Safety of transanal ileal pouch-anal anastomosis for ulcerative colitis: a retrospective observational cohort study
Abstract Background Colectomy with transanal ileal pouch-anal anastomosis (taIPAA) is a surgical technique that can be used to treat benign colorectal disease. Ulcerative colitis is the most frequent inflammatory bowel disease (IBD) and although pharmacological therapy has improved, colectomy rates...
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| Format: | Article |
| Language: | English |
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BMC
2021-09-01
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| Series: | Patient Safety in Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13037-021-00306-5 |
| _version_ | 1819115667306053632 |
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| author | Aina Lask Matthias Biebl Luca Dittrich Andreas Fischer Andreas Adler Frank Tacke Felix Aigner Rosa Schmuck Sascha Chopra Michael Knoop Johann Pratschke Safak Gül-Klein |
| author_facet | Aina Lask Matthias Biebl Luca Dittrich Andreas Fischer Andreas Adler Frank Tacke Felix Aigner Rosa Schmuck Sascha Chopra Michael Knoop Johann Pratschke Safak Gül-Klein |
| author_sort | Aina Lask |
| collection | DOAJ |
| description | Abstract Background Colectomy with transanal ileal pouch-anal anastomosis (taIPAA) is a surgical technique that can be used to treat benign colorectal disease. Ulcerative colitis is the most frequent inflammatory bowel disease (IBD) and although pharmacological therapy has improved, colectomy rates reach up to 15%. The objective of this study was to determine anastomotic leakage rates and treatment after taIPAA as well as short- and long-term pouch function. Methods We conducted a retrospective analysis of a prospective database of all patients undergoing taIPAA at an academic tertiary referral center in Germany, between 01/03/2015 and 31/08/2019. Patients with indications other than ulcerative colitis or with adjuvant chemotherapy following colectomy for colorectal carcinoma were excluded for short- and long-term follow up due to diverging postoperative care yet considered for evaluation of anastomotic leakage. Results A total of 22 patients undergoing taIPAA during the study time-window were included in analysis. Median age at the time of surgery was 32 ± 12.5 (14–54) years. Two patients developed an anastomotic leakage at 11 days (early anastomotic leakage) and 9 months (late anastomotic leakage) after surgery, respectively. In both patients, pouches could be preserved with a multimodal approach. Twenty patients out of 22 met the inclusion criteria for short and long term follow-up. Data on short-term pouch function could be obtained in 14 patients and showed satisfactory pouch function with only four patients reporting intermittent incontinence at a median stool frequency of 9–10 times per day. In the long-term we observed an inflammation or “pouchitis” in 11 patients and a pouch failure in one patient. Conclusion Postoperative complication rates in patients with benign colorectal disease remain an area of concern for surgical patient safety. In this pilot study on 22 selected patients, taIPAA was associated with two patients developing anastomotic leakage. Future large-scale validation studies are required to determine the safety and feasibility of taIPAA in patients with ulcerative colitis. |
| first_indexed | 2024-12-22T05:04:50Z |
| format | Article |
| id | doaj.art-c03b45d9f47644bd930539f9ce4d1367 |
| institution | Directory Open Access Journal |
| issn | 1754-9493 |
| language | English |
| last_indexed | 2024-12-22T05:04:50Z |
| publishDate | 2021-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Patient Safety in Surgery |
| spelling | doaj.art-c03b45d9f47644bd930539f9ce4d13672022-12-21T18:38:09ZengBMCPatient Safety in Surgery1754-94932021-09-011511910.1186/s13037-021-00306-5Safety of transanal ileal pouch-anal anastomosis for ulcerative colitis: a retrospective observational cohort studyAina Lask0Matthias Biebl1Luca Dittrich2Andreas Fischer3Andreas Adler4Frank Tacke5Felix Aigner6Rosa Schmuck7Sascha Chopra8Michael Knoop9Johann Pratschke10Safak Gül-Klein11Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – Universitätsmedizin BerlinDepartment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – Universitätsmedizin BerlinDepartment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – Universitätsmedizin BerlinDepartment of Hepatology and