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Clin Colon Rectal Surg 2022; 35(06): 445-452
DOI: 10.1055/s-0042-1758217
Review Article

The Benefits and Drawbacks of Staging Pelvic Pouches

Poppy Addison
1   Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, New York
,
Ajaratu O. Keshinro
2   Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, Minnesota
,
David M. Schwartzberg
3   Division of Colorectal Surgery and Inflammatory Bowel Disease, Department of Surgery, New York–Presbyterian/Columbia University Medical Center, New York, New York
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Abstract

Since the mid-20th century, physicians have searched for way to improve the lives of patients with ulcerative colitis (UC). Early attempts of curative resection left the patients with a permanent stoma with only primitive stoma appliances available. Gradually, stoma care improved and operations were devised to give the patient bowel continuity without the need for a permanent ostomy. As these operations were evolving, benefits and drawbacks related to fertility, ease of small bowel reach to the pelvis, and postoperative pelvic sepsis were observed. In this article, we will elucidate the various ways pelvic pouches are used to treat UC and the rationale for the timing of surgery as well as the evolution of stoma care.

Keywords

ileal pouch-anal anastomosis - staged pouches - infertility - Brooke ileostomy


Publication History

Article published online:
04 November 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Baker WNW, Glass RE, Ritchie JK, Aylett SO. Cancer of the rectum following colectomy and ileorectal anastomosis for ulcerative colitis. Br J Surg 1978; 65 (12) 862-868
    CrossrefPubMedGoogle Scholar
  • 2 Kuehn F, Hodin RA. Impact of modern drug therapy on surgery: ulcerative colitis. Visc Med 2018; 34 (06) 426-431
    CrossrefPubMedGoogle Scholar
  • 3 Rajaretnam N, Lieske B. Ileostomy. [Updated 2022 Jun 13]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022
    Google Scholar
  • 4 Brooke BN. The management of an ileostomy, including its complications. Lancet 1952; 2 (6725): 102-104
    CrossrefPubMedGoogle Scholar
  • 5 Martin ST, Vogel JD. Intestinal stomas: indications, management, and complications. Adv Surg 2012; 46 (01) 19-49
    CrossrefPubMedGoogle Scholar
  • 6 Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. BMJ 1978; 2 (6130): 85-88
    CrossrefPubMedGoogle Scholar
  • 7 Kock NG. Intra-abdominal “reservoir” in patients with permanent ileostomy. Preliminary observations on a procedure resulting in fecal “continence” in five ileostomy patients. Arch Surg 1969; 99 (02) 223-231
    CrossrefPubMedGoogle Scholar
  • 8 Nessar G, Wu JS. Evolution of continent ileostomy. World J Gastroenterol 2012; 18 (27) 3479-3482
    CrossrefPubMedGoogle Scholar
  • 9 Seetharamaiah R, West BT, Ignash SJ. et al. Outcomes in pediatric patients undergoing straight vs J pouch ileoanal anastomosis: a multicenter analysis. J Pediatr Surg 2009; 44 (07) 1410-1417
    CrossrefPubMedGoogle Scholar
  • 10 Tjandra JJ, Fazio VW, Church JM, Oakley JR, Milsom JW, Lavery IC. Similar functional results after restorative proctocolectomy in patients with familial adenomatous polyposis and mucosal ulcerative colitis. Am J Surg 1993; 165 (03) 322-325
    CrossrefPubMedGoogle Scholar
  • 11 Utsunomiya J, Iwama T, Imajo M. et al. Total colectomy, mucosal proctectomy, and ileoanal anastomosis. Dis Colon Rectum 1980; 23 (07) 459-466
    CrossrefPubMedGoogle Scholar
  • 12 Smith L, Friend WG, Medwell SJ. The superior mesenteric artery. The critical factor in the pouch pull-through procedure. Dis Colon Rectum 1984; 27 (11) 741-744
    CrossrefPubMedGoogle Scholar
  • 13 Khan F, Hull TL, Shen B. Diagnosis and management of floppy pouch complex. Gastroenterol Rep (Oxf) 2018; 6 (04) 246-256
    CrossrefPubMedGoogle Scholar
  • 14 Ross H, Steele SR, Varma M. et al; Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon Rectum 2014; 57 (01) 5-22
