IPAA in Known Preoperative Crohn's Disease: A Systematic Review.
Adult
Anal Canal
/ pathology
Colitis, Ulcerative
/ surgery
Colonic Pouches
/ adverse effects
Constriction, Pathologic
/ epidemiology
Crohn Disease
/ diagnosis
Equipment Failure
/ statistics & numerical data
Feasibility Studies
Fecal Incontinence
/ epidemiology
Female
Fistula
/ epidemiology
Follow-Up Studies
Humans
Intestinal Obstruction
/ epidemiology
Male
Outcome Assessment, Health Care
Postoperative Complications
/ epidemiology
Pouchitis
/ epidemiology
Preoperative Period
Proctocolectomy, Restorative
/ adverse effects
Quality of Life
Sepsis
/ epidemiology
Journal
Diseases of the colon and rectum
ISSN: 1530-0358
Titre abrégé: Dis Colon Rectum
Pays: United States
ID NLM: 0372764
Informations de publication
Date de publication:
01 03 2021
01 03 2021
Historique:
pubmed:
15
12
2020
medline:
28
8
2021
entrez:
14
12
2020
Statut:
ppublish
Résumé
Crohn's disease is a relative contraindication to IPAA due to perceived increased rates of pouch failure. This study aimed to determine pouch functional outcomes and failure rates in patients with a known preoperative diagnosis of Crohn's disease. A database search was performed in Ovid Medline In-Process & Other NonIndexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, and Ovid Cochrane Database of Systematic Reviews. The published human studies that reported short-term postoperative outcomes and/or long-term outcomes following IPAA in adult (≥18 years of age) Crohn's disease populations were selected. Ileal pouch anal anastomoses were constructed in patients who had Crohn's disease diagnosed preoperatively or through proctocolectomy pathology. The primary outcomes measured were long-term functional outcomes (to maximal date of follow-up) and the pouch failure rate. Of 7019 records reviewed, 6 full articles were included in the analysis. Rates of pelvic sepsis, small-bowel obstruction, pouchitis, anal stricture, and chronic sinus tract were 13%, 3%, 31%, 18%, and 28%. Rates of incontinence, urgency, pad usage in the day, pad usage at night, and need for antidiarrheals were 24%, 21%, 19%, 20%, and 28%, and mean 24-hour stool frequency was 6.3 bowel movements at a mean 69 months of follow-up. The overall pouch failure rate was 15%; no risk factors for pouch failure were identified. This investigation was limited by the small number of studies with significant study heterogeneity. In patients with known preoperative Crohn's disease, IPAA construction is feasible with functional outcomes equivalent to patients with ulcerative colitis, but, even in highly selected patients with Crohn's disease, pouch failure rates remain higher than in patients with ulcerative colitis.
Sections du résumé
BACKGROUND
Crohn's disease is a relative contraindication to IPAA due to perceived increased rates of pouch failure.
OBJECTIVE
This study aimed to determine pouch functional outcomes and failure rates in patients with a known preoperative diagnosis of Crohn's disease.
DATA SOURCES
A database search was performed in Ovid Medline In-Process & Other NonIndexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, and Ovid Cochrane Database of Systematic Reviews.
STUDY SELECTION
The published human studies that reported short-term postoperative outcomes and/or long-term outcomes following IPAA in adult (≥18 years of age) Crohn's disease populations were selected.
INTERVENTION
Ileal pouch anal anastomoses were constructed in patients who had Crohn's disease diagnosed preoperatively or through proctocolectomy pathology.
MAIN OUTCOMES MEASURES
The primary outcomes measured were long-term functional outcomes (to maximal date of follow-up) and the pouch failure rate.
RESULTS
Of 7019 records reviewed, 6 full articles were included in the analysis. Rates of pelvic sepsis, small-bowel obstruction, pouchitis, anal stricture, and chronic sinus tract were 13%, 3%, 31%, 18%, and 28%. Rates of incontinence, urgency, pad usage in the day, pad usage at night, and need for antidiarrheals were 24%, 21%, 19%, 20%, and 28%, and mean 24-hour stool frequency was 6.3 bowel movements at a mean 69 months of follow-up. The overall pouch failure rate was 15%; no risk factors for pouch failure were identified.
LIMITATIONS
This investigation was limited by the small number of studies with significant study heterogeneity.
CONCLUSION
In patients with known preoperative Crohn's disease, IPAA construction is feasible with functional outcomes equivalent to patients with ulcerative colitis, but, even in highly selected patients with Crohn's disease, pouch failure rates remain higher than in patients with ulcerative colitis.
Identifiants
pubmed: 33315711
pii: 00003453-202103000-00017
doi: 10.1097/DCR.0000000000001918
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
355-364Informations de copyright
Copyright © The ASCRS 2020.
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