title: Ileorectal anastomosis in comparison with ileal pouch anal anastomosis in reconstructive surgery for ulcerative colitis--a single institution experience.
abstract: BACKGROUND
  Ileal pouch anal anastomosis (IPAA) is the standard procedure for reconstruction after colectomy for ulcerative colitis (UC). However, ileorectal anastomosis (IRA) as an alternative has, recently experienced a revival. This study from a single center compares the clinical outcomes of these procedures.
  
  
  METHODS
  From 1992 to 2006, 253 patients consecutively underwent either IRA (n=105) or IPAA (n=148). Selection to either procedure was determined on the basis of rectal inflammation, presence of dysplasia/cancer or patient preferences. Patient-records were retrospectively evaluated. Mean follow-up time was 5.4 and 6.3 years respectively.
  
  
  RESULTS
  Major postoperative complications occurred in 12.4% of patients after IRA and in 12.8% after IPAA (ns). Complications of any kind after IRA or IPAA, even including subsequent stoma-closure, occurred in 23.8% and 39.9% respectively (p<0.01). Estimated cumulative failure rates after 5 and 10 years were 10.1% and 24.1% for IRA and 6.1% and 18.6% for IPAA respectively (ns). The most common cause for failure was intractable proctitis (4.8%) and unspecified dysfunction (4.8%) respectively. At follow-up 76.9% of patients with IRA had proctitis and 34.1% with IPAA had pouchitis. Estimated cumulative cancer-risk after 10, 20 and 25 year duration of disease was 0.0%, 2.1% and 8.7% for IRA. Figures for IPAA were 0.7%, 1.8% and 1.8% (ns).
  
  
  CONCLUSIONS
  Failure-rates did not significantly differ between patients operated with IRA or IPAA. Patients operated with IPAA had a higher cumulative number of postoperative complications. The high long-term cancer-risk after IRA indicates that this procedure should be an interim solution in younger patients.
authors: Department of Surgery, County Council of Östergötland, Linköping, Sweden; Division of Surgery, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sweden. Electronic address: peter.andersson@lio.se.
authors: Peter
authors: P
authors: Andersson
authors: Department of Surgery, County Council of Östergötland, Linköping, Sweden; Division of Surgery, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sweden.
authors: Rickard
authors: R
authors: Norblad
authors: Department of Surgery, County Council of Östergötland, Linköping, Sweden; Division of Surgery, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sweden.
authors: Johan D
authors: JD
authors: Söderholm
authors: Department of Surgery, County Council of Östergötland, Linköping, Sweden; Division of Surgery, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sweden.
authors: Pär
authors: P
authors: Myrelid
mesh_terms: D000008:Abdominal Neoplasms / Q000175:diagnosis*; D000230:Adenocarcinoma / Q000175:diagnosis*; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D019449:Pouchitis / Q000209:etiology; D011349:Proctitis / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012004:Rectal Neoplasms / Q000175:diagnosis*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007166:Immunosuppressive Agents; D019804:Mesalamine; D001379:Azathioprine
keywords: Complications;; Failure; IPAA;; IRA;; Ulcerative colitis;