Diseases of the Colon & Rectum

, Volume 34, Issue 9, pp 755–758 | Cite as

Delayed ileal pouch-anal anastomosis

Complications and functional results
  • Susan Galandiuk
  • John H. Pemberton
  • Jane Tsao
  • Duane M. Ilstrup
  • Bruce G. Wolff
Original Contributions
  • 19 Downloads

Abstract

In patients with chronic ulcerative colitis (CUC), ileal pouch-anal anastomosis (IPAA) can be performed either at the time of colectomy or as a delayed procedureaftertotal abdominal colectomy and ileostomy. There has been debate as to whether delayed IPAA results in superior functional results, since patients are frequently steroid-free and have little evidence of active disease. To assess this, we analyzed 95 patients who had undergone total abdominal colectomy, either with ileostomy and Hartmann's procedure or with ileorectostomy, 2–183 months prior to IPAA. Postoperative complications and functional results were compared with those of 776 CUC patients who underwent IPAA at the time of abdominal colectomy. Indications for prior colectomy included toxic megacolon (40 percent), failed medical therapy (36 percent), other reasons (e.g.,iatrogenic perforation, cancer) (6 percent), and reasons unclear (18 percent). Nineteen percent of delayed-IPAA patients were taking steroids at the time of pouch construction. Follow-ups were similar in the two groups. The incidence of septic and obstructive complications after delayed IPAAvs.IPAA at the time of colectomy were 10.5 percentvs.5.4 percent and 6.5 percentvs.14.5 percent, respectively. There were no significant differences in postoperative functional results between the two groups. Delayed IPAA confers no advantage over IPAA performed at the time of colectomy in terms of functional outcome. Delayed IPAA was associated with a significantly higher rate of septic complications but a lower incidence of postoperative obstruction.

Key words

Ileal pouch-anal anastomosis Three-stage procedure Colectomy Postoperative complications 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    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
  2. 2.
    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
  3. 3.
    Ballantyne GH, Pemberton JH, Beart RW Jr, Wolff BG, Dozois RR. Ileal J pouch-anal anastomosis: current techniques. Dis Colon Rectum 1985;28:197–202.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.
    Martin LW, LeCoultre C, Schubert WK. Total colectomy and mucosal proctectomy with preservation of continence in ulcerative colitis. Ann Surg 1977;186:477–80.PubMedGoogle Scholar
  6. 6.
    Oresland T, Fasth S, Nordgren S, Hulten L. The clinical and functional outcome after restorative proctocolectomy. A prospective study in 100 patients. Int J Color Dis 1989;4:50–6.Google Scholar
  7. 7.
    Nicholls RJ, Holt SD, Lubowski DZ. Restorative proctocolectomy with ileal reservoir: comparison of two-stagevs. three-stage procedures and analysis of factors that might affect outcome. Dis Colon Rectum 1989;32:323–6.PubMedGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1991

Authors and Affiliations

  • Susan Galandiuk
    • 1
  • John H. Pemberton
    • 1
  • Jane Tsao
    • 1
  • Duane M. Ilstrup
    • 1
  • Bruce G. Wolff
    • 1
  1. 1.Department of Surgery, Section of Colon and Rectal SurgeryMayo ClinicRochester

Personalised recommendations