Ileal Pouch Anal Anastomosis

Fazio, Victor W.; Kiran, Ravi P.; Remzi, Feza H.; Coffey, J. Calvin; Heneghan, Helen; Kirat, Hasan T.; Manilich, Elena; Shen, Bo; Martin, Seán T.

doi:10.1097/sla.0b013e31827d99a2

Cited by 618 publications

(259 citation statements)

References 26 publications

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“…Some studies found higher incidence of septic complications, fistula and anastomotic stricture after hand‐sewn IPAA,5, 9, 12 whereas other studies showed a trend toward higher incidence of overall complications and stricture after stapled IPAA 13, 14. Importantly, most of the previous studies included patients with ulcerative colitis (UC) rather than patients with FAP 5, 8, 14, 15 although the complication rates were different between such patients 5, 8, 14, 15. Furthermore, none of the studies used objective criteria such as the Clavien‐Dindo classification for stratifying the complications 5, 8, 9, 12, 13, 14, 15.…”

Section: Introductionmentioning

confidence: 99%

“…Importantly, most of the previous studies included patients with ulcerative colitis (UC) rather than patients with FAP 5, 8, 14, 15 although the complication rates were different between such patients 5, 8, 14, 15. Furthermore, none of the studies used objective criteria such as the Clavien‐Dindo classification for stratifying the complications 5, 8, 9, 12, 13, 14, 15. These limitations could explain inconsistent results in the previous studies, and we need evidence that focuses on patients with FAP with the use of objective criteria for assessing complications.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative complications after stapled and hand‐sewn ileal pouch‐anal anastomosis for familial adenomatous polyposis: A multicenter study

Konishi

Ishida

Ueno

et al. 2017

Annals of Gastroent Surgery

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Ileal pouch‐anal anastomosis (IPAA) after total proctocolectomy (TPC) can be conducted with either hand‐sewn or stapled anastomosis for patients with familial adenomatous polyposis (FAP). Although stapled IPAA without mucosectomy has a higher risk for developing adenomas in the remnant mucosa, it is the simpler procedure with potential benefit in short‐term outcomes. However, it remains controversial as to whether stapled IPAA has any advantages in reducing postoperative complications. The aim of the present study was to compare the postoperative complications and short‐term outcomes of stapled and hand‐sewn IPAA for patients with FAP, using a multicenter cohort sample in Japan. Data of 143 patients with FAP who underwent TPC with stapled IPAA (n=37) and hand‐sewn IPAA (n=106) at 23 institutions between 2000 and 2012 were collected. Postoperative complications, proportion of ostomy, fecal continence and overall survival were compared. Overall rates of the Clavien‐Dindo grade II‐IV complications were not different between the two groups (19% in stapled vs 25% in hand‐sewn, P=.42), with significantly fewer pouch‐related complications including leakage, pelvic abscess, vaginal fistula and anastomotic stricture in stapled IPAA (none in stapled vs 11% in hand‐sewn, P=.036). There was no mortality. Proportion of ostomy at 12 months was similar (2.7% in stapled vs 4.3% in hand‐sewn, P=.26). Mean Wexner score was similar. (0.47 in stapled vs 2.0 in hand‐sewn, P=.12). Five‐year overall survival excluding Stage IV patients was 96% in both groups. Stapled IPAA is a safe option in patients with FAP with a potential benefit in reducing pouch‐related complications.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Postoperative complications after stapled and hand‐sewn ileal pouch‐anal anastomosis for familial adenomatous polyposis: A multicenter study

Konishi

Ishida

Ueno

et al. 2017

Annals of Gastroent Surgery

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“…Therefore, surgery represents a good alternative to a long-term drug therapy. In the long term, despite the complications that can occur after IPAA, a good quality of life can be achieved for over 90% of all patients [4,5,6,7,8]. In a recently conducted case-control study there was no difference in quality of life between pouch patients versus patients receiving anti-TNFα therapy.…”

Section: Elective Surgery or Continued Drug Therapy?mentioning

confidence: 99%

“…In those patients, biological therapy can only achieve short-term improvement and postpone the need for a colectomy. In addition to those who are refractory to medical treatment, patients suffering from persistent malaise, poor drug compliance, or carcinoma anxiety will particularly benefit from surgery [4,5,6,7,8]. Restorative proctocolectomy strives to remove the complete substrate of the disease and to re-establish gastrointestinal continuity.…”

Section: Elective Surgery or Continued Drug Therapy?mentioning

confidence: 99%

“…Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become established as a standard surgical treatment for UC over the past 30 years. Ileo-anal pouch surgery provides the best possible quality of life for the patient with an average of 5-6 bowel movements per day and maintenance of continence in over 90% of patients [4,5,6,7,8]. The operation can be carried out as a one-, two- or three-stage procedure - depending on the individual risk profile of the patient.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Modern Drug Therapy on Surgery: Ulcerative Colitis

Kuehn

Hodin

2018

Visc Med

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Background: The primary treatment of ulcerative colitis (UC) is conservative, and substantial therapeutic progress has been made in the past few decades. Meanwhile, biologicals have become a mainstay in the treatment for steroid-refractory UC. Despite further development of drug therapy and an increased time span to operation, a significant proportion of patients with UC require surgical intervention. Surgical intervention needs to be carried out in medically refractory cases, imminent or malignant transformation, or complications. This article discusses the impact of modern drug therapy on surgery for UC. Methods: A selective literature search of PubMed was conducted, taking into account current studies, reviews, meta-analyses, and guidelines. Selected articles were then reviewed in detail and recommendations were drafted based on data and conclusions of the articles. Results: In recent years, modern drug therapy has changed the timing, approach, and outcomes of surgery for UC. Most of the studies showed a decrease in surgery rates over time while the rate of emergency colectomies remains unchanged. So far, no convincing surgery-sparing effect of newer medications has been established, and it remains debatable if surgery rates have decreased because of improved management for UC in general or due to the introduction of biologicals. The intensified conservative therapy with increasing use of biologics has been accompanied by a trend towards performing a three-step procedure in the last decade. There is a subset of patients with complex refractory disease who most likely benefit from elective surgery as an alternative to prolonged conservative therapies after failure of first-line treatment. The majority of patients after ileal pouch-anal anastomosis can avoid hospitalizations and colitis-related medications with their associated potential adverse effects. In addition, the procedure substantially reduces UC-related symptoms and the risk for dysplasia or cancer. There is a long-term pouch success rate of >90% after 10 and 20 years of follow-up. Conclusion: Conservative medical therapy in the treatment of UC will continue to develop and the number of approved therapeutics will grow. Surgery should not be considered as the negative endpoint of treatment modalities but as a good alternative to a prolonged conservative therapy for some patients. In conclusion, a close cooperation between the various disciplines in the pre- and postoperative management is essential in order to optimize the timing and outcome of patients with UC.

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