An ileal pouch anal anastomosis (IPAA) is the treatment of choice in selected patients to restore intestinal continuity following proctocolectomy. Data on IPAA in the Republic of Ireland is lacking, and surgery for IPAA has evolved over time. The aim of this retrospective study was to report our institutional outcomes from IPAA over a 20-year period.
Data were retrospectively collated from consecutive primary IPAA cases between 1998 and 2017 at Beaumont Hospital. Patient demographics and operative approach were examined, and pouch failure was estimated using the Kaplan–Meier method.
Ninety-five patients underwent IPAA over the study period with a mean follow-up of 9.4 ± 5.6 years. The mean age at IPAA was 35.9 ± 10.0 years, and 58.9% were male. The majority were performed in 3 stages (78.9%), were performed to treat ulcerative colitis (66.3%), were of a J-pouch configuration (96.8%), and had a stapled anastomosis (70.5%). On follow-up, 28.4% reported experiencing at least 1 episode of pouchitis and the 10-year pouch failure rate was 14%. In the last decile of the study period, the mean number of IPAA performed per year increased to 10.5 ± 2.1 (P = 0.013), the age of IPAA formation reduced (P = 0.049), and the proportion completed in a minimally invasive manner increased (P < 0.001).
Acceptable long-term outcomes were observed by our institution. A recent increase in institutional volume, reduction in patient age, and increase in the proportion of cases performed laparoscopically have been identified.
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Parks AG, Nicholls RJ (1978) Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 2(6130):85–88
Fazio VW, Kiran RP, Remzi FH, Coffey JC, Heneghan HM, Kirat HT, Manilich E, Shen B, Martin ST (2013) Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 257(4):679–685. https://doi.org/10.1097/SLA.0b013e31827d99a2
Oresland T, Bemelman WA, Sampietro GM, Spinelli A, Windsor A, Ferrante M et al (2015) European evidence based consensus on surgery for ulcerative colitis. J Crohns Colitis 9(1):4–25. https://doi.org/10.1016/j.crohns.2014.08.012
Diederen K, Sahami SS, Tabbers MM, Benninga MA, Kindermann A, Tanis PJ, Oomen MW, de Jong JR, Bemelman WA (2017) Outcome after restorative proctocolectomy and ileal pouch-anal anastomosis in children and adults. Br J Surg 104(12):1640–1647. https://doi.org/10.1002/bjs.10678
Galiatsatos P, Foulkes WD (2006) Familial adenomatous polyposis. Am J Gastroenterol 101(2):385–398. https://doi.org/10.1111/j.1572-0241.2006.00375.x
Kalbassi MR, Winter DC, Deasy JM (2003) Quality-of-life assessment of patients after ileal pouch-anal anastomosis for slow-transit constipation with rectal inertia. Dis Colon Rectum 46(11):1508–1512. https://doi.org/10.1007/s10350-004-6804-x
Kirat HT, Remzi FH (2010) Technical aspects of ileoanal pouch surgery in patients with ulcerative colitis. Clin Colon Rectal Surg 23(4):239–247. https://doi.org/10.1055/s-0030-1268250
Ferrante M, Declerck S, De Hertogh G, Van Assche G, Geboes K, Rutgeerts P et al (2008) Outcome after proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. Inflamm Bowel Dis 14(1):20–28. https://doi.org/10.1002/ibd.20278
de Zeeuw S, Ahmed Ali U, Donders RA, Hueting WE, Keus F, van Laarhoven CJ (2012) Update of complications and functional outcome of the ileo-pouch anal anastomosis: overview of evidence and meta-analysis of 96 observational studies. Int J Color Dis 27(7):843–853. https://doi.org/10.1007/s00384-011-1402-6
Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258(1):1–7. https://doi.org/10.1097/SLA.0b013e318296c732
de Buck van Overstraeten A, Wolthuis AM, D’Hoore A (2016) Transanal completion proctectomy after total colectomy and ileal pouch-anal anastomosis for ulcerative colitis: a modified single stapled technique. Color Dis 18(4):O141–O144. https://doi.org/10.1111/codi.13292
Hahnloser D, Pemberton JH, Wolff BG, Larson DR, Crownhart BS, Dozois RR (2004) The effect of ageing on function and quality of life in ileal pouch patients: a single cohort experience of 409 patients with chronic ulcerative colitis. Ann Surg 240(4):615–621; discussion 21-3. https://doi.org/10.1097/01.sla.0000141157.32234.9d
Heikens JT, de Vries J, van Laarhoven CJ (2012) Quality of life, health-related quality of life and health status in patients having restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis: a systematic review. Color Dis 14(5):536–544. https://doi.org/10.1111/j.1463-1318.2010.02538.x
