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. 2021 Jun 21;2(2):e074.
doi: 10.1097/AS9.0000000000000074. eCollection 2021 Jun.

Ileal Pouch-anal Anastomosis Complications and Pouch Failure: A systematic review and meta-analysis

Lianne Heuthorst  1 , Karin A T G M Wasmann  1 , Maud A Reijntjes  1 , Roel Hompes  1 , Christianne J Buskens  1 , Willem A Bemelman  1
Affiliations

Ileal Pouch-anal Anastomosis Complications and Pouch Failure: A systematic review and meta-analysis

Lianne Heuthorst et al. Ann Surg Open. .

Abstract

Objective: This systematic review aims to assess the incidence of pouch failure and the correlation between ileal pouch-anal anastomosis (IPAA)-related complications and pouch failure.

Background: Previous studies demonstrated wide variation in postoperative complication rates following IPAA.

Methods: A systematic review was performed by searching the MEDLINE, EMBASE, and Cochrane Library databases for studies reporting on pouch failure published from January 1, 2010, to May 6, 2020. A meta-analysis was performed using a random-effects model, and the relationship between pouch-related complications and pouch failure was assessed using Spearman's correlations.

Results: Thirty studies comprising 22,978 patients were included. Included studies contained heterogenic patient populations, different procedural stages, varying definitions for IPAA-related complications, and different follow-up periods. The pooled pouch failure rate was 7.7% (95% confidence intervals: 5.56-10.59) and 10.3% (95% confidence intervals: 7.24-14.30) for studies with a median follow-up of ≥5 and ≥10 years, respectively. Observed IPAA-related complications were anastomotic leakage (1-17%), pelvic sepsis (2-18%), fistula (1-30%), stricture (1-34%), pouchitis (11-61%), and Crohn's disease of the pouch (0-18%). Pelvic sepsis (r = 0.51, P < 0.05) and fistula (r = 0.63, P < 0.01) were correlated with pouch failure. A sensitivity analysis including studies with a median follow-up of ≥5 years indicated that only fistula was significantly correlated with pouch failure (r = 0.77, P < 0.01).

Conclusions: The single long-term determinant of pouch failure was pouch fistula, which is a manifestation of a chronic leak. Therefore, all effort should be taken to prevent an acute leak from becoming a chronic leak by early diagnosis and proactive management of the leak.

Mini abstract: This systematic review aims to assess the incidence of pouch failure and the correlation between IPAA-related complications and pouch failure. Long-term pouch failure was correlated with fistula, suggesting that early septic complications may result in fistula formation during long-term follow-up, leading to an increased risk of pouch failure.

Keywords: ileal pouch-anal anastomosis; pouch failure; ulcerative colitis.

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Conflict of interest statement

Disclosure: The authors declare that they have nothing to disclose.

Figures

FIGURE 1.
FIGURE 1.
Plot of the individual studies presenting pouch failure rates with 95% CI and the overall incidence of pouch failure with 95% CI. CI indicates confidence intervals.
FIGURE 2.
FIGURE 2.
Correlation between pelvic sepsis and pouch failure (A), and IPAA-related fistula and pouch failure (B).
See this image and copyright information in PMC

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