Mo1497: PROPHYLACTIC POSTOPERATIVE IMMUNOSUPPRESSIVE THERAPY MAY REDUCE THE RISK OF POUCH FAILURE IN PATIENTS UNDERGOING INTENTIONAL ILEAL POUCH-ANAL ANASTOMOSIS FOR CROHN’S DISEASE

Shemtov, Ron; Syal, Gaurav; Aviran, Eyal; Fleshner, Phillip

doi:10.1016/s0016-5085(22)61869-9

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“…Our group recently demonstrated significantly lower pouch failure rates after IPAA in patients with CD treated with prophylactic biologic therapy compared to patients who did not receive prophylaxis. 29 In addition, a recent article by Lavryk et al 30 suggested that a redo ileal pouch may be offered in cases of pouch failure in selected patients with CD, primarily because of improved medical treatment of pouch CD. In short, as the medical treatment of IBD improves, new surgical options will also develop.…”

Section: Discussionmentioning

confidence: 99%

Long-term Outcomes and Factors Predicting Outcome of Ileal Pouch-Anal Anastomosis When Used Intentionally for Well-Defined Crohn’s Disease

Aviran

Assaf

Zaghiyan

et al. 2023

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Crohn’s disease is considered a contraindication for IPAA. In our prior study, when IPAA was used intentionally for well-defined Crohn’s disease, we found a high incidence of recurrent disease with a low incidence of pouch failure. OBJECTIVE: This study aimed to replicate these findings in a larger cohort over a longer period. DESIGN: Retrospective review of a prospective IBD registry. SETTINGS: Large IBD referral center. PATIENTS: Patients with preoperative colorectal Crohn’s disease requiring surgery were included in the study. INTERVENTION: IPAA. MAIN OUTCOME MEASURES: Long-term Crohn’s disease recurrence, pouch failure, and pouch function. RESULTS: Forty-six patients were identified. Crohn’s disease was diagnosed on the basis of perianal disease (n = 18; 39%), small-bowel disease (n = 16; 35%), noncaseating granuloma (n = 10; 22%), and discontinuous inflammation (colorectal skip lesions) (n = 11; 24%). After a median follow-up of 93 (7–291) months, 22 patients (48%) developed recurrent Crohn’s disease based on afferent limb disease (n = 14; 30%) or pouch fistulizing disease (n = 8; 18%). Only 4 patients (9%) developed pouch failure. No clinical factor was associated with Crohn’s disease recurrence. Young age at the time of surgery and short duration of disease before IPAA were associated with pouch fistula recurrence (p = 0.003 and p = 0.03, respectively). Most patients (86%) reported excellent continence, with no urgency (67%) and median stool frequency of 6 (range, 3–9) per day. LIMITATION: Retrospective nature and relatively small sample size. CONCLUSION: This largest reported series examining the intentional use of IPAA in Crohn’s disease showed a high (48%) incidence of postoperative Crohn’s disease with a low (9%) incidence of pouch failure. Young age and short disease course before surgery were risk factors for poor outcomes. Highly motivated patients with colorectal Crohn’s disease may consider IPAA and avoid a definitive ileostomy. See Video Abstract at http://links.lww.com/DCR/C171. RESULTADOS A LARGO PLAZO Y FACTORES PREDICTORES DE RESULTADOS DE LA ANASTOMOSIS ILEOANAL CON RESERVORIO CUANDO SE USA INTENCIONALMENTE PARA LA ENFERMEDAD DE CROHN BIEN DEFINIDA ANTECEDENTES: La enfermedad de Crohn (EC) se considera una contraindicación para la anastomosis ileoanal con reservorio (IPAA). Nuestro estudio previo de IPAA cuando fue usada intencionalmente para EC bien definida mostró una alta incidencia de enfermedad recurrente con una baja incidencia de falla del reservorio. OBJETIVO: Replicar estos hallazgos en una cohorte más grande durante un período más largo. DISEÑO: Revisión retrospectiva de una base de datos prospectiva de enfermedad inflamatoria intestinal. ESCENARIO: Un centro grande de referencia de EII. PACIENTES: EC colorrectal preoperatoria con necesidad de tratamiento quirúrgico. INTERVENCIÓN: Anastomosis ileoanal con reservorio. RESULTADOS PRINCIPALES: Recurrencia de EC a largo plazo, falla del reservorio y función del reservorio. RESULTADOS: Cuarenta y seis pa...

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Section: Discussionmentioning

confidence: 99%