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Titel: Comparing continent ileostomy (CI) conversion to repair/redo IPAA: favorable outcomes
VerfasserIn: Ecker, Nils Karl Josef
Dinh, Christian
Möslein, Gabriela
Ecker, Karl-Wilhelm
Sprache: Englisch
Titel: International Journal of Colorectal Disease
Bandnummer: 38
Heft: 1
Verlag/Plattform: Springer Nature
Erscheinungsjahr: 2023
Freie Schlagwörter: Ileoanal pouch
Pouch failure
Continent ileostomy
Redo ileoanal pouch
Pouch survival
Patient’s satisfaction
DDC-Sachgruppe: 610 Medizin, Gesundheit
Dokumenttyp: Journalartikel / Zeitschriftenartikel
Abstract: Purpose This study aims to compare the outcomes of repair/redo ileal pouch-anal anastomosis (repair/redo-IPAA) with the conversion of IPAA to continent ileostomy (CI) in an effort to prevent the need for a permanent ileostomy (IS) following IPAA failure. Methods This research involved a retrospective analysis of surgical records, employing descriptive statistics and KaplanMeier survival analysis. Results Among 57 patients with an IPAA, up to three revisions were necessary due to complications or complete failure. Ultimately, repair/redo-IPAA preserved the IPAA in 14 patients (24.6%), conversion to CI salvaged the pouch in 21 patients (36.8%), and IS was unavoidable in 22 patients (38.6%). The cumulative probability of requiring conversion surgery was calculated to be 54.0% at 20 years, thereby reducing the cumulative risk of IS to 32.3%. The 20-year cumulative probability of pouch salvage by repair/redo IPAA was only 21.9%. However, this rate increased to 67.7% when conversion procedures were considered. Following repair/redo-IPAA, only 8.3% of patients reported evacuation frequencies of≤4 during the day, and 16.7% were evacuation-free at night. In contrast, after conversion to CI, 98.0% of patients reported a maximum of four evacuations in a 24-h period. After undergoing repair/redo IPAA, between half and two-thirds of patients reported experiencing incontinence or soiling, while complete continence was achieved in all patients following conversion to CI. Notably, the majority of patients expressed overall satisfaction with their respective procedures. A positive correlation was identified between very high subjective satisfaction and positive objective surgical outcomes exclusively in patients who underwent conversion to CI. Conclusion When complications or failure of IPAA occur, conversion to CI emerges as a highly viable alternative to repair/ redo IPAA. This conclusion is supported by the observation that patient satisfaction appears to be closely tied to stable surgical outcomes. To reinforce these findings, further prospective studies are warranted.
DOI der Erstveröffentlichung: 10.1007/s00384-023-04555-x
URL der Erstveröffentlichung: https://link.springer.com/article/10.1007/s00384-023-04555-x
Link zu diesem Datensatz: urn:nbn:de:bsz:291--ds-415263
hdl:20.500.11880/37198
http://dx.doi.org/10.22028/D291-41526
ISSN: 1432-1262
Datum des Eintrags: 30-Jan-2024
Fakultät: M - Medizinische Fakultät
Fachrichtung: M - Chirurgie
Professur: M - Keiner Professur zugeordnet
Sammlung:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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