Ileal-anal pouches: A review of its history, indications, and complications

被引:97
作者
Ng, Kheng-Seong [1 ,2 ]
Gonsalves, Simon Joseph [3 ]
Sagar, Peter Michael [1 ]
机构
[1] St James Univ Hosp, John Goligher Colorectal Unit, Leeds LS9 7TF, W Yorkshire, England
[2] Univ Sydney, Inst Acad Surg, Camperdown, NSW 2050, Australia
[3] Calderdale & Huddersfield NHS Fdn Trust, Huddersfield Royal Infirm, Dept Colorectal Surg, Huddersfield HD3 3EA, W Yorkshire, England
关键词
Ileal pouch; Restorative proctocolectomy; Ulcerative colitis; Crohn's disease; Familial adenomatous polyposis; QUALITY-OF-LIFE; PORTAL-VEIN THROMBI; ANTINEUTROPHIL CYTOPLASMIC ANTIBODY; FAMILIAL ADENOMATOUS POLYPOSIS; ULCERATIVE-COLITIS PATIENTS; TERM POSTOPERATIVE FUNCTION; TEMPORARY LOOP ILEOSTOMY; RESTORATIVE PROCTOCOLECTOMY; SEPTIC COMPLICATIONS; SURGICAL-TREATMENT;
D O I
10.3748/wjg.v25.i31.4320
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
The ileal pouch anal anastomosis (IPAA) has revolutionised the surgical management of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). Despite refinement in surgical technique(s) and patient selection, IPAA can be associated with significant morbidity. As the IPAA celebrated its 40th anniversary in 2018, this review provides a timely outline of its history, indications, and complications. IPAA has undergone significant modification since 1978. For both UC and FAP, IPAA surgery aims to definitively cure disease and prevent malignant degeneration, while providing adequate continence and avoiding a permanent stoma. The majority of patients experience long-term success, but "early" and "late" complications are recognised. Pelvic sepsis is a common early complication with far-reaching consequences of long-term pouch dysfunction, but prompt intervention (either radiological or surgical) reduces the risk of pouch failure. Even in the absence of sepsis, pouch dysfunction is a long-term complication that may have a myriad of causes. Pouchitis is a common cause that remains incompletely understood and difficult to manage at times. 10% of patients succumb to the diagnosis of pouch failure, which is traditionally associated with the need for pouch excision. This review provides a timely outline of the history, indications, and complications associated with IPAA. Patient selection remains key, and contraindications exist for this surgery. A structured management plan is vital to the successful management of complications following pouch surgery.
引用
收藏
页码:4320 / 4342
页数:23
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