Ileal Pouch-anal Anastomosis Complications and Pouch Failure A systematic review and meta-analysis

• Published in: Annals of surgery open Vol. 2; no. 2; p. e074
• Main Authors: Heuthorst, Lianne, Wasmann, Karin A. T. G. M., Reijntjes, Maud A., Hompes, Roel, Buskens, Christianne J., Bemelman, Willem A.
• Format: Journal Article
• Language: English
• Published: Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103 Wolters Kluwer Health, Inc 01.06.2021
• Subjects: Meta-Analysis
• ISSN: 2691-3593; 2691-3593
• DOI: 10.1097/AS9.0000000000000074

Objective: This systematic review aims to assess the incidence of pouch failure and the correlation between ileal pouch-anal anastomosis (IPAA)-related complications and pouch failure. Background: Previous studies demonstrated wide variation in postoperative complication rates following IPAA. Methods: A systematic review was performed by searching the MEDLINE, EMBASE, and Cochrane Library databases for studies reporting on pouch failure published from January 1, 2010, to May 6, 2020. A meta-analysis was performed using a random-effects model, and the relationship between pouch-related complications and pouch failure was assessed using Spearman’s correlations. Results: Thirty studies comprising 22,978 patients were included. Included studies contained heterogenic patient populations, different procedural stages, varying definitions for IPAA-related complications, and different follow-up periods. The pooled pouch failure rate was 7.7% (95% confidence intervals: 5.56–10.59) and 10.3% (95% confidence intervals: 7.24–14.30) for studies with a median follow-up of ≥5 and ≥10 years, respectively. Observed IPAA-related complications were anastomotic leakage (1–17%), pelvic sepsis (2–18%), fistula (1–30%), stricture (1–34%), pouchitis (11–61%), and Crohn’s disease of the pouch (0–18%). Pelvic sepsis (r = 0.51, P < 0.05) and fistula (r = 0.63, P < 0.01) were correlated with pouch failure. A sensitivity analysis including studies with a median follow-up of ≥5 years indicated that only fistula was significantly correlated with pouch failure (r = 0.77, P < 0.01). Conclusions: The single long-term determinant of pouch failure was pouch fistula, which is a manifestation of a chronic leak. Therefore, all effort should be taken to prevent an acute leak from becoming a chronic leak by early diagnosis and proactive management of the leak. Mini abstract: This systematic review aims to assess the incidence of pouch failure and the correlation between IPAA-related complications and pouch failure. Long-term pouch failure was correlated with fistula, suggesting that early septic complications may result in fistula formation during long-term follow-up, leading to an increased risk of pouch failure.