Annals of Coloproctology

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Original Articles

Benign GI diease, IBD, Inflammatory bowel disease,Benign diesease & IBD

Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: An Australian Institution’s Experience: Ming Han Lim, Anton R. Lord, Lisa A. Simms, Katherine Hanigan, Aleksandra Edmundson, Matthew J.F.X. Rickard, Russell Stitz, David A. Clark, Graham L. Radford-Smith; Ann Coloproctol. 2021;37(5):318-325. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.08.26

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17 Citations

Purpose
We report outcomes and evaluate patient factors and the impact of surgical evolution on outcomes in consecutive ulcerative colitis patients who had restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) at an Australian institution over 26 years.
Methods
Data including clinical characteristics, preoperative medical therapy, and surgical outcomes were collected. We divided eligible patients into 3 period arms (period 1, 1990 to 1999; period 2, 2000 to 2009; period 3, 2010 to 2016). Outcomes of interest were IPAA leak and pouch failure.
Results
A total of 212 patients were included. Median follow-up was 50 (interquartile range, 17 to 120) months. Rates of early and late complications were 34.9% and 52.0%, respectively. Early complications included wound infection (9.4%), pelvic sepsis (8.0%), and small bowel obstruction (6.6%) while late complications included small bowel obstruction (18.9%), anal stenosis (16.8%), and pouch fistula (13.3%). Overall, IPAA leak rate was 6.1% and pouch failure rate was 4.8%. Eighty-three patients (42.3%) experienced pouchitis. Over time, we observed an increase in patient exposure to thiopurine (P=0.0025), cyclosporin (P=0.0002), and anti-tumor necrosis factor (P<0.00001) coupled with a shift to laparoscopic technique (P<0.00001), stapled IPAA (P<0.00001), J pouch configuration (P<0.00001), a modified 2-stage procedure (P=0.00012), and a decline in defunctioning ileostomy rate at time of IPAA (P=0.00002). Apart from pouchitis, there was no significant difference in surgical and chronic inflammatory pouch outcomes with time.
Conclusion
Despite greater patient exposure to immunomodulatory and biologic therapy before surgery coupled with a significant change in surgical techniques, surgical and chronic inflammatory pouch outcome rates have remained stable.

Citations

Citations to this article as recorded by

A systematic review on surgical trends after ileal pouch-anal anastomosis for inflammatory bowel disease: shifting the focus from traditional to minimally invasive approaches
Gaetano Gallo, Stefano Agnesi, Silvio Danese, Andrea Vignali, Veronica De Simone, Francesco Palmieri, Gianpiero Gravante, Pierpaolo Sileri
Updates in Surgery.2026;[Epub] CrossRef
Short‐ and long‐term outcomes of IPAA for ulcerative colitis in Latin America: A retrospective, multicentre assessment

