

References 34 publications

Functional Outcome and Quality of Life after Ileal Pouch-Anal Anastomosis within a Defined Population in Sweden

Functional Outcome and Quality of Life after Ileal Pouch-Anal Anastomosis within a Defined Population in Sweden

Fulminant amoebic colitis with perforation successfully treated by staged surgery: a case report

Restorative proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis revisited

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