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

Ming Han Lim; Anton R. Lord; Lisa A. Simms; Katherine Hanigan; Aleksandra Edmundson; Matthew J.F.X. Rickard; Russell Stitz; David A. Clark; Graham L. Radford-Smith

doi:10.3393/ac.2020.08.26

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저자정보: Ming Han Lim (Royal Brisbane and Women’s Hospital) Anton R. Lord (QIMR Berghofer Medical Research Institute) Lisa A. Simms (QIMR Berghofer Medical Research Institute) Katherine Hanigan (QIMR Berghofer Medical Research Institute) Aleksandra Edmundson (QIMR Berghofer Medical Research Institute) Matthew J.F.X. Rickard (Concord Repatriation General Hospital) Russell Stitz (Royal Brisbane and Women’s Hospital) David A. Clark (Royal Brisbane and Women’s Hospital) Graham L. Radford-Smith (Royal Brisbane and Women’s Hospital)

저널정보: 대한대장항문학회 Annals of Coloproctology Annals of Coloproctolgy Vol.37 No.5

발행연도: 2021.10

수록면: 318 - 325 (8page)

DOI: 10.3393/ac.2020.08.26

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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.

#Ileal pouch-anal anastomosis #Ulcerative colitis

참고문헌 (26)

참고문헌 신청

Kaser A / 2010 / Inflammatory bowel disease / Annu Rev Immunol 28:573~621

Langholz E / 1994 / Course of ulcerative colitis: analysis of changes in disease activity over years / Gastroenterology 107:3~11

Aratari A / 2008 / Colectomy rate in acute severe ulcerative colitis in the infliximab era / Dig Liver Dis 40:821~826

Becker JM / 1993 / Ileal pouch-anal anastomosis: current status and controversies / Surgery 113:599~602

Parks AG / 1978 / Proctocolectomy without ileostomy for ulcerative colitis / Br Med J 2:85~88

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