Long-term Functional Outcomes after Restorative Proctocolectomy with J-pouch, Ileoanal Anastomosis: 10-year Experience in Thai Patients

Authors

  • Chakrapan Euanorasetr Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand

Abstract

Background: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the procedure of choice for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). Early functional outcomes after IPAA are good in Western studies, but there are minimal data on the long-term function of the pouch. The outcomes of IPAA in Thai patients are not well known. The aim of this study was to evaluate the risk of postoperative morbidity and the long-term functional results in Thai patients with UC and FAP who underwent IPAA.

Methods: A retrospectively review was carried out in 16 patients (10 with polyposis, 6 with colitis) who underwent IPAA by a single surgeon (C.E.) between May 1996 and September 2005. All patients underwent a total proctocolectomy, mucosal proctectomy, hand-sewn J-pouch ileoanal anastomosis and a protective ileostomy.

Results: The median age at surgery was 37.5 years (ranged 26-59 years). The colitis patients were older than the polyposis patients (median of 52 VS 34 years). Four patients in colitis group (66.7%) and three patients in polyposis group (30%) had coexisting colorectal carcinoma. All patients were followed for at least 12 months with a median length of follow-up at 43 months (ranged 12-124 months). There was no hospital mortality. The overall complications rate was 31.2% (30% in polyposis group and 33.3% in colitis group). The most common complication was small bowel obstruction (18.8%), followed by wound infection (12.5%), pelvic abscess and pouch fistula (6.3%). Pouchitis occurred in 6.3%. Pouch failure developed in 6.:3%. The average number of stool per day/night before IPAA in polyposis and colitis patients were 2.8/0.5 and 7.7/2.3, respectively. The average stool frequency per day / night after IPAA in polyposis and colitis group were 4.9/1 and 4.2/1, respectively. About 53% of all patients had perfect continence at night. All patients had no difficulty in evacuation or urgency.

Conclusion: IPAA in Thai patients in this study developed an acceptable morbidity and no mortality. Long-term functional outcomes after IPAA in Thai patients are as good as in Western patients.

References

1. Bach SP, Mortensen NJM. Revolution and evolution: 30 years of ileoanal pouch-surgery. Inflam Bowel Dis 2006; 12:131-45.

2. Arai K, Koganci K, Kimura H, et al. Incidence and outcome of complications following restorative proctocolectomy. Am J Surg 2005; 190: 39-42.

3. Becker JM, Stucchi AF. Proctocolectomy with ileoanal anastomosis. J Gastrointest Surg 2004; 8: 376-86.

4. Delaini GG, Scaglia M, Colucci G, et al. The ileoanal pouch procedure in the long-term perspective: a critical review. Tech Coloprocto 2005; 9:187-92.

5. Delaney CP, Fazio VW, Remzi FH, et al, Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch-anal anastomosis. Ann Surg 2003;238: 221-8.

6. Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 2004; 99:1371-85.

7. Liechtenstein GR, Cohen R, Yamashita B, et al. Quality of life after proctocolectomy with ileoanal anastomosis for patients with ulcerative colitis. J Clin Gastroenterol 2006; 40: 669-77.

8. Michelassi F, Lee J, Rubin M, et al. Long-term functional results after ileal pouch anal restorative proctocolectomy for ulcerative colitis: A prospective observational study. Ann Surg 2003; 238: 433-41.

9. Tekkis PP, Fazio VW, Lavery IC, et al. Evaluation of the learning curve in ileal pouch-anal anastomosis surgery. Ann Surg 2005; 241: 261-8.

10. Wheeler JMD, Banerjee A, Ahuja N, et al. Long-term function after restorative proctocolectomy. Dis Colon Rectum 2005; 48:946-51.

11. Lovegrove RE, Constantinides VA, Herio AG, et al. A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy. A meta-analysis of 4,183 patients. Ann Surg 2006; 244: 18-26.

12. Tulchinsky H, Hawley P, Nicholls J. Long-term failure after restorative proctocolectomy for ulcerative colitis. Ann Surg 2003;238: 229-34.

13. Farouk R, Dozois RR, Pemberton JH, et al. Incidence and subsequent impact of pelvic abscess after ileal pouch-anal anastomosis for chronic ulcerative colitis. Dis Colon Rectum 1998;41:1239-43.

14. Meagher AP, Farouk R, Dozois RR, et al, J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients. Br J Surg 1998; 85: 800-3.

15. Setti-Carraro P, Ritchie JK, Wilkinson KH, et al. The first 10 years' experience of restorative proctocolectomy for ulcerative colitis. Gut 1994;35: 1070-5.

16. Fazio VW, O'Riordain MG, Lavery IC, et al. Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 1999; 230: 575-84.

17. Church JM, Saad R, Schroder T, et al. Predicting the functional result of anastomosis to the anus: the paradox of preoperative anal resting anal pressure. Dis Colon Rectum 1993; 36:895-900.

18. Euanorasetr C. Restorative proctocolectomy with J-pouch ileoanal anastomosis. In: Thavichaigarn P, editors. Carcinoma of the colon and rectum. Bangkok: Kosit Publishing; 2006.

