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 (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 < or = .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 < .001), seepage (P < .001), pad usage (P < .001), dietary (P < .001), social (P < .001), and work restrictions (P = .025). The Cleveland Global QOL score (P = .018) was greater in group B.


CONCLUSIONS
Patients undergoing a stapled IPAA had better outcomes and QOL than those undergoing a hand-sewn IPAA.
Kirat
Hasan T
HT
Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Remzi
Feza H
FH
Kiran
Ravi P
RP
Fazio
Victor W
VW
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods* / Q000523:psychology; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D017792:Surgical Stapling; D013536:Suture Techniques; D016896:Treatment Outcome