Ileal Pouch-Anal Anastomosis

Becker, James M.; Raymond, Janice L.

doi:10.1097/00000658-198610000-00005

Cited by 168 publications

(24 citation statements)

References 14 publications

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“…However, our excellent long-term results with tech nique I, namely in terms of anorectal function, merely replicate what has repeatedly been reported by others [17][18][19][20] and seem to indicate that this technical modality is the most appropriate. This contention appears partic ularly true when FAP, rather than ulcerative colitis, is the pathology being dealt with [20].…”

Section: Discussionsupporting

confidence: 89%

Familial Adenomatous Polyposis: Surgical Approaches

Almeida¹,

Gracias²,

Santos³

et al. 1990

Dig Surg

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Familial adenomatous polyposis (FAP) is a well-recognized precancerous lesion for which large bowel resection is the only possibility of obtaining a cure. The senior author’s personal experience with the surgical treatment of 12 patients suffering from this disease is analyzed, and forms the basis for a discussion of what might be considered the ‘ideal’ approach. A restorative proctocolectomy with ileoanal anastomosis (technique I) was performed in 4 patients; total colectomy followed by ileorectal anastomosis (technique II) in 5, and panproctocolectomy with a definitive Brooke ileostomy in 3 (technique III). There was no operative mortality. Two patients from technique II (40%) developed rectal cancer 4 and 5 years after surgery, respectively, for which an abdominoperineal proctectomy with a conventional ileostomy was performed. The long-term results among patients of technique I, in terms of anorectal function, are excellent, suggesting that this modality is probably the most appropriate approach to FAP when dealing with a patient under 45 years of age.

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Section: Discussionsupporting

confidence: 89%

Familial Adenomatous Polyposis: Surgical Approaches

Almeida¹,

Gracias²,

Santos³

et al. 1990

Dig Surg

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“…In previous reports from adult populations (11,13), the type of pouch does not seem to affect the rate of pouchitis, and in our study group there was no difference between those who had a straight pull-through (50% pouchitis) or a J-pouch (46%). There is ample evidence that pouchitis is a sequela more often following surgery for ulcerative colitis rather than FP (9,10,(27)(28)(29), an observation again reiterated in our study; the study populations of Sarigol et al…”

Section: Discussionsupporting

confidence: 77%

Pouchitis in Young Patients After the Ileal Pouch-Anal Anastomosis

Perrault¹,

Berry²,

Greseth

et al. 1997

Inflammatory Bowel Diseases

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: The purpose of this study was to determine the incidence of pouchitis after the ileal pouch-anal anastomosis in young patients, and to identify possible predisposing factors. The study design included long-term follow-up of young patients after closure of their temporary diverting ileostomy, through regular visits, a detailed questionnaire, or phone call. The Kaplan-Meier method was used to summarize survival free of pouchitis in several subgroups. A logistic regression analysis of just the patients with pouchitis was used to determine whether any clinical variables could discriminate between those with acute and those with chronic pouchitis. We are closely following 97 patients with an ileal pouch-anal anastomosis-83 patients for chronic ulcerative colitis and 14 patients for familial polyposis. They have been followed for a median of 7.5 years (range 1-14.5 years). Forty-six patients (47%) developed pouchitis-44 (53%) patients after ulcerative colitis and 2 (14%) patients after polyposis. Most (92%) had loose and/or frequent stools, many had incontinence (62%) and bloody stools (62%), and less (37%) had cramping. Endoscopy was done in 82% of the patients; erythema and/or friability was seen in all patients, often with ulcers or erosions (35%); no polyposis patients had ulcers. We could not identify any predisposing factor. Metronidazole was the treatment of choice, but some patients required long-term treatment with sulfasalazine and/or steroid enemas. Pouchitis is a common long-term complication of the ileal pouch-anal anastomosis after ulcerative colitis. No predisposing factor has yet been identified in these young patients.

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“… 2 – 4 Many researchers over the last 30 years had studied this procedure with regard to the short- and long-term outcome. Some of them concluded that the functional outcome was better and the complications were less in FAP patients than in MUC patients 2 , 5 while others found them similar. In Saudi Arabia there was a single report about 30 patients who underwent IPAA; however, the differences between FAP and MUC cases have not been studied.…”

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confidence: 99%

Outcome after ileal pouch-anal anastomosis for familial adenomatous polyposis compared to mucosal ulcerative colitis in a Middle Eastern population

Al‐Sanea

Alfaifi

Homoud

et al. 2013

Annals of Saudi Medicine

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BACKGROUND AND OBJECTIVESTo compare the complications and outcome after ileal pouch-anal anastomosis (IPAA) for mucosal ulcerative colitis (MUC) and familial adenomatous polyposis (FAP).DESIGN AND SETTINGSThis is a retrospective study. The study was conducted at a single tertiary referral center.METHODSAll patients who underwent restorative proctocolectomy with IPAA at a tertiary center in Saudi Arabia from 2001 till 2009 were retrieved. Data was obtained regarding preoperative status, postoperative complications, and functional outcome.RESULTSA total of 40 patients underwent IPAA, of which 21 cases were of FAP and 19 cases of MUC. Median age at operation for FAP and MUC was 31 (range: 16–45) and 43 (range: 15–65) years, respectively (P<.05). Median length of stay was 10 days (range: 6–42) for FAP and 12 days (range: 9–27) for MUC (P=.1). Postoperative morbidity was noted in 4 cases of FAP and 6 cases of MUC (P=.36). Specifically, wound infection was noted in 2 cases of FAP compared to 3 cases of MUC (P=.55); 1 MUC case had an anastomotic leak (P=.29). One mortality was recorded among the FAP cases (P=.35). The time between the creation of IPAA and the closure of ileostomy was 4.5 and 5 months for FAP and MUC, respectively (P=.87). Median follow-up was 36 months. Median bowel frequency per 24 hours was 6 (range: 3–24) for FAP and 7 (range 3–17) for MUC (P=.54). Intestinal obstruction was reported in 3 cases of FAP and 5 cases of MUC (P=.38). One pouch was excised in a FAP patient. One case of MUC developed pouchitis.CONCLUSIONSThe outcome after IPAA was inferior for MUC compared to FAP, but it was not statistically significant due to the small sample size. The morbid status of the MUC cases and their older age contributed to the minor differences.

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Ileal Pouch-Anal Anastomosis

Cited by 168 publications

References 14 publications

Familial Adenomatous Polyposis: Surgical Approaches

Familial Adenomatous Polyposis: Surgical Approaches

Pouchitis in Young Patients After the Ileal Pouch-Anal Anastomosis

Outcome after ileal pouch-anal anastomosis for familial adenomatous polyposis compared to mucosal ulcerative colitis in a Middle Eastern population

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