Ileorectal anastomosis in ulcerative colitis: what do surgeons and patients need to know? A systematic literature review.
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Authors
Orchard, M R
Saracino, A
Hooper, J
Shabbir, J
Issue Date
2024-04-25
Type
Journal Article
Language
en
Keywords
ileorectal anastomosis , ulcerative colitis
Alternative Title
Abstract
Introduction: Ileal pouch-anal anastomosis (IPAA) is currently the gold standard for restoration of gastrointestinal continuity after colectomy for ulcerative colitis in the UK. However, with further experience of the risks relating to IPAA, the use of ileorectal anastomosis (IRA) is being revisited. Decisions regarding restorative surgery after colectomy are individual to every patient's circumstances, and this paper aims to provide a comprehensive review of the literature to guide a full discussion of the risks and benefits of IRA.
Methods: A systematic literature review was conducted of papers published from 2000 onwards relating to IRA and ulcerative colitis, in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. The papers were reviewed by two independent surgeons for information it was felt that patients and surgeons would want to know about the operation (cancer risk, bowel function, sexual and urinary function, fecundity/fertility and postoperative complications).
Results: Seventeen papers were identified for inclusion as they reported original data on one or more of the categories identified for discussion. The median ten-year cancer risk after IRA was 2.8% and the median failure rate at ten years was 21%. IRA was generally found to have lower postoperative complication rates and better bowel function than IPAA, with sexual function similar and fecundity not commented on in any paper.
Conclusions: For some patients, IRA can offer restorative surgery in the short or long term, with acceptable cancer risk, failure rate and postoperative complications, while avoiding the higher risks associated with IPAA.
Description
Open Access This is an open-access article distributed under the terms of theCreative Commons Attribution 4.0 International License,which permits unrestricted use, distribution,reproduction, and adaptation in any medium, providedthe original work is properly attributed.
Citation
Orchard, MR.; Saracino, A.; Hooper, J. and Shabbir, J. (2024) 'Ileorectal anastomosis in ulcerative colitis: what do surgeons and patients need to know? A systematic literature review', Annals of the Royal College of Surgeons of England. Available at: https://doi.org/10.1308/rcsann.2024.0012.
Publisher
Royal College of Surgeons of England
License
Journal
Annals of the Royal College of Surgeons of England
Volume
Issue
PubMed ID
ISSN
1478-7083