Modified Two-stage Ileal Pouch-Anal Anastomosis Results in Lower Rate of Anastomotic Leak Compared with Traditional Two-stage Surgery for Ulcerative Colitis
| Autor: | Nathalie Wong-Chong, Grace W. Ma, Robin S. McLeod, Mark S. Silverberg, Eran Zittan, Zane Cohen |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment Anastomotic Leak Anastomosis Lower risk Gastroenterology Inflammatory bowel disease 03 medical and health sciences Ileostomy 0302 clinical medicine Internal medicine medicine Humans Aged Retrospective Studies business.industry Proctocolectomy Proctocolectomy Restorative Retrospective cohort study General Medicine Middle Aged medicine.disease Ulcerative colitis Surgery Logistic Models Treatment Outcome 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Colitis Ulcerative Pouch business Follow-Up Studies |
| Zdroj: | Journal of Crohn'scolitis. 10(7) |
| ISSN: | 1876-4479 |
| Popis: | Background and Aims: There is a paucity of evidence in ulcerative colitis [UC] comparing the traditional two-stage [total proctocolectomy with ileal pouch-anal anastomosis [IPAA] and diverting ileostomy, followed by ileostomy closure] vs the modified two-stage restorative proctocolectomy [subtotal colectomy with end ileostomy, followed by completion proctectomy and IPAA, without diverting ileostomy]. This study examines the risk of anastomotic leak following IPAA in traditional vs modified two-stage IPAA for UC patients. Methods: This was a single-institution, retrospective study of all UC patients who underwent a traditional or modified two-stage IPAA between 2002 and 2013. The primary outcome was anastomotic leak following IPAA. Results: In all, 460 patients had a two-stage IPAA procedure; 223 [48.5%] patients underwent traditional two-stage IPAA and 237 [51.5%] patients received the modified two-stage procedure. There was more preoperative enteral corticosteroid use [44.7% vs 33.2%, p = 0.04] before the first surgery in the modified two-stage group compared with the traditional two-stage group. The modified two-stage group had higher UC disease severity at presentation [86.9% patients with moderate/severe UC vs 73.1%, p < 0.01]. However, the modified two-stage group had a lower rate of anastomotic leak following IPAA [4.6% vs 15.7%, p < 0.01] and was associated with a lower risk of anastomotic leak on univariate (odds ratio [OR] 0.26, 95% confidence interval [CI] 0.13, 0.52] and multivariate analysis [OR 0.27, 95% CI 0.12, 0.57]. Conclusions: Patients with ulcerative colitis who received the modified two-stage IPAA had a significantly lower rate of anastomotic leak following pouch creation, compared with the traditional two-stage procedure. |
| Databáze: | OpenAIRE |
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