Pouch failures following restorative proctocolectomy in ulcerative colitis
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ORIGINAL ARTICLE
Pouch failures following restorative proctocolectomy in ulcerative colitis Ilona Helavirta 1
&
Kirsi Lehto 1,2 & Heini Huhtala 3 & Marja Hyöty 1 & Pekka Collin 1,2 & Petri Aitola 2
Accepted: 17 June 2020 # The Author(s) 2020
Abstract Purpose Restorative proctocolectomy (RPC) is the most common operation in ulcerative colitis. Nevertheless, permanent ileostomy will sometimes be unavoidable. The aim was to evaluate the reasons for pouch failure and early morbidity after pouch excision. Methods The number and the reasons for pouch failures were analysed in patients undergoing RPC 1985-2016. Results Out of 491 RPC patients, 53 experienced pouch failure (10 women, 43 men); 52 out of 53 underwent pouch excision. The cumulative risk for excision at 5, 10 and 20 years was 5.6, 9.4 and 15.5%, respectively. The reasons for failure included septic events such as fistula in 12 (23%), chronic pouchitis in 11 (21%) and leakage in 8 (15%) patients. Functional reasons for pouch failure were recorded as poor function in 16 (30%), incontinence in 12 (23%) and stricture in 12 (23%) patients. Multiple causes for pouch failure were recorded for individual patients. Seven cases of Crohn’s disease were found among the failure cases: two before pouch excision and five after. Altogether, 15 Crohn’s disease diagnoses were set in the RPC cohort, giving a percentage of 47% of pouch failure in this disorder. A complication occurred in 23 (44%) patients within 30 days after surgery; 16 were mild (Clavien-Dindo grades I–II). Conclusions Eleven percent of RPC patients suffered pouch failure: more men than women. The reasons were multiple. Crohn’s disease created a risk of failure, but a half of these patients maintained the pouch. Morbidity after pouch excision was moderate, but in most cases slight. Keywords Restorative proctocolectomy . Ileal pouch . anal anastomosis . IBD surgery . Pouch failure
Introduction Since its introduction by Parks and Nicholls in 1978 [1], restorative proctocolectomy has become the procedure of choice in patients with ulcerative colitis (UC) requiring surgery. Despite the evolved details of the operation and centralization of the surgery to centres having the number of operations on an acceptable level, poor functional results and pouch-related
* Ilona Helavirta [email protected] 1
Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Teiskontie 35, FI-33521 Tampere, Finland
2
Faculty of Medicine and Health Technology, Tampere University, P.O. Box 100, FI-33014 Tampere, Finland
3
Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland
complications may compel excision of the pouch and the construction of a permanent stoma. The long-term failure rate for RPC is reported to be 10–15% [2–4]. The most common causes of pouch failure have been pelvic sepsis, poor pouch function, pouchitis and Crohn’s disease [4–6]. The factors leading to pouch excision are still poorly understood. This prompted us to explore the long-term risk of pouch
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