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Complications and functional outcomes after ileo-anal pouch excision—a systematic review of 14 retrospective observational studies

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The ileo-anal pouch (IAP) has been the gold standard procedure for maintenance of bowel continuity after panproctocolectomy for ulcerative colitis, familial adenomatous polyposis or hereditary non-polyposis colorectal cancer. However, the IAP has an estimated failure rate of 13% at 10 years post-procedure (Tulchinsky et al., Ann Surg 238(2):229–34, 2003), which can result in pouch excision (P.E.). This systematic review aims to synthesise all the available studies reporting post-operative outcomes of P.E. and its impact on patient quality of life (QoL), when available, which have not previously been summarised.

Methods

PubMed, Embase, Medline and the Cochrane library databases were searched with terms ‘Pouch AND excision’ OR ‘Pouch AND removal’ OR ‘Pouch AND remove’ OR ‘IAP AND excision’. All studies reporting post-operative morbidity, mortality or functional outcomes in patients who had P.E. were included. Studies with < 5 patients, non-English studies and conference abstracts were excluded.

Results

14 studies comprising 1601 patients were included. Overall complications varied from 18 to 63% with the most common being persistent perineal sinus (9–40%) or surgical site infection (wound—2 to 30%; intra-abdominal collection—3 to 24%). The mortality rate was between 0.58 and 1.4%. QoL is generally lower in P.E. patients compared to the normal population across various QoL measures and P.E. patients often had urinary and sexual dysfunction post-operatively.

Conclusions

There is a substantial incidence of complications after P.E.; however, there is no evidence describing QoL pre- and post-P.E. Further longitudinal research comparing QoL in patients undergoing P.E. and other treatment options such as indefinite diversion is required to definitively assess QoL post-procedure.

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Data availability

The data that support the findings of this study are available from the corresponding author [SM] upon reasonable request.

References

  1. Williams NS (1989) Restorative proctocolectomy is the first choice elective surgical treatment for ulcerative colitis. Br J Surg 76(11):1109–1110

    Article  CAS  Google Scholar 

  2. Fazio VW, Ziv Y, Church JM, Oakley JR, Lavery IC, Milsom JW, Schroeder TK (1995) Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 222(2):120–127

    Article  CAS  Google Scholar 

  3. Parks AG, Nicholls RJ (1978) Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 2(6130):85–88

    Article  CAS  Google Scholar 

  4. Madden MV, Neale KF, Nicholls RJ, Landgrebe JC, Chapman PD, Bussey HJ et al (1991) Comparison of morbidity and function after colectomy with ileorectal anastomosis or restorative proctocolectomy for familial adenomatous polyposis. Br J Surg 78(7):789–792

    Article  CAS  Google Scholar 

  5. Ambroze WL, Dozois RR, Pemberton JH, Beart RW, Ilstrup DM (1992) Familial adenomatous polyposis: results following ileal pouch-anal anastomosis and ileorectostomy. Dis Colon Rectum 35(1):12–15

    Article  Google Scholar 

  6. McLeod RS, Churchill DN, Lock AM, Vanderburgh S, Cohen Z (1991) Quality of life of patients with ulcerative colitis preoperatively and postoperatively. Gastroenterology. 101(5):1307–1313

    Article  CAS  Google Scholar 

  7. Tulchinsky H, Hawley PR, Nicholls J (2003) Long-term failure after restorative proctocolectomy for ulcerative colitis. Ann Surg 238(2):229–234

    PubMed  PubMed Central  Google Scholar 

  8. Deutsch AA, McLeod RS, Cullen J, Cohen Z (1991) Results of the pelvic-pouch procedure in patients with Crohn’s disease. Dis Colon Rectum 34(6):475–477

    Article  CAS  Google Scholar 

  9. Bengtsson J, Borjesson L, Willen R, Oresland T, Hulten L (2007) Can a failed ileal pouch anal anastomosis be left in situ? Color Dis 9(6):503–508

