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International Journal of Colorectal Disease

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Open Access 01-03-2016 | Review

Functional outcomes following ileal pouch-anal anastomosis (IPAA) in older patients: a systematic review

Authors: Lisa Ramage, Sheng Qiu, Panagiotis Georgiou, Paris Tekkis, Emile Tan

Published in: International Journal of Colorectal Disease | Issue 3/2016

Abstract

Aim

Ileal pouch-anal anastomosis (IPAA) is performed in ulcerative colitis or familial adenomatous polyposis with a view to restoration of GI continuity and prevention of permanent faecal diversion. Debate exists as to its safety in older patients. This review aims to assess functional outcomes and safety of restorative proctocolectomy (RPC) in older compared to younger patients.

Methods

Literature search was performed for age-stratified studies which assessed functional outcomes of IPAA. Twelve papers were included overall. Patients were categorized into ‘older’ and ‘younger’ groups. Analysis was split into three separate parts: 1. Age cut-off of 50 ± 5 years (with sensitivity analysis); 2. Age cut-off of 65 ± years; 3. Long-term outcomes (>10 years).

Results

With an age cut-off of 50 years (4327 versus 513 patients), complication rates were comparable with the exception of an increased rate of small-bowel obstruction in the younger patients (p = 0.034). At 1 year, 24-h stool frequency was significantly higher in the older patient group (p < 0.0001). Daytime (p < 0.0001) and night-time (p < 0.0001) incontinence rates were also significantly higher in older patients.

Overall, function deteriorated with time across all ages; however, after 10 years, there was no significant difference in incontinence rates between age groups.

Dehydration and electrolyte loss was a significant problem in patients over 65 (p < 0.0001).

Despite differences in postoperative function, quality of life was comparable between groups; however, only a few studies reported quality of life data.

Conclusion

IPAA is safe in older patients, although treating clinicians should bear in mind the increased risk of dehydration. Postoperative function is worse in older patients, but seems to level out with time and does not appear to significantly impact on overall quality of life and patient satisfaction. Assessment for suitability for RPC should not be based on chronological age in isolation. It is imperative that the correct support is given to older patients with worsened postoperative function in order to maintain patient satisfaction and adequate quality of life.

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Title: Functional outcomes following ileal pouch-anal anastomosis (IPAA) in older patients: a systematic review
Authors: Lisa Ramage
Sheng Qiu
Panagiotis Georgiou
Paris Tekkis
Emile Tan
Publication date: 01-03-2016
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 3/2016
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-015-2475-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Functional outcomes following ileal pouch-anal anastomosis (IPAA) in older patients: a systematic review

Abstract

Aim

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Aim

Methods

Results

Conclusion

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