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Curable leakage in stapled IPAA has little effect on the long-term pouch function

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to evaluate the frequency and grade of anastomotic leakage (AL) in stapled ileal pouch-anal anastomosis (IPAA) and its long-term impact on the pouch functions.

Methods

A longitudinal cohort study was conducted on UC patients who underwent stapled IPAA at Yokohama City University Medical Center between 2007 and 2018. The diagnosis and grading of AL were performed in accordance with the recommendations of the International Study Group of Rectal Cancer. We assessed the functional pouch rate, late complication, pouch survival rate, bowel function (bowel movements per day, soiling, spotting, difficulty in distinguishing feces from flatus) and pouch inflammation (pouchitis disease activity index; PDAI) in the long-term period.

Results

Two hundred seventy-six patients were analyzed. Twenty-three (8.3%; grade B/C; 13/10) patients were diagnosed with AL, but a functional pouch was achieved in all the twenty-three patients. Anastomotic stricture was significantly more common in patients with AL (AL group) than in patients without AL (non-AL group; AL/non-AL: 13.0/3.2%, p = 0.020). There were no differences in other late complications. Furthermore, the pouch survival rate did not differ between the AL and non-AL groups (100.0/97.9%/10 years, p = 0.494). There were no differences between the groups in bowel movements per day, spotting, soling, difficulty in distinguishing feces from flatus, or PDAI postoperatively.

Conclusions

Curable AL may not affect late complications (except anastomotic stricture), pouch survival, the bowel function, or pouch inflammation over the long term. Perioperative management to prevent the severity of AL is as important as preventing its occurrence.

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Availability of data and material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama, 232-0024, Japan

    Kenichiro Toritani, Hideaki Kimura, Koki Goto & Reiko Kunisaki

  2. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Kenichiro Toritani, Atsushi Ishibe & Itaru Endo

  3. Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan

    Jun Watanabe

Authors
  1. Kenichiro Toritani
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  2. Hideaki Kimura
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  3. Koki Goto
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  4. Reiko Kunisaki
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  5. Jun Watanabe
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  6. Atsushi Ishibe
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  7. Itaru Endo
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Contributions

Kenichiro Toritani and Hideaki Kimura contributed to the study design. All of the authors contributed to the data collection, data analysis, and interpretation. Kenichiro Toritani and Hideaki Kimura contributed to the statistical analyses. All of the authors contributed to the writing or review of the report and approved the final version.

Corresponding author

Correspondence to Hideaki Kimura.

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Ethics approval

The study protocol was approved by the Ethical Advisory Committee of Yokohama City University (registration no. B190800050).

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The authors declare no competing interests.

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Toritani, K., Kimura, H., Goto, K. et al. Curable leakage in stapled IPAA has little effect on the long-term pouch function. Int J Colorectal Dis 38, 43 (2023). https://doi.org/10.1007/s00384-023-04339-3

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