Ileal pouch–anal anastomosis—a personal experience reevaluating complications, pouch survival, and quality of life

Ecker, Nils Karl Josef; Woywod, Ann-Christin; Ecker, K. W.

doi:10.1007/s00053-021-00534-4

Cited by 4 publications

(2 citation statements)

References 26 publications

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“…CI or KP has been abandoned as primary reconstructive procedure ever since the implementation of IPAA as the preferred reconstructive procedure for proctocolectomy [5,7,8]. An important argument for the change in strategy was that IPAA preserves the natural defecation route, thereby preventing the requirement of a permanent stoma.…”

Section: Discussionmentioning

confidence: 99%

Salvage surgery for continent ileostomies (CI) after a first successful revision: more long-term blame on the reservoir than the nipple valve

Ecker

Tönsmann²,

Ecker³

et al. 2021

Int J Colorectal Dis

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Purpose The aim of the study was to investigate the underlying cause of long-term complications in patients requiring at least one revision surgery of a continent ileostomy (CI) and to analyze functional outcome. Methods Only patients with CI at least one revision were included in the retrospective data analysis. Four different classes of complications (Cl A–D) were defined: Cl A = Nipple valve (NV), Cl B = pouch, Cl C = outlet (stoma), and Cl D = afferent loop (AL). Associations between underlying disease and origin of complications were analyzed. Cumulative probabilities were calculated using Kaplan–Meier analysis. Results A total of 77 patients were identified with a follow-up of 30 years, requiring 133 surgeries for 148 complications (c.). Cl A 49 c. (33.1%), Cl B 50 c. (33.8%), Cl C 39 c. (26.4%), and Cl D 10 c. (6.8%). Cl A and C complications were not correlated to underlying disease, whereas Cl B and D complications were only found in ulcerative colitis (UC) and Crohn’s disease (CD). The cumulative probability of a second revision showed a linear rise, reaching 62.5% after 20 years. Cl A and B complications both reached 42.1%. Eleven (14.3%) patients (10 Cl B) had pouch failure in a follow-up period of 11.5 ± 8.7 years (1–31 years), whereas 66 (85.7%) had successful revisional surgery. Overall CI survival was 78.8% at 44 years. Conclusion CI survival is limited by inflammatory complications of the pouch based on the underlying disease and not by mechanical limitations of the NV. Trial registration numbers None.

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Section: Discussionmentioning

confidence: 99%

Salvage surgery for continent ileostomies (CI) after a first successful revision: more long-term blame on the reservoir than the nipple valve

Ecker

Tönsmann²,

Ecker³

et al. 2021

Int J Colorectal Dis

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“…Our extensive practice over nearly four decades has involved intensive work with both IPAA and CI [12][13][14]. Consequently, patients experiencing complications or failure of IPAA are often referred to our center for the decision-making process regarding repair or redo surgery versus conversion to CI.…”

Section: Introductionmentioning

confidence: 99%

Comparing Continent Ileostomy (CI) Conversion to Repair/Redo IPAA: Favorable Outcomes

Ecker,

Dinh,

Möslein

et al. 2023

Preprint

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Purpose: This study aims to compare the outcomes of repair/redo ileal pouch-anal anastomosis (repair/redo-IPAA) with the conversion of IPAA to continent ileostomy (CI) in an effort to prevent the need for a permanent ileostomy (IS) following IPAA failure. Methods: This research involved a retrospective analysis of surgical records, employing descriptive statistics and Kaplan-Meier survival analysis. Results: Among 57 patients with an IPAA, up to three revisions were necessary due to complications or complete failure. Ultimately, repair/redo-IPAA preserved the IPAA in 14 patients (24.6%), conversion to CI salvaged the pouch in 21 patients (36.8%), and IS was unavoidable in 22 patients (38.6%). The cumulative probability of requiring conversion surgery was calculated to be 54.0% at 20 years, thereby reducing the cumulative risk of IS to 32.3%. The 20-year cumulative probability of pouch salvage by repair/redo IPAA was only 21.9%. However, this rate increased to 67.7% when conversion procedures were considered. Following repair/redo-IPAA, only 8.3% of patients reported evacuation frequencies of ≤4 during the day, and 16.7% were evacuation-free at night. In contrast, after conversion to CI, 98.0% of patients reported a maximum of four evacuations in a 24-hour period. After undergoing repair/redo IPAA, between half and two-thirds of patients reported experiencing incontinence or soiling, while complete continence was achieved in all patients following conversion to CI. Notably, the majority of patients expressed overall satisfaction with their respective procedures. A positive correlation was identified between very high subjective satisfaction and positive objective surgical outcomes exclusively in patients who underwent conversion to CI. Conclusion: When complications or failure of IPAA occur, conversion to CI emerges as a highly viable alternative to repair/redo IPAA. This conclusion is supported by the observation that patient satisfaction appears to be closely tied to stable surgical outcomes. To reinforce these findings, further prospective studies are warranted. Trial registration numbers: None

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Comparing continent ileostomy (CI) conversion to repair/redo IPAA: favorable outcomes

Ecker,

Dinh,

Möslein

et al. 2023

Int J Colorectal Dis

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Purpose This study aims to compare the outcomes of repair/redo ileal pouch-anal anastomosis (repair/redo-IPAA) with the conversion of IPAA to continent ileostomy (CI) in an effort to prevent the need for a permanent ileostomy (IS) following IPAA failure. Methods This research involved a retrospective analysis of surgical records, employing descriptive statistics and Kaplan-Meier survival analysis. Results Among 57 patients with an IPAA, up to three revisions were necessary due to complications or complete failure. Ultimately, repair/redo-IPAA preserved the IPAA in 14 patients (24.6%), conversion to CI salvaged the pouch in 21 patients (36.8%), and IS was unavoidable in 22 patients (38.6%). The cumulative probability of requiring conversion surgery was calculated to be 54.0% at 20 years, thereby reducing the cumulative risk of IS to 32.3%. The 20-year cumulative probability of pouch salvage by repair/redo IPAA was only 21.9%. However, this rate increased to 67.7% when conversion procedures were considered. Following repair/redo-IPAA, only 8.3% of patients reported evacuation frequencies of ≤ 4 during the day, and 16.7% were evacuation-free at night. In contrast, after conversion to CI, 98.0% of patients reported a maximum of four evacuations in a 24-h period. After undergoing repair/redo IPAA, between half and two-thirds of patients reported experiencing incontinence or soiling, while complete continence was achieved in all patients following conversion to CI. Notably, the majority of patients expressed overall satisfaction with their respective procedures. A positive correlation was identified between very high subjective satisfaction and positive objective surgical outcomes exclusively in patients who underwent conversion to CI. Conclusion When complications or failure of IPAA occur, conversion to CI emerges as a highly viable alternative to repair/redo IPAA. This conclusion is supported by the observation that patient satisfaction appears to be closely tied to stable surgical outcomes. To reinforce these findings, further prospective studies are warranted.

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Ileal pouch–anal anastomosis—a personal experience reevaluating complications, pouch survival, and quality of life

Cited by 4 publications

References 26 publications

Salvage surgery for continent ileostomies (CI) after a first successful revision: more long-term blame on the reservoir than the nipple valve

Salvage surgery for continent ileostomies (CI) after a first successful revision: more long-term blame on the reservoir than the nipple valve

Comparing Continent Ileostomy (CI) Conversion to Repair/Redo IPAA: Favorable Outcomes

Comparing continent ileostomy (CI) conversion to repair/redo IPAA: favorable outcomes

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