Meta-analysis of short-term and long-term outcomes of J, W and S ileal reservoirs for restorative proctocolectomy.
OBJECTIVE
The choice of ileal pouch reservoir has been a contentious subject with no consensus as to which technique provides better function. This study aimed to compare short- and long-term outcomes of three ileal reservoir designs.


METHODS
Comparative studies published between 1985 and 2000 of J, W and S ileal pouch reservoirs were included. Meta-analytical techniques were employed to compare postoperative complications, pouch failure, and functional and physiological outcomes. Quality of life following surgery was also assessed.


RESULTS
Eighteen studies, comprising 1519 patients (689 J pouch, 306 W pouch and 524 S pouch) were included. There was no significant difference in the incidence of early postoperative complications between the three groups. The frequency of defecation over 24 h favoured the use of either a W or S pouch [J vs S: weighted mean difference (WMD) 1.48, P < 0.001; J vs W: WMD 0.97, P = 0.01]. The S pouch was associated with an increased need for pouch intubation (S vs J: OR 6.19, P = 0.04). The use of a J pouch was associated with a significantly higher prevalence of use of anti-diarrhoeal medication (J vs S: OR 2.80, P = 0.01; J vs W: OR 3.55, P < 0.001).


CONCLUSIONS
All three reservoirs had similar perioperative complication rates. The S pouch was associated with the need for anal intubation. There was less frequency and less need for antidiarrhoeal agents with the W rather than the J pouch.
Lovegrove
R E
RE
Imperial College London, Department of Biosurgery and Surgical Technology, St Mary's Hospital, London, UK.
Heriot
A G
AG
Constantinides
V
V
Tilney
H S
HS
Darzi
A W
AW
Fazio
V W
VW
Nicholls
R J
RJ
Tekkis
P P
PP
D016009:Chi-Square Distribution; D039021:Colonic Pouches; D006801:Humans; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative; D011788:Quality of Life