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 Oct;37(5):318-325.
doi: 10.3393/ac.2020.08.26. Epub 2020 Sep 18.

Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: An Australian Institution's Experience

Ming Han Lim  1 , Anton R Lord  2 , Lisa A Simms  2 , Katherine Hanigan  2 , Aleksandra Edmundson  2 , Matthew J F X Rickard  3   4 , Russell Stitz  5 , David A Clark  4   5   6 , Graham L Radford-Smith  1   2   6
Affiliations

Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: An Australian Institution's Experience

Ming Han Lim et al. Ann Coloproctol. 2021 Oct.

Abstract

Purpose: We report outcomes and evaluate patient factors and the impact of surgical evolution on outcomes in consecutive ulcerative colitis patients who had restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) at an Australian institution over 26 years.

Methods: Data including clinical characteristics, preoperative medical therapy, and surgical outcomes were collected. We divided eligible patients into 3 period arms (period 1, 1990 to 1999; period 2, 2000 to 2009; period 3, 2010 to 2016). Outcomes of interest were IPAA leak and pouch failure.

Results: A total of 212 patients were included. Median follow-up was 50 (interquartile range, 17 to 120) months. Rates of early and late complications were 34.9% and 52.0%, respectively. Early complications included wound infection (9.4%), pelvic sepsis (8.0%), and small bowel obstruction (6.6%) while late complications included small bowel obstruction (18.9%), anal stenosis (16.8%), and pouch fistula (13.3%). Overall, IPAA leak rate was 6.1% and pouch failure rate was 4.8%. Eighty-three patients (42.3%) experienced pouchitis. Over time, we observed an increase in patient exposure to thiopurine (P=0.0025), cyclosporin (P=0.0002), and anti-tumor necrosis factor (P<0.00001) coupled with a shift to laparoscopic technique (P<0.00001), stapled IPAA (P<0.00001), J pouch configuration (P<0.00001), a modified 2-stage procedure (P=0.00012), and a decline in defunctioning ileostomy rate at time of IPAA (P=0.00002). Apart from pouchitis, there was no significant difference in surgical and chronic inflammatory pouch outcomes with time.

Conclusion: Despite greater patient exposure to immunomodulatory and biologic therapy before surgery coupled with a significant change in surgical techniques, surgical and chronic inflammatory pouch outcome rates have remained stable.

Keywords: Ileal pouch-anal anastomosis; Ulcerative colitis.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Evolution of medical therapy regime within 30 days before colectomy over different periods. TNF, tumor necrosis factor.
Fig. 2.
Fig. 2.
Evolution of the ileal pouch-anal anastomosis procedure over a 26-year period.
See this image and copyright information in PMC

References

    1. Kaser A, Zeissig S, Blumberg RS. Inflammatory bowel disease. Annu Rev Immunol. 2010;28:573–621. - PMC - PubMed
    1. Langholz E, Munkholm P, Davidsen M, Binder V. Course of ulcerative colitis: analysis of changes in disease activity over years. Gastroenterology. 1994;107:3–11. - PubMed
    1. Aratari A, Papi C, Clemente V, Moretti A, Luchetti R, Koch M, et al. Colectomy rate in acute severe ulcerative colitis in the infliximab era. Dig Liver Dis. 2008;40:821–6. - PubMed
    1. Becker JM. Ileal pouch-anal anastomosis: current status and controversies. Surgery. 1993;113:599–602. - PubMed
    1. Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J. 1978;2:85–8. - PMC - PubMed

LinkOut - more resources