Permanent Ostomy After Ileoanal Pouch Failure

Kiran, Ravi P.; Kirat, Hasan T.; Rottoli, Matteo; Xhaja, Xhileta; Remzi, Feza H.; Fazio, Victor W.

doi:10.1097/dcr.0b013e3182312a8a

Cited by 48 publications

(19 citation statements)

References 21 publications

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“…Ileal anal pouch excision is a technically demanding procedure, deep in the pelvis, often in the setting of chronic sepsis, inflammation or stricturing disease. While several studies have reported on the indications for pouch excision, a limited number of series have looked at the postoperative complications that occur in order to understand the risks of the operation and enable surgeons to adequately counsel patients preoperatively . In our series of 147 patients having pouch excision, 57% experienced short‐term postoperative morbidity and 37% experienced long‐term postoperative morbidity.…”

Section: Discussionmentioning

confidence: 96%

“…Chronic non-healing perineal wound (n = 7) Parastomal hernia repair (n = 5) Revision of stoma (n = 3) High grade small bowel obstruction with resection (n = 1) Midline wound washout (n = 1) Recurrent presacral abscess washout (n = 1) Gastric ulcer perforation (n = 1) While several studies have reported on the indications for pouch excision, a limited number of series have looked at the postoperative complications that occur in order to understand the risks of the operation and enable surgeons to adequately counsel patients preoperatively [12,13]. In our series of 147 patients having pouch excision, 57% experienced short-term postoperative morbidity and 37% experienced long-term postoperative morbidity.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pouch excision: indications and outcomes

Lightner

Dattani²,

Dozois

et al. 2017

Colorectal Disease

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Pouch excision: indications and outcomes

Lightner

Dattani²,

Dozois

et al. 2017

Colorectal Disease

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“…In some circumstances, the ileoanal pouch may be defunctioned with an ileostomy with the pouch left in situ. 70 This strategy avoids the potential complications of reoperation in the pelvis, reduces the operative insult in some patients who are otherwise moribund, and immediately restores health and quality of life in some instances. This may allow the option of planning for definitive surgery at a future date.…”

Section: Pouch In Situmentioning

confidence: 99%

The Failed J Pouch

Pappou

Kiran

2016

Clinics in Colon and Rectal Surgery

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Restorative proctocolectomy with an ileal pouch-anal anastomosis (IPAA) was first described by Parks and Nicholls in 1978. 1 In their first description, IPAA was performed along with a mucosal proctectomy and a hand-sewn anastomosis, with the ileal reservoir created in a triple-loop (S) pouch configuration. Since that time, the technique has been further developed and refined. In the current era, mucosectomy has been largely abandoned and the most commonly performed IPAA procedure is the creation of a double loop stapled "J-shaped" pouch, with the creation of a stapled anastomosis between the reservoir and the rectum. 2,3 IPAA nowadays remains the optimal surgical procedure for patients with chronic ulcerative colitis (UC) and patients with familial adenomatous polyposis. This operation offers excellent quality of life for the majority of patients with a durable surgical and functional result, avoiding the need for a permanent ileostomy with its attendant potential effects on social, physical, psychological, and sexual areas. Nevertheless, IPAA is associated with several pouch-related complications that challenge both surgeon and patient. Reasons for pouch failure include infection, mechanical or functional difficulties, and complications of Crohn disease (CD) when this develops. Therefore, it is critical that thoughtful consideration and judgment be utilized in preparing, planning, and performing IPAA surgery to achieve optimal results.The aim of this review is to provide a structured approach to the challenges that surgeons and physicians encounter in the management of intraoperative, postoperative, and reoperative problems associated with IPAA surgery so as to minimize the occurrence of pouch failure and also to discuss the management of the poorly functioning or failed pouch. Intraoperative ChallengesThe first hurdle to overcome in IPAA surgery revolves around the need to surmount certain intraoperative difficulties such as the failure of the pouch to reach and the technical aspects of performing the IPAA.

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“…The literature on ileoanal pouch excision is even more limited than that on re-do, with a total of just under 400 cases described from five centres [454,[700][701][702][703][704][705]. Two publications each from two of these institutions report patients from the same cohort.…”

Section: Pouch Excisionmentioning

confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

et al. 2018

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Aim There is a requirement of an expansive and up to date review of surgical management of inflammatory bowel disease (IBD) that can dovetail with the medical guidelines produced by the British Society of Gastroenterology. Methods Surgeons who are members of the ACPGBI with a recognised interest in IBD were invited to contribute various sections of the guidelines. They were directed to produce a procedure based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. An editorial board was convened to ensure consistency of style, presentation and quality. Each author was asked to provide a set of recommendations which were evidence based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after 2 votes were included in the guidelines. Results All aspects of surgical care for IBD have been included along with 157 recommendations for management. Conclusion These guidelines provide an up to date and evidence based summary of the current surgical knowledge in the management of IBD and will serve as a useful practical text for clinicians performing this type of surgery.

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Permanent Ostomy After Ileoanal Pouch Failure

Cited by 48 publications

References 21 publications

Pouch excision: indications and outcomes

Pouch excision: indications and outcomes

The Failed J Pouch

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

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