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Anastomotic leak does not affect long-term and longitudinal functional outcomes after ileal pouch surgery for ulcerative colitis when managed aggressively

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Abstract

Background

Ileal pouch-anal anastomosis (IPAA) is an effective surgical alternative to a permanent ileostomy following proctocolectomy in patients with ulcerative colitis (UC). Anastomotic leakage (AL) is a serious postoperative complication of an intestinal anastomosis that is associated with increased morbidity and mortality. The aim of this study was to evaluate the longitudinal long-term functional outcomes of patients who had IPAA that was complicated by AL.

Methods

A retrospective longitudinal cohort study was performed of patients who had an IPAA procedure at a tertiary referral centre and a metropolitan private centre in Australia, over a 14-year period (October 2003–October 2017). The long-term functional outcome was assessed using objective clinical measures such as the number of bowel motions during the day and overnight, ability to defer defaecation and the presence of faecal incontinence, and repeated at annual intervals.

Results

A total of 138 patients [mean age 38.5 (± 16.9) years, 72 males] satisfied the inclusion criteria. AL was diagnosed in 14 (10%) patients [mean age 38.8 (± 17) years, 10 males], 11 (79%) of which were managed with surgery. The median bowel motion frequency during the day and overnight remained stable over a median of 62 (28–91) months follow-up, with no significant difference between those who had AL or not (p = 0.6, p = 0.1 respectively). The incidence of faecal incontinence remained low, and the majority of patients in both groups were able to defer defaecation for more than 60 min. Six patients (4.3%) had their pouch excised.

Conclusions

There is no statistical difference in longitudinal function between patients who experienced AL after IPAA surgery for UC compared with those who did not. Therefore, an acute AL does not negatively impact long-term functional outcomes in IPAA patients.

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References

  1. Parks AG, Nicholls RJ (1978) Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 2(6130):85–88

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Hulten L (1998) Proctocolectomy and ileostomy to pouch surgery for ulcerative colitis. World J Surg 22(4):335–341

    Article  CAS  PubMed  Google Scholar 

  3. Fazio VW et al (2013) Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 257(4):679–685

    Article  PubMed  Google Scholar 

  4. Utsunomiya J et al (1980) Total colectomy, mucosal proctectomy, and ileoanal anastomosis. Dis Colon Rectum 23(7):459–466

    Article  CAS  PubMed  Google Scholar 

  5. Fazio VW et al (1995) Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 222(2):120–127

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Larson DW et al (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 670-2)

    Article  PubMed  PubMed Central  Google Scholar 

  7. Exarchos G et al (2018) Quality of life of ulcerative colitis patients treated surgically with proctocolectomy and J-pouch formation: a comparative study before surgery and after closure of the defunctioning ileostomy. Ann Gastroenterol 31(3):350–355

    PubMed  PubMed Central  Google Scholar 

  8. Pemberton JH et al (1989) Quality of life after Brooke ileostomy and ileal pouch-anal anastomosis. Comparison of performance status. Ann Surg 209(5):620–626 (Discussion 626-8)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Gessler B, Eriksson O, Angenete E (2017) Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis 32(4):549–556

    Article  PubMed  PubMed Central  Google Scholar 

  10. Rickard MJ et al (2007) Ileal pouch-anal anastomosis: the Australasian experience. Colorectal Dis 9(2):139–145

    Article  CAS  PubMed  Google Scholar 

  11. McDermott FD et al (2015) Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg 102(5):462–479

    Article  CAS  PubMed  Google Scholar 

  12. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Galandiuk S et al (1990) Ileal pouch-anal anastomosis. Reoperation for pouch-related complications. Ann Surg 212(4):446–452

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Walker KG et al (2004) Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 240(2):255–259

