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. 1995 Aug;222(2):120–127. doi: 10.1097/00000658-199508000-00003

Ileal pouch-anal anastomoses complications and function in 1005 patients.

V W Fazio 1, Y Ziv 1, J M Church 1, J R Oakley 1, I C Lavery 1, J W Milsom 1, T K Schroeder 1
PMCID: PMC1234769  PMID: 7639579

Abstract

BACKGROUND: Restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has become an established surgery for patients with chronic ulcerative colitis and familial adenomatous polyposis. PURPOSE: The authors report the results of an 11-year experience of restorative proctocolectomy and IPAA at a tertiary referral center. METHODS: Chart review was performed for 1005 patients undergoing IPAA from 1983 through 1993. Preoperative histopathologic diagnoses were ulcerative colitis (n = 858), familial adenomatous polyposis (n = 62), indeterminate colitis (n = 75), and miscellaneous (n = 10). Information was obtained regarding patient demographics, type and duration of diseases, previous operations, and indications for surgery. Data were collected on surgical procedure and postoperative pathologic diagnosis. Early (within 30 days after surgery) and late complications were noted. Follow-up included an annual function and quality-of-life questionnaire, physical examination, and biopsies of the pouch and anal transitional zone. RESULTS: Of the 1005 patients (455 women), postoperative histopathologic diagnoses were as follows: ulcerative colitis (n = 812), familial adenomatous polyposis (n = 62), indeterminate colitis (n = 54), Crohn's disease (n = 67), and miscellaneous (n = 10). During a mean follow-up time of 35 months (range 1-125 months), histopathologic diagnoses were changed for 25 patients. The overall mortality rate was 1% (n = 10 patients, early = 4, late = 6); one death (0.1%) was related to pouch necrosis and sepsis. The overall morbidity rate was 62.7% (1218 complications in 630 patients; early, n = 27.5%; late, n = 50.5%). Septic complication and reoperation rates were 6.8% and 24%, respectively. The ileal pouch was removed in 34 patients (3.4%), and it is nonfunctional in 11 (1%). Functional results and quality of life were good to excellent in 93% of the patients with complete data (n = 645) and are similar for patients with ulcerative colitis, familial adenomatous polyposis, indeterminate colitis, and Crohn's disease. Patients who underwent operations from 1983 through 1988 have similar functional results and quality of life compared with patients who underwent operations after 1988. CONCLUSION: Restorative proctocolectomy with an IPAA is a safe procedure, with low mortality and major morbidity rates. Although total morbidity rate is appreciable, functional results generally are good and patient satisfaction is high.