Gastroenterology, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu BerlinDepartment of Hepatology and Gastroenterology, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu BerlinDepartment of Hepatology and Gastroenterology, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu BerlinDepartment of Surgery, Barmherzige Brüder Krankenhaus GrazDepartment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – Universitätsmedizin BerlinDepartment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – Universitätsmedizin BerlinDepartment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – Universitätsmedizin BerlinDepartment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – Universitätsmedizin BerlinDepartment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – Universitätsmedizin BerlinAbstract Background Colectomy with transanal ileal pouch-anal anastomosis (taIPAA) is a surgical technique that can be used to treat benign colorectal disease. Ulcerative colitis is the most frequent inflammatory bowel disease (IBD) and although pharmacological therapy has improved, colectomy rates reach up to 15%. The objective of this study was to determine anastomotic leakage rates and treatment after taIPAA as well as short- and long-term pouch function. Methods We conducted a retrospective analysis of a prospective database of all patients undergoing taIPAA at an academic tertiary referral center in Germany, between 01/03/2015 and 31/08/2019. Patients with indications other than ulcerative colitis or with adjuvant chemotherapy following colectomy for colorectal carcinoma were excluded for short- and long-term follow up due to diverging postoperative care yet considered for evaluation of anastomotic leakage. Results A total of 22 patients undergoing taIPAA during the study time-window were included in analysis. Median age at the time of surgery was 32 ± 12.5 (14–54) years. Two patients developed an anastomotic leakage at 11 days (early anastomotic leakage) and 9 months (late anastomotic leakage) after surgery, respectively. In both patients, pouches could be preserved with a multimodal approach. Twenty patients out of 22 met the inclusion criteria for short and long term follow-up. Data on short-term pouch function could be obtained in 14 patients and showed satisfactory pouch function with only four patients reporting intermittent incontinence at a median stool frequency of 9–10 times per day. In the long-term we observed an inflammation or “pouchitis” in 11 patients and a pouch failure in one patient. Conclusion Postoperative complication rates in patients with benign colorectal disease remain an area of concern for surgical patient safety. In this pilot study on 22 selected patients, taIPAA was associated with two patients developing anastomotic leakage. Future large-scale validation studies are required to determine the safety and feasibility of taIPAA in patients with ulcerative colitis.https://doi.org/10.1186/s13037-021-00306-5Transanal ileal pouch-anal anastomosisPouchitisUlcerative colitisAnastomotic leakage |
| spellingShingle | Aina Lask Matthias Biebl Luca Dittrich Andreas Fischer Andreas Adler Frank Tacke Felix Aigner Rosa Schmuck Sascha Chopra Michael Knoop Johann Pratschke Safak Gül-Klein Safety of transanal ileal pouch-anal anastomosis for ulcerative colitis: a retrospective observational cohort study Patient Safety in Surgery Transanal ileal pouch-anal anastomosis Pouchitis Ulcerative colitis Anastomotic leakage |
| title | Safety of transanal ileal pouch-anal anastomosis for ulcerative colitis: a retrospective observational cohort study |
| title_full | Safety of transanal ileal pouch-anal anastomosis for ulcerative colitis: a retrospective observational cohort study |
| title_fullStr | Safety of transanal ileal pouch-anal anastomosis for ulcerative colitis: a retrospective observational cohort study |
| title_full_unstemmed | Safety of transanal ileal pouch-anal anastomosis for ulcerative colitis: a retrospective observational cohort study |
| title_short | Safety of transanal ileal pouch-anal anastomosis for ulcerative colitis: a retrospective observational cohort study |
| title_sort | safety of transanal ileal pouch anal anastomosis for ulcerative colitis a retrospective observational cohort study |
| topic | Transanal ileal pouch-anal anastomosis Pouchitis Ulcerative colitis Anastomotic leakage |
| url | https://doi.org/10.1186/s13037-021-00306-5 |
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