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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 2/2022

Open Access 01-02-2022 | Ulcerative Colitis | Original Article

Prevalence of ‘pouch failure’ of the ileoanal pouch in ulcerative colitis: a systematic review and meta-analysis

Authors: Zaid Alsafi, Alice Snell, Jonathan P. Segal

Published in: International Journal of Colorectal Disease | Issue 2/2022

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Abstract

Background and aims

The ileoanal pouch (IPAA) provides patients with ulcerative colitis (UC) that have not responded to medical therapy an option to retain bowel continuity and defecate without the need for a long-term stoma. Despite good functional outcomes, some pouches fail, requiring permanent diversion, pouchectomy, or a redo pouch. The incidence of pouch failure ranges between 2 and 15% in the literature. We conducted a systematic review and meta-analysis aiming to define the prevalence of pouch failure in patients with UC who have undergone IPAA using population-based studies.

Methods

We searched Embase, Embase classic and PubMed from 1978 to 31st of May 2021 to identify cross-sectional studies that reported the prevalence of pouch failure in adults (≥ 18 years of age) who underwent IPAA for UC.

Results

Twenty-six studies comprising 23,389 patients were analysed. With < 5 years of follow-up, the prevalence of pouch failure was 5% (95%CI 3–10%). With ≥ 5 but < 10 years of follow-up, the prevalence was 5% (95%CI 4–7%). This increased to 9% (95%CI 7–16%) with ≥ 10 years of follow-up. The overall prevalence of pouch failure was 6% (95%CI 5–8%).