    CrossrefPubMedGoogle Scholar
  • 15 Gorfine SR, Fichera A, Harris MT, Bauer JJ. Long-term results of salvage surgery for septic complications after restorative proctocolectomy: does fecal diversion improve outcome?. Dis Colon Rectum 2003; 46 (10) 1339-1344
    CrossrefPubMedGoogle Scholar
  • 16 Lightner AL, Shogan BD, Mathis KL. et al. Revisional and reconstructive surgery for failing IPAA is associated with good function and pouch salvage in highly selected patients. Dis Colon Rectum 2018; 61 (08) 920-930
    CrossrefPubMedGoogle Scholar
  • 17 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
  • 18 Mor IJ, Vogel JD, da Luz Moreira A, Shen B, Hammel J, Remzi FH. Infliximab in ulcerative colitis is associated with an increased risk of postoperative complications after restorative proctocolectomy. Dis Colon Rectum 2008; 51 (08) 1202-1207 , discussion 1207–1210
    CrossrefPubMedGoogle Scholar
  • 19 Hicks CW, Hodin RA, Bordeianou L. Possible overuse of 3-stage procedures for active ulcerative colitis. JAMA Surg 2013; 148 (07) 658-664
    CrossrefPubMedGoogle Scholar
  • 20 Emile SH, Gilshtein H, Wexner SD. Outcome of ileal pouch-anal anastomosis in patients with indeterminate colitis: a systematic review and meta-analysis. J Crohn's Colitis 2020; 14 (07) 1010-1020
    CrossrefPubMedGoogle Scholar
  • 21 Jackson KL, Stocchi L, Duraes L, Rencuzogullari A, Bennett AE, Remzi FH. Long-term outcomes in indeterminate colitis patients undergoing ileal pouch-anal anastomosis: function, quality of life, and complications. J Gastrointest Surg 2017; 21 (01) 56-61
    CrossrefPubMedGoogle Scholar
  • 22 Yu CS, Pemberton JH, Larson D. Ileal pouch-anal anastomosis in patients with indeterminate colitis: long-term results. Dis Colon Rectum 2000; 43 (11) 1487-1496
    CrossrefPubMedGoogle Scholar
  • 23 Lightner AL, Jia X, Zaghiyan K, Fleshner PR. IPAA in known preoperative Crohn's disease: a systematic review. Dis Colon Rectum 2021; 64 (03) 355-364
    CrossrefPubMedGoogle Scholar
  • 24 Lightner AL. Are we able to accurately assess post IPAA pathology?. Crohn's & Colitis 360 2020; 2 (03) otaa038
    CrossrefPubMedGoogle Scholar
  • 25 Lightner AL, Fletcher JG, Pemberton JH, Mathis KL, Raffals LE, Smyrk T. Crohn's disease of the pouch: a true diagnosis or an oversubscribed diagnosis of exclusion?. Dis Colon Rectum 2017; 60 (11) 1201-1208
    CrossrefPubMedGoogle Scholar
  • 26 Bharadwaj S, Philpott JR, Barber MD, Graff LA, Shen B. Women's health issues after ileal pouch surgery. Inflamm Bowel Dis 2014; 20 (12) 2470-2482
    CrossrefPubMedGoogle Scholar
  • 27 Palomba S, Sereni G, Falbo A. et al. Inflammatory bowel diseases and human reproduction: a comprehensive evidence-based review. World J Gastroenterol 2014; 20 (23) 7123-7136
    CrossrefPubMedGoogle Scholar
  • 28 Clark-Snustad K, Butnariu M, Afzali A. Women's health and ulcerative colitis. Gastroenterol Clin North Am 2020; 49 (04) 769-789
    CrossrefPubMedGoogle Scholar
  • 29 Shin T, Okada H. Infertility in men with inflammatory bowel disease. World J Gastrointest Pharmacol Ther 2016; 7 (03) 361-369
    CrossrefPubMedGoogle Scholar
  • 30 Selinger CP, Nelson-Piercy C, Fraser A. et al. IBD in pregnancy: recent advances, practical management. Frontline Gastroenterol 2020; 12 (03) 214-224
    CrossrefPubMedGoogle Scholar
  • 31 Lepistö A, Sarna S, Tiitinen A, Järvinen HJ. Female fertility and childbirth after ileal pouch-anal anastomosis for ulcerative colitis. Br J Surg 2007; 94 (04) 478-482
    CrossrefPubMedGoogle Scholar
  • 32 Gorgun E, Cengiz TB, Aytac E. et al. Does laparoscopic ileal pouch-anal anastomosis reduce infertility compared with open approach?. Surgery 2019; 166 (04) 670-677
    CrossrefPubMedGoogle Scholar
  • 33 Gorgun E, Remzi FH, Goldberg JM. et al. Fertility is reduced after restorative proctocolectomy with ileal pouch anal anastomosis: a study of 300 patients. Surgery 2004; 136 (04) 795-803
    CrossrefPubMedGoogle Scholar