Sagar PM, Taylor BA (1994) Pelvic ileal reservoirs: the options. Br J Surg 81(3):325–332. https://doi.org/10.1002/bjs.1800810304
Lovegrove RE, Constantinides VA, Heriot AG, Athanasiou T, Darzi A, Remzi FH, Nicholls RJ, Fazio VW, Tekkis PP (2006) A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: a meta-analysis of 4183 patients. Ann Surg 244(1):18–26. https://doi.org/10.1097/01.sla.0000225031.15405.a3
Germain A, de Buck van Overstraeten A, Wolthuis A, Ferrante M, Vermeire S, Van Assche G et al (2018) Outcome of restorative proctocolectomy with an ileo-anal pouch for ulcerative colitis: effect of changes in clinical practice. Color Dis 20(2):O30–OO8. https://doi.org/10.1111/codi.13948
Joyce MR, Kiran RP, Remzi FH, Church J, Fazio VW (2010) In a select group of patients meeting strict clinical criteria and undergoing ileal pouch-anal anastomosis, the omission of a diverting ileostomy offers cost savings to the hospital. Dis Colon Rectum 53(6):905–910. https://doi.org/10.1007/DCR.0b013e3181d5e0fd
Sahami S, Buskens CJ, Fadok TY, Tanis PJ, de Buck van Overstraeten A, Wolthuis AM, Bemelman WA, D’Hoore A (2016) Defunctioning ileostomy is not associated with reduced leakage in proctocolectomy and ileal pouch anastomosis surgeries for IBD. J Crohns Colitis 10(7):779–785. https://doi.org/10.1093/ecco-jcc/jjv201
Mark-Christensen A, Erichsen R, Brandsborg S, Pachler FR, Norager CB, Johansen N et al (2018) Pouch failures following ileal pouch-anal anastomosis for ulcerative colitis. Color Dis 20(1):44–52. https://doi.org/10.1111/codi.13802
Nordenvall C, Olen O, Nilsson PJ, Ekbom A, Bottai M, Myrelid P (2016) The fate of reconstructive surgery following colectomy for inflammatory bowel disease in Sweden: a population-based cohort study. J Crohns Colitis 10(10):1165–1171. https://doi.org/10.1093/ecco-jcc/jjw073
Meagher AP, Farouk R, Dozois RR, Kelly KA, Pemberton JH (1998) J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients. Br J Surg 85(6):800–803. https://doi.org/10.1046/j.1365-2168.1998.00689.x
Fazio VW, Wu JS, Lavery IC (1998) Repeat ileal pouch-anal anastomosis to salvage septic complications of pelvic pouches: clinical outcome and quality of life assessment. Ann Surg 228(4):588–597. https://doi.org/10.1097/00000658-199810000-00015
Kiran RP, da Luz MA, Remzi FH, Church JM, Lavery I, Hammel J et al (2010) Factors associated with septic complications after restorative proctocolectomy. Ann Surg 251(3):436–440. https://doi.org/10.1097/SLA.0b013e3181cf8814
Burns EM, Bottle A, Aylin P, Clark SK, Tekkis PP, Darzi A, Nicholls RJ, Faiz O (2011) Volume analysis of outcome following restorative proctocolectomy. Br J Surg 98(3):408–417. https://doi.org/10.1002/bjs.7312
Parc Y, Reboul-Marty J, Lefevre JH, Shields C, Chafai N, Tiret E (2015) Restorative proctocolectomy and ileal pouch-anal anastomosis. Ann Surg 262(5):849–853; discussion 53-4. https://doi.org/10.1097/SLA.0000000000001406
Larson DW, Cima RR, Dozois EJ, Davies M, Piotrowicz K, Barnes SA, Wolff B, Pemberton J (2006) Safety, feasibility, and short-term outcomes of laparoscopic ileal-pouch-anal anastomosis: a single institutional case-matched experience. Ann Surg 243(5):667–670; discussion 70-2. https://doi.org/10.1097/01.sla.0000216762.83407.d2
Tan JJ, Tjandra JJ (2006) Laparoscopic surgery for ulcerative colitis - a meta-analysis. Color Dis 8(8):626–636. https://doi.org/10.1111/j.1463-1318.2006.00971.x
Beyer-Berjot L, Maggiori L, Birnbaum D, Lefevre JH, Berdah S, Panis Y (2013) A total laparoscopic approach reduces the infertility rate after ileal pouch-anal anastomosis: a 2-center study. Ann Surg 258(2):275–282. https://doi.org/10.1097/SLA.0b013e3182813741
Bartels SA, D’Hoore A, Cuesta MA, Bensdorp AJ, Lucas C, Bemelman WA (2012) Significantly increased pregnancy rates after laparoscopic restorative proctocolectomy: a cross-sectional study. Ann Surg 256(6):1045–1048. https://doi.org/10.1097/SLA.0b013e318250caa9
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McKevitt, K., Ryan, P., Sahebally, S.M. et al. Twenty years of restorative proctocolectomy with ileal pouch anal anastomosis in Beaumont Hospital. Ir J Med Sci 190, 275–280 (2021). https://doi.org/10.1007/s11845-020-02297-1
- Familial adenomatous polyposis
- Ileal pouch anal anastomosis
- Pouch failure
- Ulcerative colitis