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Outcomes and Management of the Ileal Pouch-Anal Anastomosis in the Elderly

  • Intractable Disease in the Elderly: When Conventional Therapy Fails (S Katz, Section Editor)
  • Published:
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Abstract

Purpose of Review

Ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for patients undergoing colectomy to maintain intestinal continuity. Earlier studies have suggested that outcomes are worse in elderly patients who underwent IPAA. However, more recent reports have shown that IPAA outcomes in the elderly are comparable to younger patients. We review the recent medical literature regarding outcomes and treatments for common complications in elderly IPAA patients.

Recent Findings

Compared to younger patients, IPAA in the elderly is not associated with increased major surgical complications, but is associated with increased length of stay and re-admission rate for dehydration in older patients. Rates of fecal incontinence after IPAA were similar between younger and older patients. Sacral nerve stimulation has shown early promise as a possible treatment for fecal incontinence after IPAA, but more research is needed. Pouchitis is a common complication, and antibiotics remain first-line treatment options. Other treatment options include mesalamines, steroids, immunomodulators, and biologics. The efficacy of newer biologics such as vedolizumab and ustekinumab has been reported, but more data is needed.

Summary

IPAA is safe in the elderly with high self-reported patient satisfaction. However, the elderly IPAA patient warrants special consideration regarding outcomes and management.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Internal Medicine, New York University Langone Health, New York, NY, USA

    James Q. Zhou MD & Sean Michael Duenas MD

  2. Division of Colorectal Surgery, New York University Langone Health, New York, NY, USA

    Tarik Kirat MD & Feza Remzi MD

  3. Division of Colorectal Surgery, New York University Langone Health, NYU Langone Health, 240 East 38th Street, 23rd Floor, New York, NY, 10016, USA

    Shannon Chang MD

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Correspondence to Shannon Chang MD.

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James Q. Zhou declares that he has no conflict of interest.

Sean Michael Duenas declares that he has no conflict of interest.

Tarik Kirat declares that he has no conflict of interest.

Feza Remzi declares that he has no conflict of interest.

Shannon Chang declares that she has no conflict of interest.

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This article is part of the Topical Collection on Intractable Disease in the Elderly: When Conventional Therapy Fails

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Zhou, J.Q., Duenas, S.M., Kirat, T. et al. Outcomes and Management of the Ileal Pouch-Anal Anastomosis in the Elderly. Curr Treat Options Gastro 16, 275–288 (2018). https://doi.org/10.1007/s11938-018-0184-0

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