Surgical treatment of ulcerative colitis: Ileorectal vs ileal pouch-anal anastomosis

Table 1 Morbidity and mortality after ileorectal anastomosis

Series	Period	n	Anastomotic leak (%)	Proctitis (%)	Need for proctectomy (%)	Overall morbidity (%)	Mortality (%)
da Luz Moreira et al[11]	1971-2006	86	2.3	28.0	53	8	0
Leijonmarck et al[13]	1955-1984	51	3.9	45.1	57	16	4
Pastore et al[15]	1974-1990	48	4.4	10.4	17	22.9	0
Börjesson et al[16]	1997-2003	32	3.1	9.3	12	28	0
Grundfest et al[17]	1957-1977	89	9.1	11.2	21	16.1	0
Elton et al[18]	1990-1999	18	5.6	11.0	17	22.2	0
Andersson et al[19]	1992-2006	105	2.8	8.6	13.3	12.4	0
Lepistö et al[22]	1978-2000	20	-	45.0	35	-	0
Oakley et al[23]	1960-1982	288	-	41.0	55.2	-	4.2

Table 2 Morbidity and mortality after ileal pouch-anal anastomosis

Period	No. of studies	No. of patients	Pelvic sepsis(%, 95%CI)	Pouch failure(%, 95%CI)	Pouchitis(%, 95%CI)	Mortality(%, range)
Meta-analysis studies < 2000[32]	43	9317	9.5 (8.2-10.9)	6.8 (5.8-8.4)	18.8 (15.7-22.4)	-
Meta-analysis studies ≥ 2000[33]	53	14966	7.5 (6.1-9.1)	4.3 (3.5-5.3)	26.8 (21.0-33.5)	0 (0-2.9)

Table 3 Main advantages and disadvantages of ileorectal anastomosis and ileal pouch-anal anastomosis

	IRA	IPAA
Advantages	Easier operation	Lower risk of cancer
	Lower infertility rate	No need for medical therapy
	Lower risk of urinary and sexual dysfunction	Less urgency
	Fewer bowel movements per day
	Better continence
Disadvantages	Need for maintenance therapy	Major operation
	Risk of recurrent/persistent disease	Risk of postoperative complications (pelvic nerves damage, pelvic sepsis, portal vein thrombosis)
	Higher risk of neoplastic degeneration	Pouchitis
	Need for strict surveillance
	More dietary and work restrictions

IRA: Ileorectal anastomosis; IPAA: Ileal pouch-anal anastomosis.

Table 4 Risk of cancer after ileorectal vs ileal pouch-anal anastomosis in ulcerative colitis

	Period	n	Follow-upaverage (yr)	Overall cancer rate (%)	Estimated cumulative risk after 20 years (%)
Ileorectal anastomosis
da Luz Moreira et al[11]	1971-2006	86	9	8	14
Leijonmarck et al[13]	1955-1984	51	13	0	-
Pastore et al[15]	1974-1990	48	6.3	2	14.31
Börjesson et al[16]	1997-2003	32	3.5	0	-
Grundfest et al[17]	1957-1977	89	8	4.8	5 ± 3.5
Elton et al[18]	1990-1999	18	2.6	-	-
Andersson et al[19]	1992-2006	105	5.4	-	2.1
Lepistö et al[22]	1978-2000	20	18	0	-
Oakley et al[23]	1960-1982	288	8.2	3.1	-
Baker et al[26]	1952-1976	374	> 10	5.9	6 ± 2
Ileo-pouch anal anastomosis
Kariv et al[44]	1984-2009	3203	± 12	0.4	4
Branco et al[45]	1978-2008	520	± 15	0.2	-

¹Cumulative risk at 12 years (rather than 20).