PDF herunterladen
Clin Colon Rectal Surg 2022; 35(06): 469-474
DOI: 10.1055/s-0042-1758138
Review Article

Management of Anastomotic Leaks in Ileal Pouch Anal Anastomosis for Ulcerative Colitis

Alex Liu Huang
1   Colon and Rectal Surgery Division, Department of General Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
,
Michael Plietz
1   Colon and Rectal Surgery Division, Department of General Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
,
Alexander J. Greenstein
1   Colon and Rectal Surgery Division, Department of General Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
,
Sergey Khaitov
1   Colon and Rectal Surgery Division, Department of General Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Anastomotic leaks remain a dreaded complication after ileal pouch anal anastomosis (IPAA). Their impacts can be devastating, ranging from an acute leak leading to postoperative sepsis to chronic leaks and sinus tracts resulting in long-term pouch dysfunction and subsequent pouch failure. The management of acute leaks is intricate. Initial management is important to resolve acute sepsis, but the type of acute intervention impacts long-term pouch function. Aggressive management in the postoperative period, including the use of IV fluids, broad-spectrum antibiotics, and operative interventions may be necessary to preserve pouch structure and function. Early identification and knowledge of the most common areas of leak, such as at the IPAA anastomosis, are important for guiding management. Long-term complications, such as pouch sinuses, pouch-vaginal fistulas, and diminished IPAA function complicate the overall survival and functionality of the pouch. Knowledge and awareness of the identification and management of leaks is crucial for optimizing IPAA success.

Keywords

ileal pouch anal anastomosis - anastomotic leak - pouch-vaginal fistula - Crohn's of the pouch


Publikationsverlauf

Artikel online veröffentlicht:
02. November 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Kosaraju A, Pendela VS, Hai O. Cardiogenic Shock. In: StatPearls. StatPearls Publishing; 2022. . Accessed August 20, 2022, at: http://www.ncbi.nlm.nih.gov/books/NBK482255/
    Google Scholar
  • 2 Aardoom MA, Klomberg RCW, Kemos P. et al; PIBD-VTE Group, PIBD-SETQuality Consortium. The incidence and characteristics of venous thromboembolisms in paediatric-onset inflammatory bowel disease: a prospective international cohort study based on the PIBD-SETQuality Safety Registry. J Crohn's Colitis 2022; 16 (05) 695-707
    CrossrefPubMedGoogle Scholar
  • 3 McKie K, McLoughlin RJ, Hirsh MP, Cleary MA, Aidlen JT. Risk factors for venous thromboembolism in children and young adults with inflammatory bowel disease. J Surg Res 2019; 243: 173-179
    CrossrefPubMedGoogle Scholar
  • 4 Egberg MD, Galanko JA, Barnes EL, Kappelman MD. Thrombotic and infectious risks of parenteral nutrition in hospitalized pediatric inflammatory bowel disease. Inflamm Bowel Dis 2019; 25 (03) 601-609
    CrossrefPubMedGoogle Scholar
  • 5 Diamond CE, Hennessey C, Meldau J. et al. Catheter-related venous thrombosis in hospitalized pediatric patients with inflammatory bowel disease: incidence, characteristics, and role of anticoagulant thromboprophylaxis with enoxaparin. J Pediatr 2018; 198: 53-59
    CrossrefPubMedGoogle Scholar
  • 6 Zitomersky NL, Levine AE, Atkinson BJ. et al. Risk factors, morbidity, and treatment of thrombosis in children and young adults with active inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2013; 57 (03) 343-347
    CrossrefPubMedGoogle Scholar
  • 7 Nylund CM, Goudie A, Garza JM, Crouch G, Denson LA. Venous thrombotic events in hospitalized children and adolescents with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2013; 56 (05) 485-491
    CrossrefPubMedGoogle Scholar
  • 8 Mali S. Anaphylaxis during the perioperative period. Anesth Essays Res 2012; 6 (02) 124-133
    CrossrefPubMedGoogle Scholar
  • 9 Lian L, Serclova Z, Fazio VW, Kiran RP, Remzi F, Shen B. Clinical features and management of postoperative pouch bleeding after ileal pouch-anal anastomosis (IPAA). J Gastrointest Surg 2008; 12 (11) 1991-1994
    CrossrefPubMedGoogle Scholar
  • 10 Kiely JM, Fazio VW, Remzi FH, Shen B, Kiran RP. Pelvic sepsis after IPAA adversely affects function of the pouch and quality of life. Dis Colon Rectum 2012; 55 (04) 387-392
    CrossrefPubMedGoogle Scholar
  • 11 Leenen LP, Kuypers JH. Some factors influencing the outcome of stoma surgery. Dis Colon Rectum 1989; 32 (06) 500-504
    CrossrefPubMedGoogle Scholar
  • 12 Newberry C, Lichtenstein G. Overweight and obese patients with ulcerative colitis (UC): prevalence and epidemiology in a university-based population cohort: 1812. Off J Am Coll Gastroenterol ACG 2013; 108: S546
    CrossrefPubMedGoogle Scholar
  • 13 Johnson AM, Harmsen WS, Aniwan S, Tremaine WJ, Abu Dayyeh BK, Loftus EV. Prevalence and impact of obesity on disease-specific outcomes in a population-based cohort of patients with ulcerative colitis. J Crohn's Colitis 2021; 15 (11) 1816-1823
    CrossrefPubMedGoogle Scholar
  • 14 Sahami S, Buskens CJ, Fadok TY. et al. Defunctioning ileostomy is not associated with reduced leakage in proctocolectomy and ileal pouch anastomosis surgeries for IBD. J Crohn's Colitis 2016; 10 (07) 779-785
    CrossrefPubMedGoogle Scholar
  • 15 Chen YJ, Grant R, Lindholm E. et al. Is fecal diversion necessary during ileal pouch creation after initial subtotal colectomy in pediatric ulcerative colitis?. Pediatr Surg Int 2019; 35 (04) 443-448
    CrossrefPubMedGoogle Scholar
  • 16 Mennigen R, Senninger N, Bruwer M, Rijcken E. Impact of defunctioning loop ileostomy on outcome after restorative proctocolectomy for ulcerative colitis. Int J Colorectal Dis 2011; 26 (05) 627-633
    CrossrefPubMedGoogle Scholar
  • 17 Beyer-Berjot L, Maggiori L, Birnbaum D, Lefevre JH, Berdah S, Panis Y. A total laparoscopic approach reduces the infertility rate after ileal pouch-anal anastomosis: a 2-center study. Ann Surg 2013; 258 (02) 275-282
    CrossrefPubMedGoogle Scholar
  • 18 Plietz MC, Kayal M, Rizvi A. et al. Slow and steady wins the race: a solid case for a 3-stage approach in ulcerative colitis. Dis Colon Rectum 2021; 64 (12) 1511-1520
    CrossrefPubMedGoogle Scholar
  • 19 Khan K, Manzoor T, Khan S, Hartley JE. Is diversion free ileal pouch-anal anastomosis a safe procedure? A meta-analysis of 4973 cases. Int J Colorectal Dis 2021; 36 (04) 657-669
    CrossrefPubMedGoogle Scholar
  • 20 MacLean AR, Cohen Z, MacRae HM. et al. Risk of small bowel obstruction after the ileal pouch-anal anastomosis. Ann Surg 2002; 235 (02) 200-206
    CrossrefPubMedGoogle Scholar
  • 21 Schwartzberg DM, Esen E, Remzi FH. Thoughtful ileostomy creation in patients undergoing redo IPAA. Dis Colon Rectum 2020; 63 (01) 117-120
    CrossrefPubMedGoogle Scholar
