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A systematic review and meta-analysis of the outcome of ileal pouch-anal anastomosis in patients with ulcerative colitis versus patients with familial adenomatous polyposis

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Abstract

Background

Ileal pouch-anal anastomosis (IPAA) is commonly used to restore gastrointestinal continuity after surgical treatment of mucosal ulcerative colitis (MUC) and familial adenomatous polyposis (FAP). The aim of the present systematic review was to compare the outcomes of patients with MUC and patients with FAP who underwent IPAA.

Methods

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review was performed. PubMed, Scopus, and Web of Science were searched through December 2021. Cohort and randomized studies were eligible for inclusion if they directly compared patients with MUC and FAP who underwent IPAA. The main outcome measures were pouch failure, complications, and need for pouch excision or revision. ROBINS-I tool was used to assess the risk of bias across the studies. A random-effect meta-analysis was conducted.

Results

Twenty-three studies (9200 patients) were included in this meta-analysis. Seven thousand nine hundred fifty (86.4%) had MUC and 1250 (13.6%) had FAP. The median age of patients was 33.1 years. The male to female ratio was 1.4:1. MUC had higher odds of pouchitis (OR 3.9, 95% CI 2.8–5.4, p < 0.001), stricture (OR 1.82, 95% CI 1.25–2.65, p = 0.002), fistula (OR 1.74, 95% CI 1.18–2.54, p = 0.004), and total complications (OR 1.89, 95% CI 1.3–2.77, p < 0.001) as compared to FAP. Both groups had similar odds of pelvic sepsis, leakage, pouch failure, excision, revision, and fecal incontinence.

Conclusions

Although patients with MUC undergoing IPAA may be at a higher risk of developing complications, particularly pouchitis, stricture, and fistula; the ultimate and functional outcome of the pouch is similar to patients with FAP. Pouch failure, excision and revision were similar in the two groups.

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Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA

    S. H. Emile, E. Silva-Alvarenga, Z. Garoufalia & S. D. Wexner

  2. Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt

    S. H. Emile

  3. Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan

    S. M. Khan

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  4. Z. Garoufalia
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Contributions

SDW produced the concept of the study. SE and SMK searched the literature and screened eligible articles. SE, SMK, and ZG assessed the quality of the studies. SE, SMK and ES-A extracted data from the studies. SE performed the meta-analyses and wrote the manuscript. SDW reviewed the results of the initial and final search and the preliminary and final lists of articles before approving them and revised the manuscript. All authors critically reviewed the manuscript and approved the final version.

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Correspondence to S. H. Emile.

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Supplementary Information

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Supplementary file1 (DOCX 30 KB)

Supplementary file2 (DOCX 16 KB)

Supplementary file3 (DOCX 20 KB)

Supplementary file4 Supplementary figure 1. Forest plot for cumulative meta-analysis of pouchitis (JPG 479 KB)

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Supplementary file5 Supplementary figure 2. Forest plot for cumulative meta-analysis of total complications (JPG 271 KB)

Supplementary file6 Supplementary figure 3. Forest plot for cumulative meta-analysis of pouch failure (JPG 419 KB)

Supplementary file7 Supplementary figure 4. Forest plot for cumulative meta-analysis of pouch excision (JPG 420 KB)

Supplementary file8 Supplementary figure 5. Leave-one-out sensitivity analysis of the main outcomes (JPG 273 KB)

10151_2022_2617_MOESM9_ESM.jpg

Supplementary file9 Supplementary figure 6. Baujat plots locating the sources of heterogeneity in each outcome (JPG 345 KB)

10151_2022_2617_MOESM10_ESM.pdf

Supplementary file10 Supplementary figure 7. Funnel plots for the assessment of publication bias in each outcome (PDF 145 KB)

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Emile, S.H., Khan, S.M., Silva-Alvarenga, E. et al. A systematic review and meta-analysis of the outcome of ileal pouch-anal anastomosis in patients with ulcerative colitis versus patients with familial adenomatous polyposis. Tech Coloproctol 26, 691–705 (2022). https://doi.org/10.1007/s10151-022-02617-w

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