James Q Zhou1, Sean Michael Duenas1, Tarik Kirat2, Feza Remzi2, Shannon Chang3. 1. Department of Internal Medicine, New York University Langone Health, New York, NY, USA. 2. Division of Colorectal Surgery, New York University Langone Health, New York, NY, USA. 3. Division of Colorectal Surgery, New York University Langone Health, NYU Langone Health, 240 East 38th Street, 23rd Floor, New York, NY, 10016, USA. Shannon.chang@nyumc.org.
Abstract
PURPOSE OF REVIEW: Ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for patients undergoing colectomy to maintain intestinal continuity. Earlier studies have suggested that outcomes are worse in elderly patients who underwent IPAA. However, more recent reports have shown that IPAA outcomes in the elderly are comparable to younger patients. We review the recent medical literature regarding outcomes and treatments for common complications in elderly IPAA patients. RECENT FINDINGS: Compared to younger patients, IPAA in the elderly is not associated with increased major surgical complications, but is associated with increased length of stay and re-admission rate for dehydration in older patients. Rates of fecal incontinence after IPAA were similar between younger and older patients. Sacral nerve stimulation has shown early promise as a possible treatment for fecal incontinence after IPAA, but more research is needed. Pouchitis is a common complication, and antibiotics remain first-line treatment options. Other treatment options include mesalamines, steroids, immunomodulators, and biologics. The efficacy of newer biologics such as vedolizumab and ustekinumab has been reported, but more data is needed. IPAA is safe in the elderly with high self-reported patient satisfaction. However, the elderly IPAA patient warrants special consideration regarding outcomes and management.
PURPOSE OF REVIEW: Ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for patients undergoing colectomy to maintain intestinal continuity. Earlier studies have suggested that outcomes are worse in elderly patients who underwent IPAA. However, more recent reports have shown that IPAA outcomes in the elderly are comparable to younger patients. We review the recent medical literature regarding outcomes and treatments for common complications in elderly IPAA patients. RECENT FINDINGS: Compared to younger patients, IPAA in the elderly is not associated with increased major surgical complications, but is associated with increased length of stay and re-admission rate for dehydration in older patients. Rates of fecal incontinence after IPAA were similar between younger and older patients. Sacral nerve stimulation has shown early promise as a possible treatment for fecal incontinence after IPAA, but more research is needed. Pouchitis is a common complication, and antibiotics remain first-line treatment options. Other treatment options include mesalamines, steroids, immunomodulators, and biologics. The efficacy of newer biologics such as vedolizumab and ustekinumab has been reported, but more data is needed. IPAA is safe in the elderly with high self-reported patient satisfaction. However, the elderly IPAA patient warrants special consideration regarding outcomes and management.
Authors: Howard Ross; Scott R Steele; Mika Varma; Sharon Dykes; Robert Cima; W Donald Buie; Janice Rafferty Journal: Dis Colon Rectum Date: 2014-01 Impact factor: 4.585
Authors: A Sambuelli; L Boerr; S Negreira; A Gil; G Camartino; S Huernos; Z Kogan; A Cabanne; A Graziano; H Peredo; I Doldán; O Gonzalez; E Sugai; M Lumi; J C Bai Journal: Aliment Pharmacol Ther Date: 2002-01 Impact factor: 8.171
Authors: Amy L Lightner; Kellie L Mathis; Eric J Dozois; Dieter Hahnsloser; Edward V Loftus; Laura E Raffals; John H Pemberton Journal: Inflamm Bowel Dis Date: 2017-05 Impact factor: 5.325
Authors: Ali M Abbas; Rawaa M Almukhtar; Edward V Loftus; Gary R Lichtenstein; