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Maspero M, Liska D, Kessler H, Lipman J, Steele SR, Hull T, Qazi T, Rieder F, Cohen B, Holubar SD. Redo IPAA for long rectal cuff syndrome after ileoanal pouch for inflammatory bowel disease. Tech Coloproctol 2024; 28:38. [PMID: 38451358 DOI: 10.1007/s10151-023-02909-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/24/2023] [Indexed: 03/08/2024]
Abstract
ABTRACT BACKGROUND: When constructing an ileal pouch-anal anastomosis (IPAA), the rectal cuff should ideally be 1-2 cm long to avoid subsequent complications. METHODS We identified patients from our IBD center who underwent redo IPAA for a long rectal cuff. Long rectal cuff syndrome (LRCS) was defined as a symptomatic rectal cuff ≥ 4 cm. RESULTS Forty patients met the inclusion criteria: 42.5% female, median age at redo surgery 42.5 years. The presentation was ulcerative proctitis in 77.5% of the cases and outlet obstruction in 22.5%. The index pouch was laparoscopically performed in 18 patients (45%). The median rectal cuff length was 6 cm. The pouch was repaired in 16 (40%) cases, whereas 24 (60%) required the creation of a neo-pouch. At the final pathology, the rectal cuff showed chronic active colitis in 38 (90%) cases. After a median follow-up of 34.5 (IQR 12-109) months, pouch failure occurred in 9 (22.5%) cases. The pouch survival rate was 78% at 3 years. Data on the quality of life were available for 11 (27.5%) patients at a median of 75 months after redo surgery. The median QoL score (0-1) was 0.7 (0.4-0.9). CONCLUSION LRCS, a potentially avoidable complication, presents uniformly with symptoms of ulcerative proctitis or stricture. Redo IPAA was restorative for the majority.
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Affiliation(s)
- Marianna Maspero
- Department of Colon & Rectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44106, USA
| | - David Liska
- Department of Colon & Rectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44106, USA
| | - Hermann Kessler
- Department of Colon & Rectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44106, USA
| | - Jeremy Lipman
- Department of Colon & Rectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44106, USA
| | - Scott R Steele
- Department of Colon & Rectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44106, USA
| | - Tracy Hull
- Department of Colon & Rectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44106, USA
| | - Taha Qazi
- Department of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA
| | - Florian Rieder
- Department of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA
| | - Benjamin Cohen
- Department of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA
| | - Stefan D Holubar
- Department of Colon & Rectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44106, USA.
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Aytac E, Esen E, Aydinli HH, Kirat HT, Schwartzberg DM, Remzi FH. Transabdominal re-do pouch surgery in pediatric patients for failed ileal pouch anal anastomosis: a case matched study. Pediatr Surg Int 2019; 35:895-901. [PMID: 31165911 DOI: 10.1007/s00383-019-04493-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Data regarding safety and feasibility of re-do ileal pouch anal anastomosis (IPAA) for failed ileal pouch in children are limited. In this study, we compared the short- and long-term outcomes of re-do IPAA in pediatric and adult populations in a case-matched setting. METHODS Between March 2007 and June 2017, pediatric patients undergoing a transabdominal re-do IPAA by single surgeon were reviewed and case matched with adult counterparts. Short- and long-term outcomes including complications, functional outcomes, and quality of life of the two groups were compared. RESULTS 60 patients were included (pediatric, n = 30; adult, n = 30). Time between index IPAA and re-do IPAA was shorter in the pediatric group (30 ± 26 vs 86 ± 74 months, p = 0.001). In the pediatric population, the existing pouch was more commonly used to construct the re-do pouch (n = 19 vs n = 12, p = 0.07). There was a trend towards the presence of less postoperative complications in pediatric group (n = 13 vs n = 20, p = 0.07). There were no reoperations or mortality. Long-term pouch survival was comparable between two groups (p = 0.96). Six re-do IPAAs failed in the study period. CONCLUSION Re-do IPAA is safe and feasible in pediatric population with failed IPAA and can be performed with similar short- and long-term outcomes compared to adults in experienced hands.
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Affiliation(s)
- Erman Aytac
- Department of General Surgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.,Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Eren Esen
- Department of General Surgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.,Department of Colorectal Surgery, NYU Langone Medical Center, IBD Center, 23rd Floor, New York, NY, 10016, USA
| | - H Hande Aydinli
- Department of Colorectal Surgery, NYU Langone Medical Center, IBD Center, 23rd Floor, New York, NY, 10016, USA.,Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Hasan T Kirat
- Department of Colorectal Surgery, NYU Langone Medical Center, IBD Center, 23rd Floor, New York, NY, 10016, USA.,Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - David M Schwartzberg
- Department of Colorectal Surgery, NYU Langone Medical Center, IBD Center, 23rd Floor, New York, NY, 10016, USA
| | - Feza H Remzi
- Department of Colorectal Surgery, NYU Langone Medical Center, IBD Center, 23rd Floor, New York, NY, 10016, USA. .,Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA.
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Schwartzberg DM, Remzi FH. The Role of Laparoscopic, Robotic, and Open Surgery in Uncomplicated and Complicated Inflammatory Bowel Disease. Gastrointest Endosc Clin N Am 2019; 29:563-576. [PMID: 31078253 DOI: 10.1016/j.giec.2019.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The incidence of inflammatory bowel disease is increasing and despite advances in medical therapy, patients continue to require operations for complications of their disease. Minimally invasive surgical options have impacted postoperative morbidity dramatically with reduction of pain, length of stay and adhesion formation, but additionally, this population of patients are not only concerned with successful operative therapy but also the ability to return to their lifestyle and cosmetics. Laparoscopic and robotic surgery for Crohn's disease has proven to benefit patients with ileocolic or colonic disease, however complicated disease with phlegmon, abscess or fistulae is best served with a hybrid approach. Ulcerative colitis treatment has seen advancements with laparoscopic and robotic platforms, however the benefits of minimally invasive surgery must be balanced with producible and durable outcomes.
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Affiliation(s)
- David M Schwartzberg
- Department of Surgery, Inflammatory Bowel Disease Center, New York University Langone Health, 240 East 38th Street, 23rd Floor, New York, NY 20016, USA
| | - Feza H Remzi
- Department of Surgery, Inflammatory Bowel Disease Center, New York University Langone Health, 240 East 38th Street, 23rd Floor, New York, NY 20016, USA.
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Kroesen AJ. [Surgical strategy to save ileoanal pouch reconstruction]. Chirurg 2017; 88:574-81. [PMID: 28573532 DOI: 10.1007/s00104-017-0444-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Restorative proctocolectomy under formation of an ileoanal/ileorectal J‑pouch has become the procedure of choice in the therapy of ulcerative colitis. Although patients experience a dramatic improvement of their quality of life, surgery is not successful in about 5-10% of all treated patients. The reasons for failure are chronic pouchitis, incontinence, delayed diagnosis of Crohn's disease, fistula, surgical complications, too long remnant rectal stump, chronic abscess, and surgical technical errors. Some of the reasons do not always prevent the loss of a well-functioning ileoanal pouch. In many cases, correction, closure of fistulas or even a complete reconstruction of the ileoanal pouch are possible. Based on a review of the literature and our own experience, we show in 887 patients a success rate of 75% with acceptable pouch function. Indications, technics, and results are presented.
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