Conclusions

The overall prevalence of pouch failure in patients over the age of 18 who have undergone restorative proctocolectomy in UC is 6%. These data are important for counselling patients considering this operation. Importantly, for those patients with UC being considered for a pouch, their disease course has often resulted in both physical and psychological morbidity and hence providing accurate expectations for these patients is vital.
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Literature
1.
Jackson KL, Stocchi L, Duraes L, Rencuzogullari A, Bennett AE, Remzi FH (2017) Long-term outcomes in indeterminate colitis patients undergoing ileal pouch-anal anastomosis: function, quality of life, and complications. J Gastrointest Surg 21(1):56–61CrossRef
2.
Parks AG, Nicholls RJ (1978) Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 2(6130):85–88CrossRef
3.
Heikens JT, de Vries J, Goos MR, Oostvogel HJ, Gooszen HG, van Laarhoven CJ (2012) Quality of life and health status before and after ileal pouch-anal anastomosis for ulcerative colitis. Br J Surg 99(2):263–269CrossRef
4.
5.
Uchino M, Ikeuchi H, Sugita A, Futami K, Watanabe T, Fukushima K et al (2018) Pouch functional outcomes after restorative proctocolectomy with ileal-pouch reconstruction in patients with ulcerative colitis: Japanese multi-center nationwide cohort study. J Gastroenterol 53(5):642–651CrossRef
6.
Deputy M, Segal J, Reza L, Worley G, Costello S, Burns E et al (2021) The pouch behaving badly: management of morbidity after ileal pouch-anal anastomosis. Colorectal Dis 23(5):1193–1204CrossRef
7.
Dayton MT, Larsen KR, Christiansen DD (2002) Similar functional results and complications after ileal pouch–anal anastomosis in patients with indeterminate vs ulcerative colitis. Arch Surg 137(6):690–695CrossRef
8.
Mark-Christensen A, Erichsen R, Brandsborg S, Pachler FR, Nørager CB, Johansen N et al (2018) Pouch failures following ileal pouch-anal anastomosis for ulcerative colitis. Colorectal Dis 20(1):44–52CrossRef
9.
Murphy PB, Khot Z, Vogt KN, Ott M, Dubois L (2015) Quality of life after total proctocolectomy with ileostomy or IPAA: a systematic review. Dis Colon Rectum 58(9):899–908CrossRef
10.
Camilleri-Brennan J, Munro A, Steele RJ (2003) Does an ileoanal pouch offer a better quality of life than a permanent ileostomy for patients with ulcerative colitis? J Gastrointest Surg 7(6):814–819CrossRef
11.
Lorenzo G, Maurizio C, Maria LP, Tanzanu M, Silvio L, Mariangela P et al (2016) Ileal pouch-anal anastomosis 20 years later: is it still a good surgical option for patients with ulcerative colitis? Int J Colorectal Dis 31(12):1835–1843CrossRef
12.
Olecki E, Kronfli AP, Stahl KA, King S, Razavai N, Koltun W, Hershey PA (2021) Stoma-less ileal-pouch-anal-anastomosis is not associated with increased long-term pouch failure rates in patients with ulcerative colitis. Dis Colon Rectum Conf: Am Soc Colon Rectal Surg Ann Sci Meet 7–38
13.
Erondu A, Akiyama S et al (2020) Time trend analysis of pre-operative characteristics and post-operative pouch outcomes in UC patients undergoing ileal pouch anal-anastomosis: S0777. Am J Gastroenterol
14.
Lavryk OA, Stocchi L, Hull TL, Lipman JM, Shawki S, Holubar SD et al (2020) Impact of preoperative duration of ulcerative colitis on long-term outcomes of restorative proctocolectomy. Int J Colorectal Dis 35(1):41–49CrossRef
15.
Lee GC, Deery SE, Kunitake H, Hicks CW, Olariu AG, Savitt LR et al (2019) Comparable perioperative outcomes, long-term outcomes, and quality of life in a retrospective analysis of ulcerative colitis patients following 2-stage versus 3-stage proctocolectomy with ileal pouch-anal anastomosis. Int J Colorectal Dis 34(3):491–499CrossRef
16.
Skowron KDL, Rubin M, Hurst R, Fichera A, Umanskiy K (2012) J-pouch outcomes in ulcerative colitis are not affected by preoperative administration of biologic agents. Am Soc Colon Rectal Surg Ann Meet Abstracts
17.
Lepistö A, Kärkkäinen P, Järvinen HJ (2008) Prevalence of primary sclerosing cholangitis in ulcerative colitis patients undergoing proctocolectomy and ileal pouch-anal anastomosis. Inflamm Bowel Dis 14(6):775–779CrossRef
18.
Nordenvall C, Westberg K, Söderling J, Everhov ÅH, Halfvarson J, Ludvigsson JF et al (2021) Restorative surgery is more common in ulcerative colitis patients with a high income: a population-based study. Dis Colon Rectum 64(3):301–312CrossRef
19.
Helavirta I, Lehto K, Huhtala H, Hyöty M, Collin P, Aitola P (2020) Pouch failures following restorative proctocolectomy in ulcerative colitis. Int J Colorectal Dis 35(11):2027–2033CrossRef
20.
Landerholm K, Abdalla M, Myrelid P, Andersson RE (2017) Survival of ileal pouch anal anastomosis constructed after colectomy or secondary to a previous ileorectal anastomosis in ulcerative colitis patients: a population-based cohort study. Scand J Gastroenterol 52(5):531–535CrossRef
21.
Helavirta I, Huhtala H, Hyöty M, Collin P, Aitola P (2015) Restorative proctocolectomy for ulcerative colitis in 1985–2009. Scand J Surg 105(2):73–77CrossRef
22.