  • 22 Raval MJ, Schnitzler M, O'Connor BI, Cohen Z, McLeod RS. Improved outcome due to increased experience and individualized management of leaks after ileal pouch-anal anastomosis. Ann Surg 2007; 246 (05) 763-770
    CrossrefPubMedGoogle Scholar
  • 23 Broder JC, Tkacz JN, Anderson SW, Soto JA, Gupta A. Ileal pouch-anal anastomosis surgery: imaging and intervention for post-operative complications. Radiographics 2010; 30 (01) 221-233
    CrossrefPubMedGoogle Scholar
  • 24 Traynor Jr MD, McKenna NP, Habermann EB. et al. Pouchogram prior to ileostomy reversal after ileal pouch-anal anastomosis in pediatric patients: is it useful in the setting of routine EUA?. J Pediatr Surg 2020; 55 (08) 1499-1502
    CrossrefPubMedGoogle Scholar
  • 25 Selvaggi F, Pellino G, Canonico S, Sciaudone G. Is omitting pouchography before ileostomy takedown safe after negative clinical examination in asymptomatic patients with pelvic ileal pouch? An observational study. Tech Coloproctol 2012; 16 (06) 415-420
    CrossrefPubMedGoogle Scholar
  • 26 Lawal TA, Falcone RA, von Allmen D. et al. The utility of routine pouchogram before ileostomy reversal in children and adolescents following ileal pouch anal anastomosis. J Pediatr Surg 2011; 46 (06) 1222-1225
    CrossrefPubMedGoogle Scholar
  • 27 Sossenheimer PH, Glick LR, Dachman AH. et al. Abnormal pouchogram predicts pouch failure even in asymptomatic patients. Dis Colon Rectum 2019; 62 (04) 463-469
    CrossrefPubMedGoogle Scholar
  • 28 Exarchos G, Metaxa L, Gklavas A, Koutoulidis V, Papaconstantinou I. Are radiologic pouchogram and pouchoscopy useful before ileostomy closure in asymptomatic patients operated for ulcerative colitis?. Eur Radiol 2019; 29 (04) 1754-1761
    CrossrefPubMedGoogle Scholar
  • 29 Farouk R, Dozois RR, Pemberton JH, Larson D. Incidence and subsequent impact of pelvic abscess after ileal pouch-anal anastomosis for chronic ulcerative colitis. Dis Colon Rectum 1998; 41 (10) 1239-1243
    CrossrefPubMedGoogle Scholar
  • 30 Lee PY, Fazio VW, Church JM, Hull TL, Eu KW, Lavery IC. Vaginal fistula following restorative proctocolectomy. Dis Colon Rectum 1997; 40 (07) 752-759
    CrossrefPubMedGoogle Scholar
  • 31 Shah NS, Remzi F, Massmann A, Baixauli J, Fazio VW. Management and treatment outcome of pouch-vaginal fistulas following restorative proctocolectomy. Dis Colon Rectum 2003; 46 (07) 911-917
    CrossrefPubMedGoogle Scholar
  • 32 Lolohea S, Lynch AC, Robertson GB, Frizelle FA. Ileal pouch-anal anastomosis-vaginal fistula: a review. Dis Colon Rectum 2005; 48 (09) 1802-1810
    CrossrefPubMedGoogle Scholar
  • 33 Tonolini M. Elucidating vaginal fistulas on CT and MRI. Insights Imaging 2019; 10 (01) 123
    CrossrefPubMedGoogle Scholar
  • 34 Mallick IH, Hull TL, Remzi FH, Kiran RP. Management and outcome of pouch-vaginal fistulas after IPAA surgery. Dis Colon Rectum 2014; 57 (04) 490-496
    CrossrefPubMedGoogle Scholar
  • 35 Sapci I, Akeel N, DeLeon MF, Stocchi L, Hull T. What is the best surgical treatment of pouch-vaginal fistulas?. Dis Colon Rectum 2019; 62 (05) 595-599
    CrossrefPubMedGoogle Scholar
  • 36 Ahmed Ali U, Shen B, Remzi FH, Kiran RP. The management of anastomotic pouch sinus after IPAA. Dis Colon Rectum 2012; 55 (05) 541-548
    CrossrefPubMedGoogle Scholar
  • 37 Shen B, Remzi FH, Lavery IC, Lashner BA, Fazio VW. A proposed classification of ileal pouch disorders and associated complications after restorative proctocolectomy. Clin Gastroenterol Hepatol 2008; 6 (02) 145-158 , quiz 124
    CrossrefPubMedGoogle Scholar
  • 38 Pappou EP, Kiran RP. The failed J pouch. Clin Colon Rectal Surg 2016; 29 (02) 123-129
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 39 Korsgen S, Nikiteas N, Ogunbiyi OA, Keighley MR. Results from pouch salvage. Br J Surg 1996; 83 (03) 372-374
    CrossrefPubMedGoogle Scholar
  • 40 Freeha K, Bo S. Complications related to J-pouch surgery. Gastroenterol Hepatol (N Y) 2018; 14 (10) 571-576
    PubMedGoogle Scholar
  • 41 Akbari RP, Madoff RD, Parker SC. et al. Anastomotic sinuses after ileoanal pouch construction: incidence, management, and outcome. Dis Colon Rectum 2009; 52 (03) 452-455
    CrossrefPubMedGoogle Scholar
  • 42 Lan N, Hull TL, Shen B. Endoscopic sinusotomy versus redo surgery for the treatment of chronic pouch anastomotic sinus in ulcerative colitis patients. Gastrointest Endosc 2019; 89 (01) 144-156
    CrossrefPubMedGoogle Scholar
  • 43 Ramirez RL, Fleshner P. Reoperative inflammatory bowel disease surgery. Clin Colon Rectal Surg 2006; 19 (04) 195-206
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 44 Pellino G, Vinci D, Signoriello G. et al. Long-term bowel function and fate of the ileal pouch after restorative proctocolectomy in patients with Crohn's disease: a systematic review with meta-analysis and metaregression. J Crohn's Colitis 2020; 14 (03) 418-427
    CrossrefPubMedGoogle Scholar
  • 45 Fazio VW, Kiran RP, Remzi FH. et al. Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 2013; 257 (04) 679-685
    CrossrefPubMedGoogle Scholar