19. Utsunomiya J, Iwama T, Imajo M, et al. Total colectomy, mucosal proctectomy, and ileoanal anastomosis. Dis Colon Rectum 1980; 23: 459-66.

20. Parks AG, Nicholls RJ, Belliveau P. Proctocolectomy with ileal reservoir and anal anastomosis. Br J Surg 1980; 67: 533-8

21. Farouk R, Pemberton JH, Wolff BG, et al. Functional outcomes after ileal pouch-anal anastomosis for chronic ulcerative colitis. Ann Surg 2000; 231: 919-26,

22. Dozois RR, Kelly KA, Welling DR, et al. Ileal pouch-anal anastomosis: comparison of results in familial adenomatous polyposis and chronic ulcerative colitis. Ann Surg 1989:210:268-73.

23. Fazio VW, Ziv Y, Church JM, et al. Ileal pouch-anal anastomosis complications and function in 1005 patients. Ann Surg 1995; 222:120-7.

24. Hueting WE, Buskens E, van der Tweel I, et al. Results and complications after ileal pouch anal anastomosis; a meta-analysis of 43 observational studies comprising 9,317 patients. Dig Surg 2005; 22: 69-79.

25. Parc Y, Piquard A, Dozois R, et al. Long-term outcome of familial adenomatous polyposis patients after restorative coloproctectomy. Ann Surg 2004; 239: 378-82.

26. Romanos J, Samarasekera DN, Stebbing JF, et al. Outcome of 200 restorative proctocolectomy operations: the John Radcliff Hospital experience. Br J Surg 1997; 84: 814-8.

27. Pemberton JH, Kelly KA, Beart RW Jr, et al. lleal pouch-anal anastomosis for chronic ulcerative colitis. Long-term results. Ann Surg 1987; 206: 504-13.

28. Bullard KM, Madoff RD, Gemlo BT, Is ileoanal pouch function stable with time? Dis Colon Rectum 2002; 45: 299-304.

29. Marcello PW, Roberts PL, Schoetz DJ Jr, et al. Long-term results of the ileoanal pouch procedure. Arch Surg 1993; 128:500-3.

30. Reilly WT, Pemberton JH, Wolff BG, et al. Randomized prospective trial comparing ileal pouch-anal anastomosis performed by excising the anal mucosa to ileal pouch-anal anastomosis performed by preserving the anal mucosa. Ann Surg 1997; 225: 666-76.

31. MacLean AR, Cohen Z, MacRae HM, et al. Risk of small bowel obstruction after the ileal pouch-anal anastomosis. Ann Surg 2002; 235: 200-6.

32. Marcello PW, Roberts PL, Schoetz DJ Jr, et al. Obstruction after ileal pouch-anal anastomosis: a preventable complication? Dis Colon Rectum 1993; 36: 1105-11.

33. Francois Y, Dozois RR, Kelly KA, et al. Small intestinalobstruction complicating ileal pouch-anal anastomosis. Ann Surg 1989; 209: 46-50.

34. Belliveau P, Trudel J, Vasilevsky CA, et al. Ileoanal anastomosis with reservoir: complications and long-term results. Can J Surg 1999; 42: 345-52.

35. Heuschen UA, Autschbach F, Allemeyer EH, et al. Long-term follow-up after ileoanal pouch procedure: algorithm for diagnosis, classification, and management of pouchitis. Dis Colon Rectum 2001: 44: 487-99.

36. Mikkola K, Luukkonen P, Jarvinen HJ. Long-term results of restorative proctocolectomy for ulcerative colitis. Int J Colorectal Dis 1995; 10: 10-4.

37. Sandborn WJ, Tremaine WJ, Batts KP, et al. Pouchitis after ileal pouch-anal anastomosis: a pouchitis disease activity index. Mayo Clin Proc 1994; 69: 409-15.

38. Korsgen S. Keighley MIR. Causes of failure and life expectancy of the ileoanal pouch, Int J Colorectal Dis 1997; 12: 4-8.

39. Fazio VW, Tekkis PP, Remzi F, et al. Quantification of risk for pouch failure after ileal pouch anal anastomosis surgery. Ann Surg 2003; 238: 605-14.

40. Heuschen UA, Hinz U, Allemeyer EH, et al. Risk factors for ileoanal J-pouch related septic complications in ulcerative colitis and familial adenomatous polyposis. Ann Surg 2002;235: 207-16.

41. Lehrmann J, Stucchi AF, LaPorte WW, et al, Complications and outcomes after ileal pouch-anal anastomosis (IPAA): A meta-analysis of more than 8300 patients. Gastroenterology 2003;124: A814.

42. Michelassi F, Hurst R. Restorative proctocolectomy with J-pouch ileoanal anastomosis. Arch Surg 2000;135: 347-353.

43. Mcintyre PB, Pemberton JH, Wolff BG, et al. Comparing functional results one year and ten years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Dis Colon Rectum 1994; 37: 303-7.

44. Seidel SA, Peach SE, Newman M, et al. Ileoanal pouch procedures: clinical outcomes and quality of life assessment. Am Surg 1999; 65: 40-6.