Mukewar S, Wu X, Lopez R, Bo S (2014) Comparison of long-term outcomes of S and J pouches and continent ileostomies in ulcerative colitis patients with restorative proctocolectomy-experience in subspecialty pouch center ✩. J Crohns Colitis 8(10):1227–1236CrossRef
23.
Nieminen I, Huhtala H, Hyöty M, Collin P, Aitola P (2013) P346 The experience of restorative proctocolectomy for ulcerative colitis during 1985–2009. J Crohns Colitis 7(Supplement_1):S148-S
24.
Keighley MR (2000) The final diagnosis in pouch patients for presumed ulcerative colitis may change to Crohn’s disease: patients should be warned of the consequences. Acta Chir Iugosl 47(4 Suppl 1):27–31PubMed
25.
Delaney CP, Remzi FH, Gramlich T, Dadvand B, Fazio VW (2002) Equivalent function, quality of life and pouch survival rates after ileal pouch-anal anastomosis for indeterminate and ulcerative colitis. Ann Surg 236(1):43–48CrossRef
26.
Heuschen U, Schmidt J, Allemeyer E, Stern J, Heuschen G (2001) The ileo-anal pouch procedure: Complications, quality of life, and long-term results. Zentralbl Chir 126(Suppl 1):36–42CrossRef
27.
Fazio VW, Kiran RP, Remzi FH, Coffey JC, Heneghan HM, Kirat HT et al (2013) Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 257(4):679–685CrossRef
28.
Berndtsson I, Lindholm E, Oresland T, Börjesson L (2007) Long-term outcome after ileal pouch-anal anastomosis: function and health-related quality of life. Dis Colon Rectum 50(10):1545–1552CrossRef
29.
Arai K, Koganei K, Kimura H, Akatani M, Kitoh F, Sugita A et al (2005) Incidence and outcome of complications following restorative proctocolectomy. Am J Surg 190(1):39–42CrossRef
30.
Farouk R, Pemberton JH, Wolff BG, Dozois RR, Browning S, Larson D (2000) Functional outcomes after ileal pouch-anal anastomosis for chronic ulcerative colitis. Ann Surg 231(6):919–926CrossRef
31.
Fazio VW, Ziv Y, Church JM, Oakley JR, Lavery IC, Milsom JW et al (1995) Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 222(2):120–127CrossRef
32.
Pemberton JH, Kelly KA, Beart RW Jr, Dozois RR, Wolff BG, Ilstrup DM (1987) Ileal pouch-anal anastomosis for chronic ulcerative colitis. Long-term results Ann Surg 206(4):504–513PubMed
33.
MacRae HM, McLeod RS, Cohen Z, O’Connor BI, Ton EN (1997) Risk factors for pelvic pouch failure. Dis Colon Rectum 40(3):257–262CrossRef
34.
Heuthorst L, Wasmann KATGM, Reijntjes MA, Hompes R, Buskens CJ, Bemelman WA (2021) Ileal pouch-anal anastomosis complications and pouch failure: a systematic review and meta-analysis. Ann Surg Open 2(2):e074
35.
Emile SH, Gilshtein H, Wexner SD (2020) Outcome of ileal pouch-anal anastomosis in patients with indeterminate colitis: a systematic review and meta-analysis. J Crohns Colitis 14(7):1010–1020CrossRef
36.
Leowardi C, Hinz U, Tariverdian M, Kienle P, Herfarth C, Ulrich A et al (2010) Long-term outcome 10 years or more after restorative proctocolectomy and ileal pouch-anal anastomosis in patients with ulcerative colitis. Langenbecks Arch Surg 395(1):49–56CrossRef
37.
Tulchinsky H, Hawley PR, Nicholls J (2003) Long-term failure after restorative proctocolectomy for ulcerative colitis. Ann Surg 238(2):229–234PubMedPubMedCentral
38.
McCormick PH, Guest GD, Clark AJ, Petersen D, Clark DA, Stevenson AR et al (2012) The ideal ileal-pouch design: a long-term randomized control trial of J- vs W-pouch construction. Dis Colon Rectum 55(12):1251–1257CrossRef
39.
Flynn J, Larach JT, Kong JCH, Warrier SK, Heriot A (2021) Robotic versus laparoscopic ileal pouch-anal anastomosis (IPAA): a systematic review and meta-analysis. Int J Colorectal Dis 36(7):1345–1356CrossRef
40.
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):275–282CrossRef
41.
Fajardo AD, Dharmarajan S, George V, Hunt SR, Birnbaum EH, Fleshman JW et al (2010) Laparoscopic versus open 2-stage ileal pouch: laparoscopic approach allows for faster restoration of intestinal continuity. J Am Coll Surg 211(3):377–383CrossRef
42.
Frese JP, Gröne J, Lauscher JC, Konietschke F, Kreis ME, Seifarth C (2021) Risk factors for failure of ileal pouch-anal anastomosis in patients with refractory ulcerative colitis. Surgery
43.
Barnes EL, Kochar B, Jessup HR, Herfarth HH (2019) The incidence and definition of Crohn’s disease of the pouch: a systematic review and meta-analysis. Inflamm Bowel Dis 25(9):1474–1480CrossRef
44.
Lightner AL, Fletcher JG, Pemberton JH, Mathis KL, Raffals LE, Smyrk T (2017) Crohn’s disease of the pouch: a true diagnosis or an oversubscribed diagnosis of exclusion? Dis Colon Rectum 60(11):1201–1208CrossRef
45.
Barnes EL, Holubar SD, Herfarth HH (2021) Systematic review and meta-analysis of outcomes after ileal pouch-anal anastomosis in primary sclerosing cholangitis and ulcerative colitis. J Crohns Colitis 15(8):1272–1278CrossRef
Metadata
Title
Prevalence of ‘pouch failure’ of the ileoanal pouch in ulcerative colitis: a systematic review and meta-analysis
Authors
Zaid Alsafi
Alice Snell
Jonathan P. Segal
Publication date
01-02-2022
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 2/2022
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-021-04067-6

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