title: Survival of ileal pouch anal anastomosis constructed after colectomy or secondary to a previous ileorectal anastomosis in ulcerative colitis patients: a population-based cohort study.
abstract: OBJECTIVE
  Ileorectal anastomosis (IRA) affects bowel function, sexual function and reproduction less negatively than ileal pouch anal anastomosis (IPAA), the standard reconstruction after colectomy for ulcerative colitis (UC). In younger UC patients, IRA may have a role postponing pelvic surgery and IPAA. The aim of the present study was to investigate the survival of IPAA secondary to IRA compared to IPAA as primary reconstruction, as this has not previously been studied in UC.
  
  
  METHODS
  All patients with UC diagnosis between 1960 and 2010 in Sweden were identified from the National Patient Registry. From this cohort, colectomized patients reconstructed with primary IPAA and patients reconstructed with IPAA secondary to IRA were identified. The survival of the IPAA was followed up until pouch failure, defined as pouchectomy and ileostomy or a diverting ileostomy alone.
  
  
  RESULTS
  Out of 63,796 patients, 1796 were reconstructed with IPAA, either primarily (n = 1720) or secondary to a previous IRA (n = 76). There were no demographic differences between the groups, including length of follow-up (median 12.6 (IQR 6.7-16.6) years and 10.0 (IQR 3.5-15.9) years, respectively). Failure of the IPAA occurred in 103 (6.0%) patients with primary and in 6 (8%) patients after secondary IPAA (P = 0.38 log-rank). The 10-year pouch survival was 94% (95% CI 93-96) for primary IPAA and 92% (81-97) for secondary.
  
  
  CONCLUSIONS
  Patients choosing IRA as primary reconstruction do not have an increased risk of failure of a later secondary IPAA in comparison with patients with primary IPAA.
authors.affiliation: a Department of Surgery , Ryhov County Hospital , Jönköping , Sweden.|b Department of Surgery, Colorectal unit , Oxford University Hospitals NHS Foundation Trust , Oxford , UK.
authors.forename: Kalle
authors.initials: K
authors.lastname: Landerholm
authors.affiliation: c Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden.|d Faculty of Medicine , Suez Canal University , Ismailia , Egypt.
authors.forename: Maie
authors.initials: M
authors.lastname: Abdalla
authors.affiliation: c Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden.|e Department of Surgery , County Council of Östergötland , Linköping , Sweden.
authors.forename: Pär
authors.initials: P
authors.lastname: Myrelid
authors.affiliation: a Department of Surgery , Ryhov County Hospital , Jönköping , Sweden.|c Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden.
authors.forename: Roland E
authors.initials: RE
authors.lastname: Andersson
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D007082:Ileum / Q000601:surgery; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data*; D013548:Sweden; D013997:Time Factors; D017211:Treatment Failure
keywords: Ulcerative colitis; ileal pouch anal anastomosis; ileoanal pouches; ileoanal reservoir; ileorectal anastomosis; inflammatory bowel disease; pelvic pouches; pouch failure; pouch survival; restorative proctocolectomy