    Article  PubMed  PubMed Central  Google Scholar 

  15. Heuschen UA et al (2002) Outcome after septic complications in J pouch procedures. Br J Surg 89(2):194–200

    CAS  PubMed  Google Scholar 

  16. Rahbari NN et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147(3):339–351

    Article  PubMed  Google Scholar 

  17. Lindgren R et al (2011) What is the risk for a permanent stoma after low anterior resection of the rectum for cancer? A six-year follow-up of a multicenter trial. Dis Colon Rectum 54(1):41–47

    Article  PubMed  Google Scholar 

  18. Clark DA et al (2019) Drain fluid amylase as a sensitive biomarker for the early detection of anastomotic leakage in ileal pouch surgery. Colorectal Dis 21(4):460–464

    Article  CAS  PubMed  Google Scholar 

  19. Weston-Petrides GK et al (2008) Comparison of outcomes after restorative proctocolectomy with or without defunctioning ileostomy. Arch Surg 143(4):406–412

    Article  PubMed  Google Scholar 

  20. Remzi FH et al (2006) The outcome after restorative proctocolectomy with or without defunctioning ileostomy. Dis Colon Rectum 49(4):470–477

    Article  PubMed  Google Scholar 

  21. Farouk R et al (1998) Incidence and subsequent impact of pelvic abscess after ileal pouch-anal anastomosis for chronic ulcerative colitis. Dis Colon Rectum 41(10):1239–1243

    Article  CAS  PubMed  Google Scholar 

  22. Tulchinsky H, Hawley PR, Nicholls J (2003) Long-term failure after restorative proctocolectomy for ulcerative colitis. Ann Surg 238(2):229–234

    PubMed  PubMed Central  Google Scholar 

  23. Chang S, Shen B, Remzi F (2017) When not to pouch: important considerations for patient selection for ileal pouch-anal anastomosis. Gastroenterol Hepatol (N Y) 13(8):466–475

    Google Scholar 

  24. Yu CS, Pemberton JH, Larson D (2000) Ileal pouch-anal anastomosis in patients with indeterminate colitis: long-term results. Dis Colon Rectum 43(11):1487–1496

    Article  CAS  PubMed  Google Scholar 

  25. Reese GE et al (2007) The effect of Crohn’s disease on outcomes after restorative proctocolectomy. Dis Colon Rectum 50(2):239–250

    Article  PubMed  Google Scholar 

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Acknowledgements

Ms Anita Pelecanos is to be thanked for her statistical input.

Funding

No funding was received for this study.

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Authors and Affiliations

  1. Royal Brisbane and Women’s Hospital, Herston Road, Brisbane, QLD, 4066, Australia

    J. Yu, D. A. Clark, D. Sidhom & A. Edmundson

  2. Faculty of Medicine and Health, Surgical Outcomes Research Centre (SOuRCe), University of Sydney, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia

    D. A. Clark & M. Solomon

  3. University of Qld, St Lucia, Brisbane, QLD, 4072, Australia

    J. Yu, D. A. Clark & A. Edmundson

  4. St Vincent’s Private Hospital Northside, 627 Rode Road, Chermside, Brisbane, QLD, 4032, Australia

    D. A. Clark

Authors
  1. J. Yu
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  2. D. A. Clark
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  3. D. Sidhom
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  4. A. Edmundson
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  5. M. Solomon
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Corresponding author

Correspondence to D. A. Clark.

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The investigators declare that there are no conflicts of interest.

Ethical approval

Ethical and governance approvals for this study were granted by the Royal Brisbane and Women’s Hospital and St Vincent’s Private Hospital Human Research Ethics and Governance Committees (RBWH HREC: LNR/2018/QRBW/46564, SVPHN: HREC 18/26). No material from other sources were included, so no permission to reproduce is needed.

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Yu, J., Clark, D.A., Sidhom, D. et al. Anastomotic leak does not affect long-term and longitudinal functional outcomes after ileal pouch surgery for ulcerative colitis when managed aggressively. Tech Coloproctol 24, 1285–1292 (2020). https://doi.org/10.1007/s10151-020-02331-5

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  • DOI: https://doi.org/10.1007/s10151-020-02331-5

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