Pouch failure of ileal pouch in patients with ulcerative colitis
Abstract
AIM: the purpose of this study is figure out around "pouch failure" including time of its onset, identify risk factors of "pouch failure", as well as evaluation of the effectiveness of treatment of complications that led to "pouch failure" in patients with ulcerative colitis.
PATIENTS AND METHODS: the retrospective single-center study included 144 patients from 2011 to 2018, who had J-pouch surgery at the Ryzhikh National Medical Research Center of Coloproctology Median time of follow-up of patients with J-pouch - 32 (20; 43) months.
RESULTS: the definition of «pouch failure» was phrased as the condition, which develops when J-pouch associated complications are being shown and requires switch off J-pouch by removing of pouch or ileostomy or ileostomy won’t being able to closed during 12 months or more.
The multivariate analysis has shown that hypoalbuminemia was independent risk factor of «pouch failure» OR = 5,74, 95% CI 1,83 – 18,01, p=0,003. Also multivariate analysis of pouch associated complications impact to risk of «pouch failure» was performed and those have statistically significant higher risk of «pouch failure»: pouch associated fistula – OR = 127,93, 95% CI19,86 -824,07, p=0,0000003, ileal-pouch anastomosis leakage - OR = 5,55, 95% CI1,06 -29,14, p=0,043, and ileus - OR = 13,72, 95% CI2,86 -65,87, p=0,001.
Among 30 patients with «pouch failure»: 11(36,7%) cases ileostomy wasn’t closed, but pouch was saved, in 8 (26,6%) cases pouch was removed. In 5(16,7%) J-pouch was removed due to refusing of «pouch salvage surgery».
CONCLUSION: identification of risk factors of «pouch failure» is still actual problem. Our study has identified definition of «pouch failure» and time of its onset, also risk factors of «pouch failure» was found out and results of the treatment of pouch complications was got. That would be really helpful to continue this study with more patients and longer time of follow-up for getting more evidences.
About the Author
Artur E. KulikovRussian Federation
References
1. Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. British medical journal. 1978;2:85–8.
2. Andersson P, Söderholm JD. Surgery in ulcerative colitis: indication and timing. Digestive diseases (Basel, Switzerland). 2009;27:335–40. https://doi.org/10.1159/000228570.
3. Lovegrove RE, Heriot AG, Constantinides V, Tilney HS, et al. Meta-analysis of short-term and long-term outcomes of J, W and S ileal reservoirs for restorative proctocolectomy. Colorectal Disease. 2007;9:310–20. https://doi.org/10.1111/j.1463-1318.2006.01093.x.
4. Shelygin Yu.A., Kashnikov V.N., Sushkov O.I., Gusev A.V., et al. Small intestinal reservoirs in the rehabilitation of patients with ulcerative colitis. Koloproktologia. 2014;49:50–6.
5. Alexander F. Complications of ileal pouch anal anastomosis. Seminars in pediatric surgery. 2007;16:200–4. https://doi.org/10.1053/j.sempedsurg.2007.04.009
6. Achkasov S.I., Sushkov O.I., Kulikov A.E., Binnatli S.A., et al. Risk factors for the development of complications of pelvic small intestinal reservoirs in patients with ulcerative colitis. Koloproktologia. 2020;19:51–66.https://doi.org/10.33878/2073-7556-2020-19-1-51-66
7. Sherman J, Greenstein AJ, Greenstein AJ. Ileal j pouch complications and surgical solutions: a review. Inflammatory bowel diseases. 2014;20:1678–85. https://doi.org/10.1097/MIB.0000000000000086
8. Binnatli Sh.A., Aleshin D.V., Kulikov A.E., Romanov R.I. Quality of life of patients operated on for ulcerative colitis (literature review). Koloproktologia. 2019;18:89–100. https://doi.org/10.33878/2073-7556-2019-18-1-89-100
9. Alsafi Z, Snell A, Segal JP. Prevalence of «pouch failure» of the ileoanal pouch in ulcerative colitis: a systematic review and meta-analysis. International journal of colorectal disease. 2021. https://doi.org/10.1007/S00384-021-04067-6.
10. Zittan E, Wong-Chong N, Ma GW, McLeod RS, Silverberg MS, Cohen Z. Modified two-stage ileal pouch-anal anastomosis results in lower rate of anastomotic leak compared with traditional two-stage surgery for ulcerative colitis. Journal of Crohn’s and Colitis. 2016;10:766–72. https://doi.org/10.1093/ecco-jcc/jjw069
11. Nisar PJ, Kiran RP, Shen B, Remzi FH, Fazio VW. Factors Associated With Ileoanal Pouch Failure in Patients Developing Early or Late Pouch-Related Fistula. Diseases of the Colon & Rectum. 2011;54:446–53. https://doi.org/10.1007/DCR.0b013e318206ea42.
12. Mark-Christensen A, Erichsen R, Brandsborg S, Pachler FR, Nørager CB, Johansen N, идр. Pouch failures following ileal pouch–anal anastomosis for ulcerative colitis. Colorectal Disease 2018;20:44–52. https://doi.org/10.1111/codi.13802
13. Leowardi C, Hinz U, Tariverdian M, Kienle P, et al. Long-term outcome 10 years or more after restorative proctocolectomy and ileal pouch–anal anastomosis in patients with ulcerative colitis. Langenbeck’s Archives of Surgery. 2010;395:49–56. https://doi.org/10.1007/s00423-009-0479-7
14. Helavirta I, Lehto K, Huhtala H, Hyöty M, et al. Pouch failures following restorative proctocolectomy in ulcerative colitis. International journal of colorectal disease. 2020;35:2027–33. https://doi.org/10.1007/S00384-020-03680-1
15. Alsafi Z, Snell A, Segal JP. Prevalence of «pouch failure» of the ileoanal pouch in ulcerative colitis: a systematic review and meta-analysis. International journal of colorectal disease. 2021. https://doi.org/10.1007/S00384-021-04067-6
16. Meagher AP, Farouk R, Dozois RR, Kelly KA, et el. J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients. The British journal of surgery. 1998;85:800–3. https://doi.org/10.1046/j.1365-2168.1998.00689.x
17. Ishii H, Kawai K, Hata K, Shuno Y, Nishikawa T, et al. Comparison of functional outcomes of patients who underwent hand-sewn or stapled ileal pouch-anal anastomosis for ulcerative colitis. International Surgery. 2015;100:1169–76. https://doi.org/10.9738/INTSURG-D-15-00012.1
18. Forbes SS, O’Connor BI, Charles Victor J, Cohen Z, et al. Sepsis is a major predictor of failure after ileal pouch-anal anastomosis. Diseases of the Colon and Rectum. 2009;52:1975–81. https://doi.org/10.1007/DCR.0b013e3181beb3f0
Review
For citations:
Kulikov A.E. Pouch failure of ileal pouch in patients with ulcerative colitis. Koloproktologia. 2022;21(3).
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