45. Radice E, Nelson H, Devine RM, et al. lleal pouch-anal anastomosis in patients with colorectal cancer: Long-term functional and oncologic outcomes. Dis Colon Rectum 1998;41:11-7.

46. Thompson-Fawcett MW, Richard CS, O'Connor Bl, et al. Quality of life is excellent after a pelvic pouch for colitis-associated neoplasia. Dis Colon Rectum 2000; 43: 1497-502.

47. Holdsworth PJ, Johnston D. Anal sensation after restorative proctocolectomy for ulcerative colitis. Br J Surg 1988; 75:993-6.

48. Deen KI, Williams JG, Grant EA, et al. Randomized trial to determine the optimum level of pouch-anal anastomosis in stapled restorative proctocolectomy. Dis Colon Rectum 1995; 38:133-8.

49. Miller R, Lewis GT, Bartolo DC, et al. Sensory discrimination and dynamic activity in the anorectum: evidence using a new ambulatory technique. Br J Surg 1988; 75: 1003-7.

50. Thompson-Franscett MW, Mortensen NJ, Warren BF. "Cuffitis" and inflammatory changes in the columnar cuff, anal transitional zone, and ileal reservoir after stapled pouch-anal anastomosis. Dis Colon Rectum 1999; 42: 348-55.

51. Remzi FH, Fazio VW, Delaney CP, et al. Dysplasia of the anal transitional zone after ileal pouch-anal anastomosis: results of prospective evaluation after a minimum of ten years. Dis Colon Rectum 2003; 46: 6-13.

52. Choen S, Tsunoda A, Nicholls RJ. Prospective randomized trial comparing anal function after hand-sewn ileoanal anastomosis with mucosectomy versus stapled ileoanal anastomosis without mucosectomy in restorative proctocolectomy. Br J Surg 1991; 78: 430-4.

53. Luukkonen P, Jarvinen H. Stapled vs hand-sutured ileoanal anastomosis in restorative proctocolectomy. A prospective, randomized study. Arch Surg 1993; 128: 437-40.

54. Hallgren TA, Fasth SB, Oresland TO, et al. lleal pouch anal function after endoanal mucosectomy and handsewn ileoanal anastomosis compared with stapled anastomosis without mucosectomy. Eur J Surg 1995; 161: 915-21.

55. Mc Intyre PB, Remberton JH, Beart RW Jr, et al, Double-stapled VS handsewn ileal pouch-anal anastomosis in patients with chronic ulcerative colitis. Dis Colon Rectum 1994;37: 430-3.

56. Baratsis S, Hadjidimitriou F, Christodoulou M, et al. Adenocarcinoma in the anal canal after ileal pouch-anal anastomosis for ulcerative colitis using a double stapling technique: report of a case. Dis Colon Rectum 2002;45:687-91.

57. Laureti S, Ugolini F, D'Errico A, et al. Adenocarcinoma below ileoanal anastomosis for ulcerative colitis: report of a case and review of the literature. Dis Colon Rectum 2002;45:418-21.

58. Sequens R. Cancer in the anal canal (transitional zone) after restorative proctocolectomy with stapled ileal pouch-anal anastomosis. Int J Colorectal Dis 1997;12: 254-5.

59. Puthu D, Rajan N, Rao R, et al. Carcinoma of the rectal pouch following restorative proctocolectomy, Report of a case. Dis Colon Rectum 1992; 35: 257-60.

60. Shen B, Lashner BA, Bennett AE, et al. Treatment of rectal cuff inflammation (cuffitis) in patients with ulcerative colitis following restorative proctocolectomy and ileal pouch-anal anastomosis. Am J Gastroenterol 2004;99:1527-31.

61. McHugh SM, Diamant NE, Mcleod R, et al. S-pouches vs. J pouches. A comparison of functional outcomes. Dis Colon Rectum 1987;30: 671-7.

62. Johnston D, Williamson ME, Lewis WG, et al. Prospective controlled trial of duplicated (J) versus quadruplicated (W) pelvic ileal reservoirs in restorative proctocolectomy for ulcerative colitis. Gut 1996; 39: 242-7.

63. Tjandra JJ, Fazio VW, Milsom JW, et al. Omission of temporary diversion in restorative proctocolectomy-is it safe? Dis Colon Rectum 1993; 36:1007-13.

64. Galandiuk S, Wolff B, Dozois RR, et al. lleal pouch-anal anastomosis without ileostomy. Dis Colon Rectum 1991:34:870-3.

65. Wong KS, Remzi FH, Gorgun E, et al. Loop ileostomy closure after restorative proctocolectomy: outcome in 1,504 patients. Dis Colon Rectum 2005;48:243-50.

Downloads

Published

2007-03-30

How to Cite

1.
Euanorasetr C. Long-term Functional Outcomes after Restorative Proctocolectomy with J-pouch, Ileoanal Anastomosis: 10-year Experience in Thai Patients. Thai J Surg [Internet]. 2007 Mar. 30 [cited 2024 Dec. 23];28(1):1-10. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/241343

Issue

Section

Original Articles