Stapled ileal pouch anal anastomoses are safer than handsewn anastomoses in patients with ulcerative colitis

Ziv, Yehiel; Fazio, Victor W.; Church, James M.; Lavery, Ian C.; King, Tai Ming; Ambrosetti, P.

doi:10.1016/s0002-9610(97)89634-1

Cited by 121 publications

(76 citation statements)

References 13 publications

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“…§Analysed in a subgroup of 108 patients in whom 107 septic complications were located in levels II or III and one dorsal cuff ®stula originated from the blind limb of the pouch; ¶analysed in a subgroup of 66 patients in whom septic complications were located in level III. IPAA, ileal pouch±anal anastomosis However, the risk of pouch failure due to septic complications in the region of the rectal cuff was relatively low, which counters reservations expressed against the handsewn technique with a short rectal cuff for construction of the pouch±anal anastomosis 26 .…”

Section: Discussionmentioning

confidence: 99%

Outcome after septic complications in J pouch procedures

Heuschen

Allemeyer

Hinz

et al. 2002

British Journal of Surgery

135

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Background: Despite the wide range of surgical approaches for pouch salvage, septic complications are among the main causes of pouch failure.Methods: This study analysed the mode and outcome of various therapeutic approaches for pouch salvage and the impact of time of diagnosis, localization and form of septic complications on the risk of pouch failure in 131 patients with septic complications of a total of 706 patients undergoing a J pouch procedure.Results: Septic complications consisted of 76´3 per cent ®stulas, 15´3 per cent anastomotic breakdowns and 8´4 per cent pelvic abscesses. A total of 107 patients (81´7 per cent) with septic complications required a mean of 2´2 surgical procedures. The frequency of permanent defunctioning and excision of the pouch in the 131 patients with septic complications was 23´7 and 6´1 per cent respectively. The estimated cumulative 3-, 5-and 10-year rate of pouch failure in patients with septic complications was 19´6, 31´1 and 39´2 per cent respectively. The risk of pouch failure was signi®cantly affected by the site of origin of septic complications (P = 0´02). The 5-year pouch failure rate increased in a subgroup of patients with septic complications at the pouch±anal anastomosis when the anal sphincter was involved (50´1 versus 29´2 per cent; P = 0´18).Conclusion: Pouch failure as a result of septic complications may occur several years after ileal pouch± anal anastomosis. For prevention of pouch failure, surgery for septic complications is required in a high percentage of patients and repeated attempts are justi®ed. Follow-up studies are required for further analysis of pouch failure.

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Section: Discussionmentioning

confidence: 99%

Outcome after septic complications in J pouch procedures

Heuschen

Allemeyer

Hinz

et al. 2002

British Journal of Surgery

135

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“…"'6'17 Because the groups were small, differences between operations, primarily in terms of stool frequency not controlled. Indeed, a good example of this is the recent report by Ziv et al 29 When such confounding factors are eliminated by randomizing patients prospectively, only slight differences between operations can be documented.…”

Section: Discussionmentioning

confidence: 99%

Randomized Prospective Trial Comparing Ileal Pouch-Anal Anastomosis Performed by Excising the Anal Mucosa to Ileal Pouch-Anal Anastomosis Performed by Preserving the Anal Mucosa

Reilly¹,

Pembérton²,

Wolff³

et al. 1997

Annals of Surgery

161

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ObjectiveThe purpose of the study is to compare the results of ileal pouch-anal anastomosis (IPM) in patients in whom the anal mucosa is excised by handsewn techniques to those in whom the mucosa is preserved using stapling techniques. Summary Background DataIleal pouch-anal anastomosis is the operation of choice for patients with chronic ulcerative colitis requiring proctocolectomy. Controversy exists over whether preserving the transitional mucosa of the anal canal improves outcomes. MethodsForty-one patients (23 men, 18 women) were randomized to either endorectal mucosectomy and handsewn IPM or to double-stapled IPM, which spared the anal transition zone. All patients were diverted for 2 to 3 months. Nine patients were excluded. Preoperative functional status was assessed by questionnaire and anal manometry. Twenty-four patients underwent more extensive physiologic evaluation, including scintigraphic anopouch angle studies and pudendal nerve terminal motor latency a mean of 6 months after surgery. Quality of life similarly was estimated before surgery and after surgery. Univariate analysis using Wilcoxon test was used to assess differences between groups. ResultsThe two groups were identical demographically. Overall outcomes in both groups were good. Thirty-three percent of patients who underwent the handsewn technique and 35% of patients who underwent the double-stapled technique experienced a postoperative 666

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“…According to some studies, stapled technique results in fewer septic complications than hand-sewn technique (23,24). A systematic review of dysplasia after IPAA in 2040 patients showed a pooled prevalence of dysplasia of 1.13% in the pouch, the anal transitional zone, and the rectal cuff.…”

Section: Discussionmentioning

confidence: 99%

Restorative Proctocolectomy for Ulcerative Colitis in 1985–2009

et al. 2015

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Background and Aims:Restorative proctocolectomy is the most common operation in patients with ulcerative colitis. the aim was to evaluate long-term changes in our operative treatment and early and late complications related to restorative proctocolectomy. Results: the indication for surgery was active chronic colitis in 168 (47.7%), acute colitis in 159 (45.2%), and cancer or dysplasia in 25 (7.1%) patients. ileal pouch-anal anastomosis was performed using hand-sewn anastomosis with mucosectomy in 283 patients and stapled anastomosis in 69. a shift from hand-sewn to stapler ileal pouch-anal anastomosis took place in 2005. covering ileostomy was carried out in 133 (37.8%) patients. there were 82 (23.3%) J-pouch-related complications. the operative mortality was 0.3%. there were significantly fewer leakages and early re-operations when covering ileostomy was used than when it was omitted: 6.0% versus 16.4% (p = 0.004), 4.5% versus 11.9% (p = 0.02), respectively. there were more strictures in hand-sewn than in stapled ileal pouch-anal anastomoses (17.6% vs. 0%, p = 0.001). Pouchitis occurred at least once in 134 (38.1%) patients.Conclusion: the ileal pouch-anal anastomosis technique used in restorative proctocolectomy had changed over the past years from hand-sewn to stapled anastomosis. covering ileostomy seemed to protect against major complications. Pouchitis was the most common late complication.

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Stapled ileal pouch anal anastomoses are safer than handsewn anastomoses in patients with ulcerative colitis

Cited by 121 publications

References 13 publications

Outcome after septic complications in J pouch procedures

Outcome after septic complications in J pouch procedures

Randomized Prospective Trial Comparing Ileal Pouch-Anal Anastomosis Performed by Excising the Anal Mucosa to Ileal Pouch-Anal Anastomosis Performed by Preserving the Anal Mucosa

Restorative Proctocolectomy for Ulcerative Colitis in 1985–2009

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