Document Type : short communication
Authors
- maryam kouhestani 1
- Seyed Vahid Hossein 2
- Alimohammad Bananzadeh 3
- ali reza safarpour 4
- khadije gorgi 5
- mohammad masoud andalib 6
1 colorectal fellowship, shiraz university of medical sciences, department of colorectal surgery
2 Colorectal Research Center, Shiraz University of Medical Sciences
3 Department of Surgery, Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
4 Assistant Professor of Epidemiology (By Research) Gastroenterohepatology Research Center Internal Medicine Research Institute Shiraz University of Medical Sciences
5 Department of Surgery, School of Medicine Colorectal Research Center Shahid Faghihi Hospital Shiraz University of Medical Sciences
6 colorectal fellowship Department of Surgery, School of Medicine Colorectal Research Center Shahid Faghihi Hospital Shiraz University of Medical Sciences
Abstract
Objective: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the restorative procedure of choice for medically refractory ulcerative colitis (UC). In patients who undergo proctocolectomy with IPAA, fecal continence outcomes are an issue. The present study evaluated fecal incontinence in patients who underwent IPAA for UC.
Methods: This was a case series study. We reviewed the clinical records of all patients who had undergone a proctocolectomy with IPAA for UC at the Colorectal Department of Shiraz University of Medical Sciences, Iran, between January 2010 and December 2022. Each patient completed a Cleveland Clinic Florida Fecal Incontinence Scoring System (CCFFIS) questionnaire to evaluate fecal incontinence one year after the closure of the colostomy. Data analysis was conducted utilizing various statistical measures such as mean, count (percentage), chi-square, and one-way ANOVA tests. The entire analysis was performed using SPSS 26 software. P values less than 0.05 were deemed statistically significant.
Results: From January 2010 to December 2022, 159 patients who underwent IPAA surgery were included in the study. Of these patients, 108 (67.9%) had no complaint about fecal incontinence (score 0). The median CCFFIS score was 2.19, and there were no significant differences between gender, age, technique, and number of procedures regarding fecal incontinence (P values 0.475,0.125, 0.319, and 0.376, respectively).
Conclusion: This study confirmed that total proctocolectomy with IPAA is a complex surgery that could have good functional results if patients are selected carefully and an experienced surgeon performs the procedure.
Keywords
Main Subjects
- Abdalla M, Norblad R, Olsson M, Landerholm K, Andersson P, Söderholm JD, et al. Anorectal function after ileo-rectal
anastomosis is better than pelvic pouch in selected ulcerative colitis patients. Dig Dis Sci. 2020;65(1):250-9. doi: 10.1007/s10620-019-05757-6.
2. Fradet C, Kern J, Atanasov P, Wirth D, Borsi A. Impact of surgery and its complications in ulcerative colitis patients in
clinical practice: a systematic literature review of real-world evidence in Europe. Int J Surg Open. 2020;22:22-32. doi:
10.1016/j.ijso.2019.11.010.
3. Jonker JE, Hofker HS, Trzpis M, Broens PM. Fecal continence outcomes are associated with the type, height, and stage procedure of ileal pouch-anal anastomosis. Int J Colorectal Dis. 2020;35(9):1749-57. doi: 10.1007/s00384-020-03626-7.
4. Kühn F, Klar E. Surgical principles in the treatment of ulcerative colitis. Viszeralmedizin. 2015;31(4):246-50. doi:
10.1159/000438894.
5. Mège D, Figueiredo MN, Manceau G, Maggiori L, Bouhnik Y, Panis Y. Three-stage laparoscopic ileal pouch-anal
anastomosis is the best approach for high-risk patients with inflammatory bowel disease: an analysis of 185 consecutive patients. J Crohns Colitis. 2016;10(8):898-904. doi: 10.1093/ecco-jcc/jjw040.
6. Mineccia M, Cravero F, Massucco P, Portigliotti L, Bertolino F, Daperno M, et al. Laparoscopic vs open restorative
proctocolectomy with IPAA for ulcerative colitis: impact of surgical technique on creating a well-functioning pouch. Int J Surg. 2018;55:201-6. doi: 10.1016/j.ijsu.2018.04.006.