    Article  CAS  Google Scholar 

  10. Byrne CM, Rooney PS (2015) Ileo-anal pouch excision: a review of indications and outcomes. World J Surg Proced 119–26

  11. Körsgen S, Keighley MR (1997) Causes of failure and life expectancy of the ileoanal pouch. Int J Color Dis 12(1):4–8

    Article  Google Scholar 

  12. Meagher AP, Farouk R, Dozois RR, Kelly KA, Pemberton JH (1998) J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients. Br J Surg 85(6):800–803

    Article  CAS  Google Scholar 

  13. MacRae HM, McLeod RS, Cohen Z, O’Connor BI, Ton EN (1997) Risk factors for pelvic pouch failure. Dis Colon Rectum 40(3):257–262

    Article  CAS  Google Scholar 

  14. (ACPGBI) AoCoGBaI. Ileoanal pouch pouch report. https://www.acpgbi.org.uk/content/uploads/2016/07/Ileoanal-Pouch-Report-2017FINAL.compressed.pdf2017

  15. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097

    Article  Google Scholar 

  16. Au S, MacDonald S (2020) Outcomes of ileoanal pouch excision: morbidity, mortality and quality of life - CRD42020169424. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020169424: PROSPERO

  17. Watts JM, de Dombal FT, Goligher JC (1966) Long-term complications and prognosis following major surgery for ulcerative colitis. Br J Surg 53(12):1014–1023

    Article  CAS  Google Scholar 

  18. Sharmin S, Kypri K, Khanam M, Wadolowski M, Bruno R, Mattick RP (2017) PARENTAL supply of alcohol in childhood and risky drinking in adolescence: systematic review and meta-analysis. Int J Environ Res Public Health 14(3)

  19. Heikens JT, de Vries J, van Laarhoven CJ (2012) Quality of life, health-related quality of life and health status in patients having restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis: a systematic review. Color Dis 14(5):536–544

    Article  CAS  Google Scholar 

  20. Das P, Smith JJ, Tekkis PP, Heriot AG, Antropoli M, John NR (2007) Quality of life after indefinite diversion/pouch excision in ileal pouch failure patients. Color Dis 9(8):718–724

    Article  CAS  Google Scholar 

  21. Holubar SD, Neary P, Aiello A, Shawki S, Delaney CP, Steele SR, Hull T, Stocchi L (2019) Ileal pouch revision vs excision: short-term (30-day) outcomes from the National Surgical Quality Improvement Program. Color Dis 21(2):209–218

    Article  CAS  Google Scholar 

  22. Kalaiselvan R, McWhirter D, Martin K, Byrne C, Rooney PS (2019) Ileo-anal pouch excision and permanent ileostomy - indications and outcomes from a tertiary centre. Surgeon

  23. Karoui M, Cohen R, Nicholls J (2004) Results of surgical removal of the pouch after failed restorative proctocolectomy. Dis Colon Rectum 47(6):869–875

    Article  Google Scholar 

  24. Kiran RP, Kirat HT, Rottoli M, Xhaja X, Remzi FH, Fazio VW (2012) Permanent ostomy after ileoanal pouch failure: pouch in situ or pouch excision? Dis Colon Rectum 55(1):4–9

    Article  Google Scholar 

  25. Lachance S, Abou-Khalil M, Vasilevsky CA, Ghitulescu G, Morin N, Faria J, Boutros M (2018) Outcomes of ileal pouch excision: an American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) analysis. J Gastrointest Surg 22(12):2142–2149

    Article  Google Scholar 

  26. Lepisto A, Luukkonen P, Jarvinen HJ (2002) Cumulative failure rate of ileal pouch-anal anastomosis and quality of life after failure. Dis Colon Rectum 45(10):1289–1294

    Article  Google Scholar 

  27. Lightner AL, Dattani S, Dozois EJ, Moncrief SB, Pemberton JH, Mathis KL (2017) Pouch excision: indications and outcomes. Color Dis 19(10):912–916

