Comparison of outcomes after hand-sewn versus stapled ileal pouch-anal anastomosis in 3,109 patients

Background The aim of this study was to compare outcomes after primary hand-sewn versus stapled ileal pouch-anal anastomosis (IPAA). Methods Patients undergoing a primary IPAA (1983–2007) were identified from a prospective pelvic pouch database. Differences between group A (hand-sewn) and group B (s...

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Bibliographic Details
Published in:Surgery 2009-10, Vol.146 (4), p.723-730
Main Authors: Kirat, Hasan T., MD, Remzi, Feza H., MD, Kiran, Ravi P., MD, Fazio, Victor W., MD
Format: Article
Language:English
Subjects:
Adult
Aged
Anastomosis, Surgical - methods
Anastomosis, Surgical - psychology
Colonic Pouches
Female
Humans
Male
Middle Aged
Quality of Life
Surgery
Surgical Stapling
Suture Techniques
Treatment Outcome
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Summary:Background The aim of this study was to compare outcomes after primary hand-sewn versus stapled ileal pouch-anal anastomosis (IPAA). Methods Patients undergoing a primary IPAA (1983–2007) were identified from a prospective pelvic pouch database. Differences between group A (hand-sewn) and group B (stapled) for pre-operative and peri-operative factors, complications, functional outcomes, and quality of life (QOL) were investigated. Results Of 3,382 patients with a primary IPAA, 3,109 were included. Median follow-up was 7.1 years (0.1–24). Mean age was 37.9 ± 13.2 years. Overall, 1,741 patients (56%) were male. Group A ( n  = 474) and group B ( n = 2635) had similar age ( P = .28), sex ( P = .8), albumin level ( P = .74), prior colectomy ( P = .98), and use of steroids ( P = .1). Group A had a greater use of ileostomy ( P = .001) and a longer duration of stay ( P < .001). Group B had a greater body mass index ( P < .001) and J-pouch ( P  ≤ .001). Wound infection ( P = .42) and pouchitis ( P = .59) were similar. Anastomotic stricture ( P  = .002), septic complications ( P = .019), bowel obstruction ( P = .027), and pouch failure ( P  < .001) were greater in group A. At most recent follow-up, bowel frequency ( P = .74) and rate of urgency were similar ( P = .71). A greater proportion of patients in group A described incontinence ( P  
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2009.06.041