Anastomotic leak does not affect long-term and longitudinal functional outcomes after ileal pouch surgery for ulcerative
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ORIGINAL ARTICLE
Anastomotic leak does not affect long‑term and longitudinal functional outcomes after ileal pouch surgery for ulcerative colitis when managed aggressively J. Yu1,3 · D. A. Clark1,2,3,4 · D. Sidhom1 · A. Edmundson1,3 · M. Solomon2 Received: 1 June 2020 / Accepted: 13 August 2020 © Springer Nature Switzerland AG 2020
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. Keywords Anastomotic leak · Ileal pouch · Long-term functional outcomes
Introduction
* D. A. Clark [email protected] 1
Royal Brisbane and Women’s Hospital, Herston Road, Brisbane, QLD 4066, Australia
2
Faculty of Medicine and Health, Surgical Outcomes Research Centre (SOuRCe), University of Sydney, Missenden Road, Camperdown, Sydney, NSW 2050, Australia
3
University of Qld, St Lucia, Brisbane, QLD 4072, Australia
4
St Vincent’s Private Hospital Northside, 627 Rode Road, Chermside, Brisbane, QLD 4032, Australia
Restorative proctocolectomy and ileal pouch anal-anastomosis (IPAA) is an effective surgical alternative to a permanent ileostomy for patients with inflammatory bowel disease (IBD) [1–4]. Faecal continence is preserved following IPAA due to sparing of the anal sphincters and the formation of an ileal pouch that act
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