    Article  CAS  Google Scholar 

  28. Lohsiriwat V, Clark SK (2008) Persistent perineal sinus after ileoanal pouch excision in inflammatory bowel diseases: incidence, risk factors, and clinical course. Dis Colon Rectum 51(12):1795–1799

    Article  Google Scholar 

  29. Maya AM, Boutros M, DaSilva G, Wexner SD (2015) IPAA-related sepsis significantly increases morbidity of ileoanal pouch excision. Dis Colon Rectum 58(5):488–493

    Article  Google Scholar 

  30. Nisar PJ, Turina M, Lavery IC, Kiran RP (2014) Perineal wound healing following ileoanal pouch excision. J Gastrointest Surg 18(1):200–207

    Article  Google Scholar 

  31. Prudhomme M, Dehni N, Dozois RR, Tiret E, Parc R (2006) Causes and outcomes of pouch excision after restorative proctocolectomy. Br J Surg 93(1):82–86

    Article  CAS  Google Scholar 

  32. Tan HT, Morton D, Connolly AB, Pringle W, White M, Keighley MR (1998) Quality of life after pouch excision. Br J Surg 85(2):249–251

    Article  CAS  Google Scholar 

  33. Worley GHT, Patsouras D, Sahnan K, Adegbola SO, Mahmood H, Faiz OD et al (2019) Ileal pouch excision: a contemporary observational cohort. Dis Colon Rectum 62(4):454–462

    Article  Google Scholar 

  34. Mismetti P, Laporte S, Darmon JY, Buchmuller A, Decousus H (2001) Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery. Br J Surg 88(7):913–930

    Article  CAS  Google Scholar 

  35. Jenkinson C, Stewart-Brown S, Petersen S, Paice C (1999) Assessment of the SF-36 version 2 in the United Kingdom. J Epidemiol Community Health 53(1):46–50

    Article  CAS  Google Scholar 

  36. Fazio VW, O’Riordain MG, Lavery IC, Church JM, Lau P, Strong SA et al (1999) Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230(4):575–584 (Discussion 84-6)

  37. Setti-Carraro P, Ritchie JK, Wilkinson KH, Nicholls RJ, Hawley PR (1994) The first 10 years’ experience of restorative proctocolectomy for ulcerative colitis. Gut. 35(8):1070–1075

    Article  CAS  Google Scholar 

  38. Chan SW, Tulloch E, Cooper ES, Smith A, Wojcik W, Norman JE (2017) Montgomery and informed consent: where are we now? BMJ 357:j2224

    Article  Google Scholar 

  39. Fuchshuber PR, Greif W, Tidwell CR, Klemm MS, Frydel C, Wali A, Rosas E, Clopp MP (2012) The power of the National Surgical Quality Improvement Program--achieving a zero pneumonia rate in general surgery patients. Perm J 16(1):39–45

    Article  Google Scholar 

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Funding

This research was partially funded by Salts Healthcare Ltd.

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Authors and Affiliations

  1. Department of Surgery, University Hospital Monklands, Airdrie, North Lanarkshire, Scotland, ML6 0JS, UK

    S. MacDonald, S. Au & A. Macdonald

  2. Department of Surgery, Wishaw General Hospital, 50 Netherton St., Wishaw, Scotland, ML2 0DP, UK

    M. Thornton

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  1. S. MacDonald
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  2. S. Au
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  3. M. Thornton
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  4. A. Macdonald
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Contributions

A.M. and M.T. conceived of the presented idea and developed the theory behind the process. S.A. and S.M. created the data extraction protocol and extracted the data after identifying the studies. S.A. and S.M summarised and analysed the results. S.M. wrote the manuscript which was reviewed by S.A., A.M. and M.T.

Corresponding author

Correspondence to S. MacDonald.

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MacDonald, S., Au, S., Thornton, M. et al. Complications and functional outcomes after ileo-anal pouch excision—a systematic review of 14 retrospective observational studies. Int J Colorectal Dis 36, 677–687 (2021). https://doi.org/10.1007/s00384-021-03838-5

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