  • 34 Oresland T, Palmblad S, Ellström M, Berndtsson I, Crona N, Hultén L. Gynaecological and sexual function related to anatomical changes in the female pelvis after restorative proctocolectomy. Int J Colorectal Dis 1994; 9 (02) 77-81
    CrossrefPubMedGoogle Scholar
  • 35 Asztély M, Palmblad S, Wikland M, Hultén L. Radiological study of changes in the pelvis in women following proctocolectomy. Int J Colorectal Dis 1991; 6 (02) 103-107
    CrossrefPubMedGoogle Scholar
  • 36 Hull TL, Joyce MR, Geisler DP, Coffey JC. Adhesions after laparoscopic and open ileal pouch-anal anastomosis surgery for ulcerative colitis. Br J Surg 2012; 99 (02) 270-275
    CrossrefPubMedGoogle Scholar
  • 37 Bartels SA, DʼHoore A, Cuesta MA, Bensdorp AJ, Lucas C, Bemelman WA. Significantly increased pregnancy rates after laparoscopic restorative proctocolectomy: a cross-sectional study. Ann Surg 2012; 256 (06) 1045-1048
    CrossrefPubMedGoogle Scholar
  • 38 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
  • 39 Ravid A, Richard CS, Spencer LM. et al. Pregnancy, delivery, and pouch function after ileal pouch-anal anastomosis for ulcerative colitis. Dis Colon Rectum 2002; 45 (10) 1283-1288
    CrossrefPubMedGoogle Scholar
  • 40 Remzi FH, Gorgun E, Bast J. et al. Vaginal delivery after ileal pouch-anal anastomosis: a word of caution. Dis Colon Rectum 2005; 48 (09) 1691-1699
    CrossrefPubMedGoogle Scholar
  • 41 Foulon A, Dupas JL, Sabbagh C. et al. Defining the most appropriate delivery mode in women with inflammatory bowel disease: a systematic review. Inflamm Bowel Dis 2017; 23 (05) 712-720
    CrossrefPubMedGoogle Scholar
  • 42 Faye AS, Oh A, Kumble LD. et al. Fertility impact of initial operation type for female ulcerative colitis patients. Inflamm Bowel Dis 2020; 26 (09) 1368-1376
    CrossrefPubMedGoogle Scholar
  • 43 PAPooSE Study Group*. Pregnancy outcomes after stoma surgery for inflammatory bowel disease: the results of a retrospective multicentre audit. Colorectal Dis 2022; 24 (07) 838-844
    CrossrefPubMedGoogle Scholar
  • 44 Campigotto M, Braini A, Casarotto MM, Crocè SL, Sablich R. Childbearing and delivery in women with ulcerative colitis and ileostomy or Ileal pouch-anal anastomosis. ACG Case Rep J 2022; 9 (06) e00805
    CrossrefPubMedGoogle Scholar
  • 45 van der Woude CJ, Ardizzone S, Bengtson MB. et al; European Crohn's and Colitis Organization. The second European evidenced-based consensus on reproduction and pregnancy in inflammatory bowel disease. J Crohn's Colitis 2015; 9 (02) 107-124
    CrossrefPubMedGoogle Scholar
  • 46 Challine A, Voron T, O'Connell L. et al. Does an ileo-anal anastomosis decrease the rate of successful pregnancy compared to an ileorectal anastomosis? A national study of 1,491 patients. Ann Surg 2022
    PubMedGoogle Scholar
  • 47 Olsen KØ, Juul S, Bülow S. et al. Female fecundity before and after operation for familial adenomatous polyposis. Br J Surg 2003; 90 (02) 227-231
    CrossrefPubMedGoogle Scholar
  • 48 Park YE, Kim TO. Sexual dysfunction and fertility problems in men with inflammatory bowel disease. World J Mens Health 2020; 38 (03) 285-297
    CrossrefPubMedGoogle Scholar
  • 49 Picaud O, Beyer-Berjot L, Parc Y. et al. Laparoscopic rectal dissection preserves erectile function after ileal pouch-anal anastomosis: a two-centre study. Colorectal Dis 2021; 23 (01) 123-131
    CrossrefPubMedGoogle Scholar
  • 50 Lindsey I, George B, Kettlewell M, Mortensen N. Randomized, double-blind, placebo-controlled trial of sildenafil (Viagra) for erectile dysfunction after rectal excision for cancer and inflammatory bowel disease. Dis Colon Rectum 2002; 45 (06) 727-732
    CrossrefPubMedGoogle Scholar
  • 51 Luo WY, Singh S, Cuomo R, Eisenstein S. Modified two-stage restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis: a systematic review and meta-analysis of observational research. Int J Colorectal Dis 2020; 35 (10) 1817-1830
    CrossrefPubMedGoogle Scholar