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Selected References

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  1. Binderow S. R., Wexner S. D. Current surgical therapy for mucosal ulcerative colitis. Dis Colon Rectum. 1994 Jun;37(6):610–624. doi: 10.1007/BF02051000. [DOI] [PubMed] [Google Scholar]
  2. Choen S., Tsunoda A., Nicholls R. J. Prospective randomized trial comparing anal function after hand sewn ileoanal anastomosis with mucosectomy versus stapled ileoanal anastomosis without mucosectomy in restorative proctocolectomy. Br J Surg. 1991 Apr;78(4):430–434. doi: 10.1002/bjs.1800780415. [DOI] [PubMed] [Google Scholar]
  3. Fleshman J. W., Cohen Z., McLeod R. S., Stern H., Blair J. The ileal reservoir and ileoanal anastomosis procedure. Factors affecting technical and functional outcome. Dis Colon Rectum. 1988 Jan;31(1):10–16. doi: 10.1007/BF02552562. [DOI] [PubMed] [Google Scholar]
  4. Heald R. J., Allen D. R. Stapled ileo-anal anastomosis: a technique to avoid mucosal proctectomy in the ileal pouch operation. Br J Surg. 1986 Jul;73(7):571–572. doi: 10.1002/bjs.1800730719. [DOI] [PubMed] [Google Scholar]
  5. Keighley M. R., Kmiot W. Surgical options in ulcerative colitis: role of ileo-anal anastomosis. Aust N Z J Surg. 1990 Nov;60(11):835–848. doi: 10.1111/j.1445-2197.1990.tb07487.x. [DOI] [PubMed] [Google Scholar]
  6. Kelly K. A. Anal sphincter-saving operations for chronic ulcerative colitis. Am J Surg. 1992 Jan;163(1):5–11. doi: 10.1016/0002-9610(92)90244-l. [DOI] [PubMed] [Google Scholar]
  7. Kmiot W. A., Keighley M. R. Totally stapled abdominal restorative proctocolectomy. Br J Surg. 1989 Sep;76(9):961–964. doi: 10.1002/bjs.1800760931. [DOI] [PubMed] [Google Scholar]
  8. Lavery I. C., Tuckson W. B., Easley K. A. Internal anal sphincter function after total abdominal colectomy and stapled ileal pouch-anal anastomosis without mucosal proctectomy. Dis Colon Rectum. 1989 Nov;32(11):950–953. doi: 10.1007/BF02552271. [DOI] [PubMed] [Google Scholar]
  9. Lohmuller J. L., Pemberton J. H., Dozois R. R., Ilstrup D., van Heerden J. Pouchitis and extraintestinal manifestations of inflammatory bowel disease after ileal pouch-anal anastomosis. Ann Surg. 1990 May;211(5):622–629. [PMC free article] [PubMed] [Google Scholar]
  10. Luukkonen P., Järvinen H. Stapled vs hand-sutured ileoanal anastomosis in restorative proctocolectomy. A prospective, randomized study. Arch Surg. 1993 Apr;128(4):437–440. doi: 10.1001/archsurg.1993.01420160075012. [DOI] [PubMed] [Google Scholar]
  11. Marcello P. W., Roberts P. L., Schoetz D. J., Jr, Coller J. A., Murray J. J., Veidenheimer M. C. Long-term results of the ileoanal pouch procedure. Arch Surg. 1993 May;128(5):500–504. doi: 10.1001/archsurg.1993.01420170030003. [DOI] [PubMed] [Google Scholar]
  12. McMullen K., Hicks T. C., Ray J. E., Gathright J. B., Timmcke A. E. Complications associated with ileal pouch-anal anastomosis. World J Surg. 1991 Nov-Dec;15(6):763–767. doi: 10.1007/BF01665312. [DOI] [PubMed] [Google Scholar]
  13. Nicholls R. J. Restorative proctocolectomy with ileal reservoir: indications and results. Schweiz Med Wochenschr. 1990 Apr 7;120(14):485–488. [PubMed] [Google Scholar]
  14. Parks A. G., Nicholls R. J. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J. 1978 Jul 8;2(6130):85–88. doi: 10.1136/bmj.2.6130.85. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Pemberton J. H., Kelly K. A., Beart R. W., Jr, Dozois R. R., Wolff B. G., Ilstrup D. M. Ileal pouch-anal anastomosis for chronic ulcerative colitis. Long-term results. Ann Surg. 1987 Oct;206(4):504–513. doi: 10.1097/00000658-198710000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Pemberton J. H., Phillips S. F., Ready R. R., Zinsmeister A. R., Beahrs O. H. Quality of life after Brooke ileostomy and ileal pouch-anal anastomosis. Comparison of performance status. Ann Surg. 1989 May;209(5):620–628. doi: 10.1097/00000658-198905000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Sagar P. M., Taylor B. A. Pelvic ileal reservoirs: the options. Br J Surg. 1994 Mar;81(3):325–332. doi: 10.1002/bjs.1800810304. [DOI] [PubMed] [Google Scholar]
  18. Schoetz D. J., Jr, Coller J. A., Veidenheimer M. C. Can the pouch be saved? Dis Colon Rectum. 1988 Sep;31(9):671–675. doi: 10.1007/BF02552580. [DOI] [PubMed] [Google Scholar]
  19. Tjandra J. J., Fazio V. W., Church J. M., Oakley J. R., Milsom J. W., Lavery I. C. Similar functional results after restorative proctocolectomy in patients with familial adenomatous polyposis and mucosal ulcerative colitis. Am J Surg. 1993 Mar;165(3):322–325. doi: 10.1016/s0002-9610(05)80834-7. [DOI] [PubMed] [Google Scholar]
  20. Tjandra J. J., Fazio V. W., Milsom J. W., Lavery I. C., Oakley J. R., Fabre J. M. Omission of temporary diversion in restorative proctocolectomy--is it safe? Dis Colon Rectum. 1993 Nov;36(11):1007–1014. doi: 10.1007/BF02047291. [DOI] [PubMed] [Google Scholar]
  21. Tuckson W., Lavery I., Fazio V., Oakley J., Church J., Milsom J. Manometric and functional comparison of ileal pouch anal anastomosis with and without anal manipulation. Am J Surg. 1991 Jan;161(1):90–96. doi: 10.1016/0002-9610(91)90366-l. [DOI] [PubMed] [Google Scholar]
  22. Tytgat G. N., van Deventer S. J. Pouchitis. Int J Colorectal Dis. 1988 Nov;3(4):226–228. doi: 10.1007/BF01660720. [DOI] [PubMed] [Google Scholar]
  23. Wexner S. D., Jensen L., Rothenberger D. A., Wong W. D., Goldberg S. M. Long-term functional analysis of the ileoanal reservoir. Dis Colon Rectum. 1989 Apr;32(4):275–281. doi: 10.1007/BF02553479. [DOI] [PubMed] [Google Scholar]
  24. Wexner S. D., Wong W. D., Rothenberger D. A., Goldberg S. M. The ileoanal reservoir. Am J Surg. 1990 Jan;159(1):178–185. doi: 10.1016/s0002-9610(05)80625-7. [DOI] [PubMed] [Google Scholar]
  25. Winslet M. C., Barsoum G., Pringle W., Fox K., Keighley M. R. Loop ileostomy after ileal pouch-anal anastomosis--is it necessary? Dis Colon Rectum. 1991 Mar;34(3):267–270. doi: 10.1007/BF02090168. [DOI] [PubMed] [Google Scholar]
  26. Zuccaro G., Jr, Fazio V. W., Church J. M., Lavery I. C., Ruderman W. B., Farmer R. G. Pouch ileitis. Dig Dis Sci. 1989 Oct;34(10):1505–1510. doi: 10.1007/BF01537101. [DOI] [PubMed] [Google Scholar]

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