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KMID : 1141920210370050318
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Annals of Coloproctology
2021 Volume.37 No. 5 p.318 ~ p.325
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Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: An Australian Institution’s Experience
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Lim Ming Han
Lord Anton R.
Simms Lisa A.
Hanigan Katherine
Edmundson Aleksandra
Rickard Matthew J. F. X.
Stitz Russell
Clark David A.
Radford-Smith Graham L.
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Abstract
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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.
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KEYWORD
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Ileal pouch-anal anastomosis, Ulcerative colitis
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