Abstract
Background and aimsThe ileoanal pouch (IPAA) provides patients with ulcerative colitis (UC) that have not responded to medical therapy an option to retain bowel continuity and defecate without the need for a long-term stoma. Despite good functional outcomes, some pouches fail, requiring permanent diversion, pouchectomy, or a redo pouch. The incidence of pouch failure ranges between 2 and 15% in the literature. We conducted a systematic review and meta-analysis aiming to define the prevalence of pouch failure in patients with UC who have undergone IPAA using population-based studies.MethodsWe searched Embase, Embase classic and PubMed from 1978 to 31st of May 2021 to identify cross-sectional studies that reported the prevalence of pouch failure in adults (≥ 18 years of age) who underwent IPAA for UC.ResultsTwenty-six studies comprising 23,389 patients were analysed. With < 5 years of follow-up, the prevalence of pouch failure was 5% (95%CI 3–10%). With ≥ 5 but < 10 years of follow-up, the prevalence was 5% (95%CI 4–7%). This increased to 9% (95%CI 7–16%) with ≥ 10 years of follow-up. The overall prevalence of pouch failure was 6% (95%CI 5–8%).ConclusionsThe overall prevalence of pouch failure in patients over the age of 18 who have undergone restorative proctocolectomy in UC is 6%. These data are important for counselling patients considering this operation. Importantly, for those patients with UC being considered for a pouch, their disease course has often resulted in both physical and psychological morbidity and hence providing accurate expectations for these patients is vital.
Highlights
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is considered to be the gold standard surgical treatment for ulcerative colitis (UC) that is refractory to medical therapy [1]
The studies demonstrated a significant amount of heterogeneity at each time frame (< 5 years (I2 = 89%, P < 0.01), ≥ 5 but < 10 (I2 = 91%, P < 0.01), ≥ 10 years (I2 = 97%, P < 0.01) and overall prevalence of pouch failure (I2 = 95%, P < 0.01))
There are relatively few studies that provide long follow-up periods, with only 7 articles in our meta-analysis following patient for ≥ 10 years. This would have added another dimension to our understanding of pouch failure, with there being a suggestion of increasing failure rates with time [36, 37]
Summary
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is considered to be the gold standard surgical treatment for ulcerative colitis (UC) that is refractory to medical therapy [1]. IPAA involves resection of the diseased colon and rectum and restoration of bowel continuity, allowing the patient to defecate without the need of an ileostomy This in turn has been shown to improve patients’ quality of life [3]. Serious complications such as pelvic sepsis, strictures, anastomotic leaks, de novo Crohn’s disease, pouchitis and persistent pouch dysfunction can occur These are known risk factors for pouch failure, defined as the need for pouch resection, permanent diversion, or a redo pouch. Conclusions The overall prevalence of pouch failure in patients over the age of 18 who have undergone restorative proctocolectomy in UC is 6% These data are important for counselling patients considering this operation. For those patients with UC being considered for a pouch, their disease course has often resulted in both physical and psychological morbidity and providing accurate expectations for these patients is vital
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