Ileal Pouch Excision: A Contemporary Observational Cohort
| Autor: | Dimitrios Patsouras, Kapil Sahnan, Susan K. Clark, Guy Worley, Omar Faiz, Samuel O Adegbola, Humza Mahmood |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Reoperation medicine.medical_specialty medicine.medical_treatment Colonic Pouches Familial adenomatous polyposis Cohort Studies 03 medical and health sciences Ileostomy Postoperative Complications 0302 clinical medicine medicine Humans Retrospective Studies Wound Healing Proctocolectomy business.industry Dissection Proctocolectomy Restorative Gastroenterology Retrospective cohort study General Medicine Middle Aged medicine.disease Ulcerative colitis United Kingdom Surgery Adenomatous Polyposis Coli 030220 oncology & carcinogenesis Cohort Quality of Life Colitis Ulcerative Female 030211 gastroenterology & hepatology Pouch business Cohort study |
| Zdroj: | Diseases of the Colon & Rectum. 62:454-462 |
| ISSN: | 0012-3706 |
| DOI: | 10.1097/dcr.0000000000001273 |
| Popis: | Background Pouch excision is required for many of those patients experiencing pouch failure in whom ileostomy alone is inadequate and revision surgery is not appropriate. The published rate of pouch failure is approximately 10% at 10 years, resulting in a growing cohort of patients requiring excision. Objective In this article, we aim to describe the indications for excision and postoperative outcomes at our center since 2004. Design This is a retrospective observational study. Settings This study was conducted at a tertiary referral center for ileal pouch dysfunction. Cases were documented from 2004 to 2017. Patients The cohort comprised 92 patients; 83% were diagnosed with ulcerative colitis, 15% with familial adenomatous polyposis, and 2% with indeterminate colitis. Interventions Patients underwent excision of pelvic ileal pouches. Main outcome measures The primary outcomes measured were the time to perineal wound healing and healing at 6 months. Thirty- and 90-day morbidity and mortality were evaluated. Results Postoperative histology was consistent with Crohn's disease in 1 patient. The median time from pouch creation to excision was 7 years. The rate of perineal wound healing at 6 months was 78%, and regression analysis demonstrated significantly improved chances of healing for noninfective indications for excision (p = 0.023; OR, 15.22; 95% CI, 1.45-160.27) and for more recent procedures (p = 0.032; OR, 12.00; 95% CI, 1.87-76.87). Limitations This study was limited because it was retrospective in nature, and it was a single-center experience. Conclusions This study represents the most contemporary cohort of patients undergoing pouch excision surgery. The procedure retains a relatively high postoperative morbidity, but this study demonstrates a learning curve with improving perineal healing over time associated with a high institutional volume. Defunctioning ileostomy may improve perineal wound healing in patients with infective indications for excision. Further investigation is required to establish the quality-of-life benefits of pouch excision in this modern cohort. See Video Abstract at http://links.lww.com/DCR/A804. |
| Databáze: | OpenAIRE |
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