ABSTRACT
AIM: Restorative proctocolectomy with ileal-pouch anal anastomosis is the procedure of choice for ulcerative colitis. Unfortunately, up to 10% of pouches will fail, requiring either reconstruction or excision. While several series have reported on the aetiology of pouch failure, no study to date has focused on the postoperative complications associated with pouch excision. METHODS: Patients who had excision of ileoanal reservoir with ileostomy (CPT code 45136) were included. Data abstracted included preoperative, operative and postoperative variables. A Kaplan-Meier curve of pouch survival was performed. RESULTS: In all, 147 patients met the inclusion criteria for the study. The median age of patients was 47 years (73 women), and 132 had a diagnosis of ulcerative colitis at the time of colectomy. The most common indications for pouch excision were sepsis (n = 46; 31%) and Crohn's disease (n = 37; 25%). 84 (57%) patients experienced short-term (< 30 days) postoperative complications, the most common of which was a surgical site infection (n = 32; 21%); 55 (37%) patients had long-term complications (> 30 days) postoperatively, the most common of which was a return to the operating room (n = 19; 13%) largely for perineal wounds. Thirty-day mortality was zero. 4.8%, 47.6%, 65.3% and 84.4% of patients had undergone pouch excision by 1, 5, 10 and 20 years from the time of pouch construction, respectively. CONCLUSIONS: Pouch excision has a high rate of both short- and long-term postoperative complications. Patients should be appropriately counselled to set expectations accordingly. In view of these findings we suggest that this operation should ideally be performed at a high volume centre with the availability of a multidisciplinary surgical team.
Subject(s)
Colonic Pouches/adverse effects , Ileostomy/adverse effects , Postoperative Complications/etiology , Proctocolectomy, Restorative/adverse effects , Reoperation/adverse effects , Adult , Colectomy/adverse effects , Colitis, Ulcerative/surgery , Crohn Disease/surgery , Female , Humans , Ileostomy/methods , Male , Middle Aged , Proctocolectomy, Restorative/methods , Reoperation/methods , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
Preliminary literature suggests that oral immunoglobulin therapy may be of value in severe GI infections, but the optimal antibody class, dosage, and duration of treatment still need to be defined in larger, controlled clinical trials. Most of the information currently available comes from case series and small, uncontrolled trials. Additionally, there is no clear indication on how to select the best candidates for this type of therapy, since the limited information in the literature comes from different patient populations. In all probability, the substantial cost of this approach to treatment will not be justifiable in most pediatric patients with gastroenteritis.