Colorectal Disease.2026;[Epub] CrossRef
ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment
Michel Adamina, Peter Kienle, María Chaparro, Bram Verstockt, Silvia Minozzi, Mariangela Allocca, Raja Atreya, Nicolas Avellaneda, Manuel Barreiro-De Acosta, Robert Battat, Dominik Bettenworth, Irina Blumenstein, Steven R Brown, John P Burke, Flavio Capri
Journal of Crohn's and Colitis.2026;[Epub] CrossRef
Clinical Practice Guideline for the Surgical Management of Ulcerative Colitis
Amy L. Lightner, Ira L. Leeds, Michael F. McGee, Aaron J. Dawes, Carrie Y. Peterson, Mukta K. Krane, Traci L. Hedrick, Wolfgang B. Gaertner
Diseases of the Colon & Rectum.2026; 69(8): 2012. CrossRef
The prevalence of pouch fistulas in ulcerative colitis following restorative proctocolectomy: a systematic review and meta-analysis
Sheng Wei Lo, Ishaan Dharia, Danujan Sriranganathan, Maia Kayal, Edward L. Barnes, Jonathan P. Segal
Intestinal Research.2025; 23(1): 56. CrossRef
Patient-reported Outcome Measures in Ileoanal Pouch Surgery: a Systematic Review
Zakary Ismail Warsop, Carlo Alberto Manzo, Natalie Yu, Bilal Yusuf, Christos Kontovounisios, Valerio Celentano
Journal of Crohn's and Colitis.2024; 18(3): 479. CrossRef
Surgical outcomes in ileal Crohn's disease complicated by ileosigmoid fistula
Ashley Jenkin, Aleksandra Edmundson, David Clark
ANZ Journal of Surgery.2024; 94(9): 1563. CrossRef
The Role of Minimally Invasive Surgery in the Management of Inflammatory Bowel Disease: Current Trends and Future Directions
Sanskruti Rathod , Nishant Kumar, German D Matiz, Sheryl Biju, Peter Girgis, Nagma Sabu, Hassan Mumtaz, Ali Haider
Cureus.2024;[Epub] CrossRef
Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: Predictors of Early and Late Complications
Yajnadatta Sarangi, Ashok Kumar, Somanath Malage, Nalinikanta Ghosh, Rahul Rahul, Ashish Singh, Supriya Sharma, Rajneesh K Singh, Anu Behari, Ashok Kumar
Cureus.2024;[Epub] CrossRef
Management and Outcomes of Ileal Pouch-Urethral Fistulas
João Pedro Emrich Accioly, Mariana Maspero, Hanson Zhao, Roger K. Khouri Jr., Olga Lavryk, Kenneth W. Angermeier, Tracy Hull, Hadley M. Wood
Urology.2023; 172: 213. CrossRef
Ileo-Anal Pouch Anastomosis and New Remedial Approaches for Ulcerative Colitis: A Review Article
Abhijeet Jankar, Tripti Shrivastava
Cureus.2023;[Epub] CrossRef
Review of long‐term complications and functional outcomes of ileoanal pouch procedures in patients with inflammatory bowel disease
Yusuf Hassan, William R. Connell, Alisha Rawal, Emily K. Wright
ANZ Journal of Surgery.2023; 93(6): 1503. CrossRef
Population outcomes, trends and the future of pouch surgery for ulcerative colitis: a 19‐year New South Wales data linkage study
Hugh L. Giddings, Kheng‐Seong Ng, Michael J. Solomon, Daniel Steffens, Joe Van Buskirk, Jane Young
ANZ Journal of Surgery.2023; 93(11): 2686. CrossRef
Ileoanal pouch cancers in ulcerative colitis and familial adenomatous polyposis: A systematic review and meta-analysis
Danujan Sriranganathan, Danilo Vinci, Gianluca Pellino, Jonathan P. Segal
Digestive and Liver Disease.2022; 54(10): 1328. CrossRef
Evolving Experimental Platforms to Evaluate Ulcerative Colitis
Tiffany T. Sharma, Rebecca R. Rabizadeh, Vibhav S. Prabhakar, Matthew I. Bury, Arun K. Sharma
Advanced Biology.2022;[Epub] CrossRef
Multicenter Study of Drain Fluid Amylase as a Biomarker for the Detection of Anastomotic Leakage After Ileal Pouch Surgery Without a Diverting Ileostomy
David A. Clark, • Aleksandra Edmundson, Daniel Steffens, Graham Radford-Smith, Michael Solomon
Diseases of the Colon & Rectum.2022; 65(11): 1335. CrossRef
Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: An Australian Institution’s Experience
Ming Han Lim, Anton R. Lord, Lisa A. Simms, Katherine Hanigan, Aleksandra Edmundson, Matthew J.F.X. Rickard, Russell Stitz, David A. Clark, Graham L. Radford-Smith
Annals of Coloproctology.2021; 37(5): 318. CrossRef

The Clinical Results of a Total Proctocolectomy with an Ileal Pouch-Anal Anastomosis: 12 Cases.: Lee, Gyoung Chun , Lee, Seung Hyun , Ahn, Byung Kwon , Baek, Sung Uhn; J Korean Soc Coloproctol. 2003;19(1):6-12.

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Abstract PDF: PURPOSE
A restorative proctocolectomy has been accepted as the operation of choice for ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess the postoperative complications and functional outcomes following a total proctocolectomy with a J ileal pouch-anal anastomosis.
METHODS
The medical records of 12 patients who had undergone a total proctocolectomy, with a J ileal pouch-anal anastomosis, between January 1997 and June 2002, were retrospectively reviewed according to sex, age, underlying disease and postoperative complications. We evaluated the functional outcomes using medical record reviews and patients and telephone interviews.
RESULTS
Total proctocolectomy, with a J ileal pouch-anal anastomosis, were done for ulcerative colitis (n=2) and familial adenomatous polyposis (n=10). A diverting ileostomy was performed in 8 patients. Postoperative complications occurred in 7 patients (58%), intestinal obstructions in 4 and complications related with anastomosis in 3, i.e. J ileal pouch leakage (n=2) and ileal pouch-vaginal fistula (n=1). Re-operations, due to postoperative complications, were performed in 4 patients, i.e. small bowel segmental resection (n=1), adhesiolysis (n=1), diverting ileostomy (n=1) and ileal pouch resection & reconstruction (n=1). The daily median defecation frequencies were 7.7 (range 4~20) a month after the operation, 5.4 (3~12) at 2~3 months, 4.5 (3~7) at 6 months and 4.1 (3~5) at 12 months, following the operation. Two patients had gas incontinence, 1 had fluid incontinence, 4 had night soiling and 3 needed pads, but these incontinences, the need for anti-diarrhea medication and the use of pads, all improved within 6 months of the operation. Fluid incontinence and the use of pads improved within 3 months of the operation, gas incontinence and night soiling improved within 6 months of the operation. The mean length of follow-up was 30.6 months.
CONCLUSIONS
The postoperative complication rate was 58%. Thirty-three percent of patients had fecal incontinence, but all these improved within 6 months. The long- term functional outcomes, after a total proctocolectomy with J ileal pouch-anal anastomosis, were satisfactory, and the postoperative complications acceptable. The postoperative complication rates were no different between the protective diverting ileostomy and non-ileostomy .

