Ileo-anal pouch excision:A review of indications and outcomes

• 作者: Caroline Mary Byrne Paul Stephen Rooney
• 来源期刊: 世界外科手术杂志
• 学科: 医学
• 关键词: INDICATIONS and OUTCOMES Ileo-anal POUCH POUCH FAILURE POUCH EXCISION
• 年，卷（期）: 2015,（1）
• 页码范围: 119-126
• 页数: 8页
• 分类号: R

摘要

Restorative proctocolectomy(RP)is the surgical treatment of choice for ulcerative colitis(UC)and patients with familial adenomatous polyposis(FAP).A devastating complication for both patient and surgeon is failure of the pouch that requires excision.There is currently no single paper in the literature that consolidates the indications for ileo-anal pouch excision and the subsequent outcomes following this procedure.A literature search was carried out to identify articles on RP and ileal pouch-anal anastomosis.The main search terms used were“RP”;“ileal pouch-anal anastomosis”or“ileal reservoir”or“ileal pouch”;“failure of ileal pouchanal anastomosis”and“excision of ileal pouch-anal anastomosis”.The search was completed using electronic databases MEDLINE,PubMed and EMBASE from 1975 to June 2014.Characteristics of patients with pouch failure differ between institutions.Reported overall excision rates of the pouches vary and in this review ranged from 0.93%to 12.8%.Age and lower institutional volume(less than 3.3 cases)were independent predictors of pouch failure;however surgeon case load was not.The main reasons identified for excision are sepsis(early cause),Crohn’s disease and poor functional outcomes(both late causes).Pouch cancers in UC and FAP are still rare but 135 cases exist in the literature.The most common complication following excision is persistent perineal sinus.The decision to excise a pouch should not be taken lightly and an awareness of the technical pitfalls and complications that can occur should be fully appreciated.