Diseases of the Colon & Rectum

, Volume 36, Issue 12, pp 1105–1111 | Cite as

Obstruction after ileal pouch-anal anastomosis: A preventable complication?

  • Peter W. Marcello
  • Patricia L. Roberts
  • David J. SchoetzJr.
  • John A. Coller
  • John J. Murray
  • Malcolm C. Veidenheimer
Original Contributions
  • 33 Downloads

Abstract

Small bowel obstruction is a common complication after ileal pouch-anal anastomosis. This review of 460 patients examines the frequency of small bowel obstruction and determines potential risk factors. The leading indication for ileal pouch-anal anastomosis was ulcerative colitis (83 percent). In 142 patients (31 percent), loop ileostomy was rotated 180° to facilitate emptying of the ileostomy. Ninety-four patients (20 percent) had 109 episodes of obstruction. Obstruction occurred after creation of the pouch (40 episodes), closure of the ileostomy (29 episodes), or developed during the subsequent followup period (40 episodes). Operative intervention was required in 39 percent of the episodes (7 percent of all patients). At operation, the most common point of obstruction was at closure of the ileostomy (n=22/42, 52 percent). In 16 of these patients, the ileostomy had been rotated. Multiple risk factors, including age, sex, primary diagnosis, surgeon incidence, pouch type, prior colectomy, steroid usage, stomal rotation, technique of closure of the ileostomy, and prior obstruction, were examined by univariate and multivariate analysis. Of all factors, only stomal rotation was statistically significant (P= 0.0005, chi-squared analysis). Rotation of the loop ileostomy during ileal pouch-anal anastomosis, although an apparent technical refinement, is unnecessary and predisposes to obstruction.

Key words

Ileal pouch-anal anastomosis Postoperative complications Obstruction Loop ileostomy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Pemberton JH, Phillips SF, Ready RR, Zinsmeister AR, Beahrs OH. Quality of life after Brooke ileostomy and ileal pouch-anal anastomosis: comparison of performance status. Ann Surg 1989;209:620–7.PubMedGoogle Scholar
  2. 2.
    Skarsgard ED, Atkinson KG, Bell GA, Pezim ME, Seal AM, Sharp FR. Function and quality of life results after ileal pouch surgery for chronic ulcerative colitis and familial polyposis. Am J Surg 1989;157:467–71.PubMedGoogle Scholar
  3. 3.
    Becker JM, Parodi JE. Total colectomy with preservation of the anal sphincter. Surg Annu 1989;21:263–302.PubMedGoogle Scholar
  4. 4.
    Pemberton JH, Kelly KA, Beart RW Jr, Dozois RR, Wolff BG, Ilstrup DM. Ileal pouch-anal anastomosis for chronic ulcerative colitis: long-term results. Ann Surg 1987;206:504–13.PubMedGoogle Scholar
  5. 5.
    Nicholls RJ. Restorative proctocolectomy with various types of reservoir. World J Surg 1987;11:751–62.PubMedGoogle Scholar
  6. 6.
    Schoetz DJ Jr, Coller JA, Veidenheimer MC. Ileoanal reservoir for ulcerative colitis and familial polyposis. Arch Surg 1986;121:404–9.PubMedGoogle Scholar
  7. 7.
    Fleshman JW, Cohen Z, McLeod RS, Stern H, Blair J. The ileal reservoir and ileoanal anastomosis procedure: factors affecting technical and functional outcome. Dis Colon Rectum 1988;31:10–6.PubMedGoogle Scholar
  8. 8.
    Williams NS, Johnston D. The current status of mucosal proctectomy and ileo-anal anastomosis in the surgical treatment of ulcerative colitis and adenomatous polyposis. Br J Surg 1985;72:159–68.PubMedGoogle Scholar
  9. 9.
    Vasilevsky C-A, Rothenberger DA, Goldberg SM. The S ileal pouch-anal anastomosis. World J Surg 1987;11:742–50.PubMedGoogle Scholar
  10. 10.
    Turnbull RB Jr, Weakley FL. Atlas of intestinal stomas. St. Louis: CV Mosby, 1967.Google Scholar
  11. 11.
    Miller JS, Ferguson CM, Amerson JR, Dobkin KA, McGarity WC. Ileal pouch-anal anastomosis: the Emory University experience. Am Surg 1991;57:89–95.PubMedGoogle Scholar
  12. 12.
    Poppen B, Svenberg T, Bark T, Sjögren B, Rubio C, Drakenberg B, Slezak P. Colectomy-proctomucosectomy with S-pouch: operative procedures, complications, and functional outcome in 69 consecutive patients. Dis Colon Rectum 1992;35:40–7.PubMedGoogle Scholar
  13. 13.
    Öresland T, Fasth S, Nordgren S, Hultén L. The clinical and functional outcome after restorative proctocolectomy: a prospective study in 100 patients. Int J Colorectal Dis 1989;4:50–6.PubMedGoogle Scholar
  14. 14.
    Feinberg SM, McLeod RS, Cohen Z. Complications of loop ileostomy. Am J Surg 1987;153:102–7.PubMedGoogle Scholar
  15. 15.
    Nicholls RJ, Holt SD, Lubowski DZ. Restorative proctocolectomy with ileal reservoir: comparison of twostagevs. three-stage procedures and analysis of factors that might affect outcome. Dis Colon Rectum 1989;32:323–6.PubMedGoogle Scholar
  16. 16.
    Fonkalsrud EW, Stelzner M, McDonald N. Experience with the endorectal ileal pullthrough with lateral reservoir for ulcerative colitis and polyposis. Arch Surg 1988;123:1053–8.PubMedGoogle Scholar
  17. 17.
    Francois Y, Dozois RR, Kelly KA,et al. Small intestinal obstruction complicating ileal pouch-anal anastomosis. Ann Surg 1989;209:46–50.PubMedGoogle Scholar
  18. 18.
    Galandiuk S, Pemberton JH, Tsao J, Ilstrup DM, Wolff BG. Delayed ileal pouch-anal anastomosis: complications and functional results. Dis Colon Rectum 1991;34:755–8.PubMedGoogle Scholar
  19. 19.
    Stelzner M, Phillips JD, Fonkalsrud EW. Acute ileus from steroid withdrawal simulating intestinal obstruction after surgery for ulcerative colitis. Arch Surg 1990;125:914–7.PubMedGoogle Scholar
  20. 20.
    Ambroze WL Jr, Wolff BG, Kelly KA, Beart RW Jr, Dozois RR, Ilstrup DM. Let sleeping dogs lie: role of the omentum in the ileal pouch-anal anastomosis procedure. Dis Colon Rectum 1991;34:563–5.PubMedGoogle Scholar
  21. 21.
    Fasth S, Hultén L. Loop ileostomy: a superior diverting stoma in colorectal surgery. World J Surg 1984;8:401–7.PubMedGoogle Scholar
  22. 22.
    Winslet MC, Drolc Z, Allan A, Keighley MR. Assessment of the defunctioning efficiency of the loop ileostomy. Dis Colon Rectum 1991;34:699–703.PubMedGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1993

Authors and Affiliations

  • Peter W. Marcello
    • 1
  • Patricia L. Roberts
    • 1
  • David J. SchoetzJr.
    • 1
  • John A. Coller
    • 1
  • John J. Murray
    • 1
  • Malcolm C. Veidenheimer
    • 1
  1. 1.Department of Colon and Rectal SurgeryLahey Clinic Medical CenterBurlington

Personalised recommendations