Case Report

A Case of Turcot's Syndrome Combined with Colon Cancer in a 15-year-old Girl.: Lee, Seok Ryeol , Lee, Kil Yeon , Lee, Kee Hyung , Leem, Won , Kim, Hyo Jong , Lee, Ju Hie; J Korean Soc Coloproctol. 2002;18(3):200-204.

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Abstract PDF: Turcot's syndrome is a rare hereditary disease marked by the association of central nervous system neuroepithelial tumor with colonic polyposis. Authors report herein a case of a 15-year-old girl diagnosed as having Turcot's syndrome, otherwise known as brain tumor-polyposis syndrome, combined with sigmoid colon cancer. The patient was carried out craniostomy and brain tumor removal. The tumor was confirmed histologically to be oligodendroglioma. The patient visited the department of internal medicine for bloody diarrhea during 6 months. Colonoscopy and biopsy was done. The patient was diagnosed as having Turcot's syndrome combined with sigmoid colon cancer, and was then transferred to the department of surgery for treatment of sigmoid colon cancer. Total proctocolectomy and IPAA (ileal pouch-anal anastomosis) was carried out. Multiple polyps were found in the colon, two large masses were confirmed histologically to be adenocarcinoma. The remaining polyps were adenomas. This case report describes the characteristic features of Turcot's syndrome presented by this patient.

Original Articles

The Correlation between Quality of Life and Functional Outcome after Restorative Proctocolectomy and Ileal Pouch-Anal Anastomosis.: Yoon, Eyi Sang , Lee, Kil Yeon , Lee, Suk Hwan , Yoon, Choong; J Korean Soc Coloproctol. 2006;22(1):15-23.

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Abstract PDF: PURPOSE
The restorative proctocolectomy (RP) and ileal pouch-anal anastomosis (IPAA) has been accepted as the operation of choice for chronic ulcerative colitis (CUC) and familial adenomatous polyposis (FAP). However, much is still unknown about the functional outcome and the quality of life (QoL) in patients undergoing RP. The aims of this study were to evaluate the functional outcome and the QoL in patients undergoing RP and to assess the correlation between functional outcome and QoL.
METHODS
The medical records of 20 patients who had undergone a RP for CUC (n=11) and FAP (n=9) from January 1993 to December 2003 were reviewed. The QoL was evaluated with the Korean version of Short Form 36 (SF-36) by telephone interview. The functional outcome was assessed by means of the Global Assessment of Function Scale (GAFS). The QoL of patients was compared with that of the general population matched for age and gender (n=107) with including the 7 men, the median age will be thought to be that of the 13 women.
RESULTS
There were 7 men (35%) and 13 women (65%), and the median age was 46 years. The QoL in patients undergoing RP was comparable to that of the healthy general population on all scales. The Physical Component Summary (PCS) was correlated significantly with the daytime and the nighttime incontinence (P<0.01). The Mental Component Summary (MCS) was correlated significantly with the daytime and the nighttime incontinence and the daytime bowel movement (P<0.05).
CONCLUSIONS
This study demonstrates that the QoL in patients undergoing RP is excellent and that the daytime incon tinence and the nighttime incontinence are significant factor influencing the QoL.

Manometric Assessment after Ileal Pouch- Anal Anastomosis.: Yu, Chang Sik , Kim, Hee Chul , Park, Sang Gyu , Kim, Sook Young , Cho, Young Gyu , Hong, Hyun Ki , Kim, Jin Cheon; J Korean Soc Coloproctol. 2001;17(4):187-192.

