Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May;25(5):1280-1286.
doi: 10.1007/s11605-020-04617-3. Epub 2020 May 4.

The Optimal Ileal Pouch: Physiologic Parameters Significantly Correlate with Overall Pouch Function

Affiliations

The Optimal Ileal Pouch: Physiologic Parameters Significantly Correlate with Overall Pouch Function

Joseph C Melvin et al. J Gastrointest Surg. 2021 May.

Abstract

Background: Ileal pouch function is affected by several patient factors and pouch physiology. The significance of pouch physiology on optimal pouch function has not been well characterized. The purpose of this study was to examine specific post-ileal pouch anal anastomosis (IPAA) physiologic parameters to determine impact on pouch function and quality of life.

Methods: Patients undergoing proctocolectomy with IPAA for ulcerative colitis were examined. Post-IPAA compliance, pouch anal pressure gradient (PAPG), and function were assessed 6-8 months postoperatively. Compliance was calculated as change in volume divided by change in pressure. PAPG was calculated as the difference between anal pressure and intra-pouch pressure at a fixed volume. Pouch function evaluation included stool frequency and episodes of incontinence. Quality of life was evaluated using the Rockwood Fecal Incontinence Quality of Life Scale.

Results: A total of 125 patients were investigated. Post-IPAA resting anal pressure averaged 58.1 ± 15 mmHg. Mean volume and intra-pouch pressure at evacuation were 245 mL and 33.9 mmHg, respectively. Compliance averaged 11.2 mmHg/mL with a mean PAPG of - 29.3 mmHg. Compliance and PAPG correlated with 24-h (p = 0.003, p = 0.004) and nighttime stool frequency (p = 0.04, p = 0.03). Daytime continence was impacted by compliance (p = 0.04), PAPG (p = 0.02), and resting anal pressure (p = 0.02).

Conclusion: This unique evaluation reveals a significant correlation between IPAA physiologic properties and function. Optimal function and quality of life depend in part on maintaining optimal pouch compliance and pressure differentials between the pouch and anal canal, defined by the pouch anal pressure gradient.

Keywords: Inflammatory bowel disease; Physiology; Pouch.

PubMed Disclaimer

References

    1. Fazio VW, Kiran RP, Remzi FH, Coffey JC, Heneghan HM, Kirat HT, Manilich E, Shen B, Martin ST. Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg. 2013;257(4):679-85. - DOI
    1. Landisch R, Knechtges P, Otterson M, Ludwig K, Ridolfi T. Pouch volvulus in patients having undergone restorative proctocolectomy for ulcerative colitis: a case series. Dis Colon Rectum. 2018;61(6):713-718. - DOI
    1. Naumann DN, Abbott S, Hall D, Bowley DM. Pouch dysfunction: don’t forget the surgeons! Frontline Gastroenterol. 2013;4(4):308-9. - DOI
    1. Sunde ML, Ricanek P, Oresland T, Jahnsen J, Naimy N, Faerden AE. Determinants of optimal bowel function in ileal pouch-anal anastomosis - physiological differences contributing to pouch function. Scand J Gastroenterol. 2018;53(1):8-14. - DOI
    1. Lewis WG, Miller AS, Williamson ME, Sagar PM, Holdsworth PJ, Axon AT, et al. The perfect pelvic pouch--what makes the difference? Gut. 1995;37(4):552-6. - DOI

LinkOut - more resources