7. Baek SJ, Dozois EJ, Mathis KL, Lightner AL, Boostrom SY, Cima RR, et al. Safety, feasibility, and short-term outcomes
in 588 patients undergoing minimally invasive ileal pouchanal anastomosis: a single-institution experience. Tech
Coloproctol. 2016;20(6):369-74. doi: 10.1007/s10151-016-1465-z.
8. Lan N, Smukalla STM, Chang S. Fecal incontinence and defecatory disorders in patients with ileal pouch-anal
anastomosis. Gastroenterol Hepatol (N Y). 2023;19(1):41-7.
9. Steele SR, Hull TL, Hyman N, Maykel JA, Read TE, Whitlow CB. The ASCRS Textbook of Colon and Rectal Surgery. 4th ed. Springer; 2022.
10. Hunt CW, Cavallaro PM, Bordeianou LG. Metrics used to quantify fecal incontinence and constipation. Clin Colon
Rectal Surg. 2021;34(1):5-14. doi: 10.1055/s-0040-1714245.
11. Lee GC, Deery SE, Kunitake H, Hicks CW, Olariu AG, Savitt LR, et al. Comparable perioperative outcomes, long-term
outcomes, and quality of life in a retrospective analysis of ulcerative colitis patients following 2-stage versus 3-stage
proctocolectomy with ileal pouch-anal anastomosis. Int J Colorectal Dis. 2019;34(3):491-9. doi: 10.1007/s00384-018-
03221-x.
12. Kamal N, Motwani K, Wellington J, Wong U, Cross RK. Fecal incontinence in inflammatory bowel disease. Crohns Colitis 360. 2021;3(2):otab013. doi: 10.1093/crocol/otab013.
13. de Buck van Overstraeten A, Wolthuis AM, Vermeire S, Van Assche G, Laenen A, Ferrante M, et al. Long-term functional outcome after ileal pouch anal anastomosis in 191 patients with ulcerative colitis. J Crohns Colitis. 2014;8(10):1261-6. doi: 10.1016/j.crohns.2014.03.001.
14. Tekkis PP, Lovegrove RE, Tilney HS, Smith JJ, Sagar PM, Shorthouse AJ, et al. Long-term failure and function after
restorative proctocolectomy - a multi-centre study of patients from the UK National Ileal Pouch Registry. Colorectal Dis.
2010;12(5):433-41. doi: 10.1111/j.1463-1318.2009.01816.x.
15. Hahnloser D, Pemberton JH, Wolff BG, Larson DR, Crownhart BS, Dozois RR. Results at up to 20 years after ileal pouchanal anastomosis for chronic ulcerative colitis. Br J Surg. 2007;94(3):333-40. doi: 10.1002/bjs.5464.
16. Seifarth C, Börner L, Siegmund B, Buhr HJ, Ritz JP, Gröne J. Impact of staged surgery on quality of life in refractory ulcerative colitis. Surg Endosc. 2017;31(2):643-9. doi:10.1007/s00464-016-5010-y. 17. Maggiori L, Panis Y. Surgical management of IBD--from an open to a laparoscopic approach. Nat Rev Gastroenterol Hepatol. 2013;10(5):297-306. doi: 10.1038/nrgastro.2013.30.
18. Chok AY, Tang CL, Tan E. Comparing laparoscopic versus open ileal pouch-anal anastomosis: current issues and future considerations. Ann Laparosc Endosc Surg. 2019 Feb 28;4:25.doi: 10.21037/ales.2019.01.14.
19. Magro F, Gionchetti P, Eliakim R, Ardizzone S, Armuzzi A, Barreiro-de Acosta M, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations,pregnancy, cancer surveillance, surgery, and ileo-anal pouch
disorders. J Crohns Colitis. 2017;11(6):649-70. doi: 10.1093/ecco-jcc/jjx008.
20. Safarpour AR, Hosseini SV, Mehrabani D. Epidemiology of inflammatory bowel diseases in Iran and Asia; a mini review. Iran J Med Sci. 2013;38(2 Suppl):140-9.
21. Caviglia GP, Garrone A, Bertolino C, Vanni R, Bretto E, Poshnjari A, et al. Epidemiology of inflammatory bowel
diseases: a population study in a healthcare district of North-West Italy. J Clin Med. 2023;12(2):641. doi: 10.3390/
jcm12020641.
)