Mucosectomy vs. stapled ileal pouch—anal anastomosis in patients with familial adenomatous polyposis

Remzi, Feza H.; Church, James M.; Bast, Jane; Lavery, Ian C.; Strong, Scott A.; Hull, Tracy L.; Harris, G. J. C.; Delaney, Conor P.; O’Riordain, Michael; McGannon, Ellen; Fazio, Victor W.

doi:10.1007/bf02234377

Cited by 142 publications

(136 citation statements)

References 11 publications

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“…Although some authors showed favorable results toward stapled IPAA,5, 9, 12 others reported no benefit or a trend toward higher complications 13, 14. In the present study, the analysis revealed no significant difference in the rates of overall complications or extra‐pelvic complications between stapled and hand‐sewn IPAA.…”

Section: Discussioncontrasting

confidence: 53%

“…The authors reported 31% and 23% pouch‐related complications in stapled and hand‐sewn IPAA, respectively. In a consecutive series of 119 restorative TPC for FAP during the period from 1982 to 1999 by Remzi et al.,9 stapled IPAA was introduced from 1988 and finally accounted for 65% of the study population. In Japan, the present data clearly showed that surgeons consistently preferred hand‐sewn IPAA during the study period of 2001‐2012, and stapled IPAA has been conducted rather selectively, although patient characteristics and surgical backgrounds were similar between the groups.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported several pros and cons on these two anastomotic techniques. Stapled IPAA is the simpler type of anastomosis with shorter length of operation and better fecal continence possibly as a result of omission of mucosectomy and preservation of the anal transitional zone (ATZ) 5, 7, 8, 9, 10. In contrast, hand‐sewn IPAA with mucosectomy can reduce a substantial risk for developing adenomas at the anastomotic site 11…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

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: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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Extracolonic Manifestations of Familial Adenomatous Polyposis After Proctocolectomy

Tulchinsky

Keidar²,

Strul³

et al. 2005

Arch Surg

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Long‐term outcomes following restorative proctocolectomy ileal pouch‐anal anastomosis in pediatric ulcerative colitis patients: Multicenter national study in Japan

Ikeuchi

Uchino

Sugita

et al. 2018

Annals of Gastroent Surgery

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BackgroundFew studies have investigated surgical outcomes following a colectomy in pediatric patients with ulcerative colitis (UC).PurposeThis study aimed to determine long‐term outcomes in a large cohort of pediatric patients who underwent proctocolectomy with ileal pouch‐anal anastomosis (IPAA) for UC.MethodsPediatric patients (<17 years old) who underwent surgery at 12 different hospitals in Japan between May 1979 and March 2015 were included in this study. Information was obtained by the use of a questionnaire survey.ResultsThere were 113 (53.3%) male and 99 (46.7%) female pediatric patients. The most common indication for elective surgery was failure of medical management, whereas emergency surgery was carried out for fulminant cases. A hand‐sewn IPAA was used with a mucosectomy in 112 (52.8%), stapled anastomosis in 93 (43.9%), and not specified in 7 (3.3%) patients. Small bowel obstruction and surgical site infection were the most frequent early postoperative complications (POC), whereas pouchitis, small bowel obstruction, and perianal fistula were frequent late POC. The most common late POC was pouchitis, found in 38 (17.9%) of the patients, whereas pouch failure was noted in 11 patients at the latest follow‐up examination. Cumulative pouch survival rate after 10 years was 91.7%. There were no significant differences regarding gender or anastomotic procedure in relation to cumulative pouch survival rate.ConclusionTo avoid pouch failure following an IPAA procedure, it is important to recognize that pouchitis or an anal fistula may lead to this condition in pediatric UC patients.

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Mucosectomy vs. stapled ileal pouch—anal anastomosis in patients with familial adenomatous polyposis

Abstract: Familial adenomatous polyposis patients with stapled ileal pouch-anal anastomosis have better functional outcome and can avoid temporary diversion. This should be balanced against a 28 percent incidence of adenomas in the anal transitional zone.

Cited by 142 publications

References 11 publications

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

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

Extracolonic Manifestations of Familial Adenomatous Polyposis After Proctocolectomy

Long‐term outcomes following restorative proctocolectomy ileal pouch‐anal anastomosis in pediatric ulcerative colitis patients: Multicenter national study in Japan

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