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Abstract PDF: PURPOSE
Functional derangement in bowel movement after ileal pouch-anal anastomosis (IPAA) is not infrequent. It results from several mechanisms mainly decreased rectal reservoir capacity and rectal sensation. Anal sphincter or pelvic nerve damage during surgery contributes physiological changes, also. This study was performed to evaluate manometric changes after IPAA and compare them with functional outcomes regarding anastomotic technique.
METHODS
Forty seven (M:F=23:24) patients who underwent IPAA and manometric assessment were enrolled. Pathological diagnoses of them were 32 ulcerative colitis, 12 familial adenomatous polyposis, and 3 hereditary non-polyposis colorectal cancer. Every pouch was constructed in J shape, 15cm length. Pouch-anal anastomosis was performed by 27 hand-sewn and 20 double stapling technique. Diverting ileostomy was performed in 30 cases (64%) and closed 2-3 months after IPAA. Manometry was performed preoperatively and 3 to 6 months interval, postoperatively. Twenty two patients underwent full manometic assessment pre- and post-operatively. The others did it either pre or postsoperatively. Functional outcome was investigated at the median follow-up period 25 (2-54) months. Statistical analysis was performed by using Chi- square and Fisher's exact test. Significance was assigned to a P value of <0.05.
RESULTS
Maximum resting pressure (MRP) was significantly decreased postoperatively (85.2 vs. 60.6 mmHg; P=0.002). This phenomenon could be observed throughout the follow-up period. However, the difference was getting smaller as times went by. Rectoanal inhibitory reflex (RAIR) was identified 96% preoperatively, and only 22% postoperatively (P=0.000). Rectal compliance was decreased at the time of ileostomy closure, and improved remarkably since 6 months after closure. In comparison of manometric findings according to anastomotic technique, MRP in hand- sewn group was significantly decreased (52.3 vs. 77.0 mmHg; P=0.003). RAIR could be identified more frequently in double stapled group (31.6 vs. 15.4%; P>0.05). Postoperative stool frequency and incontinence rate were not different between two groups. Thirty one percent of patients revealed night time seepage. MRP of this seepage group was significantly lower than the other group (67.9 vs. 48.4 mmHg; P=0.038).
CONCLUSIONS
Characteristic changes of manometric findings after IPAA were summarized as decrease of MRP and disappearance of RAIR. Rectal compliance was significantly improved since 6 months after IPAA or ileostomy closure. Decrease of MRP was more remarkable in hand-sewn group. However, we could not find any difference in functional outcomes between two anastomotic techniques. MRP was a crutial factor for postoperative seepage.

Comparison of the Result of Restorative Proctocolectomy and Ileal Pouch-anal Anastomosis in Familial Adenomatous Polyposis and Ulcerative Colitis.: Park, Sun Jin , Lee, Gil Yeon , Lee, Kee Hyung , Koh, Suck Hwan , Hong, Sung Wha , Oh, Soo Myung , Yoon, Choong; J Korean Soc Coloproctol. 2001;17(4):171-176.

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Abstract PDF: PURPOSE
The aim of this study was to compare the early postoperative results and the long-term outcome of restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) in familial adenomatous polyposis (FAP) and ulcerative colitis (UC).
METHODS
Thirty patients that underwent IPAA for either FAP (14 patients) or UC (16 patients) at Kyung-Hee University Hospital between January 1987 and December 1999 were studied retrospectively. Either handsewn or stapled anastomosis technique was used in IPAA. Most patients (12 patients in FAP, 16 patients in UC) had a two-stage operation with temporary diverting loop ileostomy and two patients with FAP had a one-stage operation without temporary ileostomy.
RESULTS
One patient in the UC group died from sepsis after operation (n=16, 6.25%), but no patients in the FAP group died. Overall operative complications appeared in two patients (14.3%) and four patients (25%) with FAP and UC, respectively. At follow-up (mean, 47.3 months), pouchitis was developed in four patients with UC, but no patients with FAP. The mean daytime stool frequency was 4.5 stools per day in FAP patients and 5.8 stools per day in UC patients (P=0.031), but night-time stool frequency was similar between two groups (1.2 and 1.4 in FAP and UC, respectively; P>0.05). Daytime fecal incontinence was noticed in two patients (14.3%) with FAP and four patients (26.7%) with UC. Night-time fecal incontinence was noticed in three patients (21.4%) with FAP and six patients (40.0%) with UC.
CONCLUSIONS
FAP patients tolerated the operation better and had less long-term disability than did UC patients. This suggested that the long-term outcome of IPAA procedure may depend on the primary disease rather than the procedure itself.

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