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Review
. 2012 Jul;27(7):843-53.
doi: 10.1007/s00384-011-1402-6. Epub 2012 Jan 10.

Update of complications and functional outcome of the ileo-pouch anal anastomosis: overview of evidence and meta-analysis of 96 observational studies

Sharonne de Zeeuw  1 , Usama Ahmed Ali, Rogier A R T Donders, Willem E Hueting, Frederik Keus, Cees J H M van Laarhoven
Affiliations
Review

Update of complications and functional outcome of the ileo-pouch anal anastomosis: overview of evidence and meta-analysis of 96 observational studies

Sharonne de Zeeuw et al. Int J Colorectal Dis. 2012 Jul.

Erratum in

  • Int J Colorectal Dis. 2012 Apr;27(4):553. Ali, Usama Ahmed [corrected to Ahmed Ali, Usama]

Abstract

Objective: The objective of this study is to provide a comprehensive update of the outcome of the ileo-pouch anal anastomosis (IPAA).

Data sources: An extensive search in PubMed, EMBASE, and The Cochrane Library was conducted.

Study selection and data extraction: All studies published after 2000 reporting on complications or functional outcome after a primary open IPAA procedure for UC or FAP were selected. Study characteristics, functional outcome, and complications were extracted.

Data synthesis: A review with similar methodology conducted 10 years earlier was used to evaluate developments in outcome over time. Pooled estimates were compared using a random-effects logistic meta-analyzing technique. Analyses focusing on the effect of time of study conductance, centralization, and variation in surgical techniques were performed.

Results: Fifty-three studies including 14,966 patients were included. Pooled rates of pouch failure and pelvic sepsis were 4.3% (95% CI, 3.5-6.3) and 7.5% (95% CI 6.1-9.1), respectively. Compared to studies published before 2000, a reduction of 2.5% was observed in the pouch failure rate (p = 0.0038). Analysis on the effect of the time of study conductance confirmed a decline in pouch failure. Functional outcome remained stable over time, with a 24-h defecation frequency of 5.9 (95% CI, 5.0-6.9). Technical surgery aspects did not have an important effect on outcome.

Conclusion: This review provides up to date outcome estimates of the IPAA procedure that can be useful as reference values for practice and research. It is also shows a reduction in pouch failure over time.

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Figures

Fig. 1
Fig. 1
Flowchart of study selection resulting in the 53 included studies
Fig. 2
Fig. 2
Proportions of pouch failure following an IPAA procedure in studies published since 2000. The size of the dot correlates with the population size of the study. The lines represent the 95% CI. The pooled incidence of all studies is 4.3%
Fig. 3
Fig. 3
Proportions of pelvic sepsis following an IPAA procedure in studies published since 2000. The size of the dot correlates with the population size of the study. The lines represent the 95% CI. The pooled incidence of all studies is 7.5%
Fig. 4
Fig. 4
Scatter plot depicting the median year of inclusion and the rate of pouch failure of studies included in both reviews
Fig. 5
Fig. 5
Error bar chart depicting the median rate of pouch failure compared to the median year of inclusion (divided into interquartile ranges)
Fig. 6
Fig. 6
Relationship between moment of study conductance (median year of inclusion) and inclusion rate of patients, divided in the past three decades
See this image and copyright information in PMC

References

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