Temporal changes in functional outcomes of stapled and hand‐sewn ileal pouch‐anal anastomosis for ulcerative colitis and familial adenomatous polyposis

Abstract

Aim Little is known about how ileal pouch‐anal anastomosis (IPAA) influences anorectal manometric data. This study aimed to clarify temporal changes in anorectal manometric data and faecal incontinence in IPAA. Methods We examined 32 patients with ulcerative colitis (UC) or familial adenomatous polyposis (FAP) undergoing restorative proctocolectomy with stapled or hand‐sewn IPAA. Maximum resting pressure (MRP) and maximum squeezing pressure (MSP) were analysed before and 1–3, 6–9, and 12–24 months after IPAA. Cleveland Clinic Florida‐Faecal Incontinence Score (CCF‐FIS) was measured 6–9 and 12–24 months after IPAA. Results Fourteen patients underwent stapled IPAA and 18 patients underwent hand‐sewn IPAA. MRP decreased 1–3 months after stapled IPAA (median: 42.3 mmHg vs. 60.0 mmHg at preoperative value, p = 0.039), but recovered afterwards. In hand‐sewn IPAA, the median MRP decreased to 29.5 mmHg at 1–3 months after IPAA (baseline: 64.8 mmHg, p < 0.0001), and remained unchanged thereafter. Stapled IPAA did not affect MSP; however, hand‐sewn IPAA caused a reduction in the median MSP from 191.3 mmHg to 141.3 mmHg at 1–3 months (p = 0.035), which gradually increased afterwards. The median CCFFIS was 5.5 points at 6–9 months and 2 points at 12–24 months after stapled IPAA. The score was high (11 points) at 6–9 months but decreased to 5 points at 12–24 months after hand‐sewn IPAA (p = 0.022). Conclusion We present time trends in functional outcomes of IPAA. MRP showed a transient decrease after stapled IPAA, whereas it remained low after hand‐sewn IPAA. CCFFIS was high only at 6–9 months after hand‐sewn IPAA.

Stapled Anastomosis Versus Hand-Sewn Anastomosis With Mucosectomy for Ileal Pouch-Anal Anastomosis: A Systematic Review and Meta-analysis of Postoperative Outcomes, Functional Outcomes, and Oncological Safety

“…Five studies were excluded for the following reasons 13 - 16 : 1 study included patients undergoing stapled anastomosis and compared high with low anastomosis, 13 1 study included only patients undergoing a hand-sewn anastomosis, 14 1 study included patients with rectal cancer, 15 1 study compared the outcomes of the reversal loop ileostomy, 16 and 1 study was a narrative review. 17 We then retained 31 trials 18 - 48 : 3 RCTs, 39 , 40 , 44 5 prospective clinical trials, 19 - 23 and 24 CCTs. 18 , 24 - 38 , 41 - 43 , 45 - 48 The demographic data of the studies are summarized in Table 1 .…”

“… 17 We then retained 31 trials 18 - 48 : 3 RCTs, 39 , 40 , 44 5 prospective clinical trials, 19 - 23 and 24 CCTs. 18 , 24 - 38 , 41 - 43 , 45 - 48 The demographic data of the studies are summarized in Table 1 . These studies included 8872 patients, 4871 patients in the stapled group, and 4038 hand-sewn group, and were published between 1991 and 2022.…”

Long-term prognosis after stapled and hand-sewn ileal pouch–anal anastomoses for familial adenomatous polyposis: a multicenter retrospective study

“…In many previous studies, most comparisons between stapled and hand-sewn IPAA have focused on postoperative complications or functional outcomes [ 21 – 23 ]. Regarding short-term prognosis, a previous national study in Japan has reported that the 5-year OS is similar between stapled and hand-sewn IPAA [ 14 ].…”

Assessing anorectal function in patients with recurrent ulcerative colitis

“…General information regarding the enrolled patients was collected, including sex, age at UC diagnosis, past medication history, disease extent according to the Montreal classification, disease manifestation based on the Truelove-Witts classification [ 9 ], presence of extraintestinal manifestations, and more. Baseline measurements included BMI, ESR, serum CRP, Hb and albumin (ALB) levels, fecal calprotectin levels, Inflammatory Bowel Disease Questionnaire (IBD-Q) score [ 10 ], and self-rated anxiety and depression assessed using the Zung Self-Rating Anxiety/Depression Scale (SAS/SDS) score, Cleveland Clinic Fecal Inconsistency (CCFI) score [ 11 ], and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score [ 12 ]. Notably, special attention was directed towards rectal inflammation during endoscopic examinations, with endoscopies performed within the preceding three months being deemed sufficient.…”