Long-term results of abdominal salvage surgery following restorative proctocolectomy

Tekkis, Paris; Heriot, Alexander G.; Smith, Jason; Das, P.; Canero, Antonio; Nicholls, R. J.

doi:10.1002/bjs.5242

Cited by 70 publications

(44 citation statements)

References 34 publications

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“…Self-perceived quality of life (according to the questionnaire and the SF-36 form) is consistent with results obtained with ileal pouch -anal anastomosis 4,8,10 .…”

Section: Discussionsupporting

confidence: 84%

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Interposition of a gastric pouch between ileum and anus after proctocolectomy: Long-term results in 3 patients

Ortega‐Deballon

Cheynel

Digiacomo

et al. 2009

Surgery

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“…Self-perceived quality of life (according to the questionnaire and the SF-36 form) is consistent with results obtained with ileal pouch -anal anastomosis 4,8,10 .…”

Section: Discussionsupporting

confidence: 84%

“…In this setting, it is not always possible to recreate an ileal or jejunal pouch. Despite salvage surgery, 12 % to 40 % of patients with pouch failure end up with a permanent ileostomy 3,4,5 .…”

Section: Introductionmentioning

confidence: 99%

Interposition of a gastric pouch between ileum and anus after proctocolectomy: Long-term results in 3 patients

Ortega‐Deballon

Cheynel

Digiacomo

et al. 2009

Surgery

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“…15 Pouch retention rates after reconstructive surgery range between 0 and 50%. 12,[17][18][19][20][21][22][23][24][25][26][27] Indications for pouch salvage surgery affect the outcomes. For this reason, we propose a classification of reasons for pouch salvage in Table 4.…”

Section: Discussionmentioning

confidence: 99%

“…Structural or OO dysfunctions have better results compared with septic complications. 7,11,12,17,28 Thus, it is important to distinguish between these entities and to know the aetiology of pouch malfunctions in order to choose the optimal treatment. The commonest conditions of surgical interest are discussed below; medical conditions and conservative management will also be briefly addressed.…”

Section: Discussionmentioning

confidence: 99%

“…6,[8][9][10] Better outcomes are reported for the treatment of outlet obstruction (OO) or non-septic complications, whereas salvage for pelvic sepsis is a matter of concern. 7,11,12 The aims of this paper are to report experience with pouch salvage at our centre, which has expertise in pouch surgery, and to provide the reader with an overview of ileal pouch dysfunctions and complications and their surgical management.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Salvage Surgery for Ileal Pouch Complications and Dysfunctions. The Experience of a Referral Centre and Review of Literature

Pellino¹,

Selvaggi²

2015

ECCOJC

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Background and Aims: Failure rates of restorative proctocolectomy with ileo pouch-anal anastomosis (IPAA) range between 3.5 and 15%. Salvage surgery aims to preserve the pouch and transanal evacuation. We report our experience with salvage, review the outcomes of revisional pouch surgery, and propose a classification of pouch dysfunction. Methods: We collected data on patients undergoing pouch salvage surgery between 1987 and 2014 at our hospital. Pre-and post-salvage functional data were assessed. Function at the 3-year follow-up was compared with that of matched IPAA controls (study patients:controls, 1:3). Results: Considering only patients who underwent primary IPAA at our centre (n = 31), 5-year failure was higher after salvage compared with primary IPAA (28.8 vs 5.7% log rank test, p = 0.005). Overall, we included 39 patients, with eight additional patients who received primary IPAA elsewhere, undergoing 46 procedures. Most patients had a J-pouch (74.4%) and needed salvage for septic complications. A transperineal approach was used in 22 patients, whereas 17 underwent abdominal salvage, with 77.3 and 64.7% success rates, respectively. Minor surgery was effective but required repeated procedures. Overall failure was 28.2% at a median follow-up of 42 (1-153) months. A significant decrease in bowel frequency (p = 0.021) and rate of urgency (p = 0.009) was observed at the 3-year follow-up after salvage in 25 patients available for comparison. Functional results after major salvage procedures were poorer compared with healthy IPAA controls (p = 0.003). Conclusions: Salvage surgery is effective and safe in experienced teams, but the 5-year failure rate is higher after salvage than after successful primary pouch surgery. Sepsis brings about a higher risk of failure compared with mechanical causes of dysfunction.

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Ileal pouch–anal anastomosis

McGuire

Brannigan

O'Connell

2007

British Journal of Surgery

102

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Long-term results of abdominal salvage surgery following restorative proctocolectomy

Abstract: Abdominal salvage surgery was associated with a failure rate of 21.4 per cent. A successful outcome was less likely when the procedure was carried out for septic compared with non-septic indications. The rate of pouch failure increased with length of follow-up.

Cited by 70 publications

References 34 publications

Interposition of a gastric pouch between ileum and anus after proctocolectomy: Long-term results in 3 patients

Interposition of a gastric pouch between ileum and anus after proctocolectomy: Long-term results in 3 patients

Outcomes of Salvage Surgery for Ileal Pouch Complications and Dysfunctions. The Experience of a Referral Centre and Review of Literature

Ileal pouch–anal anastomosis

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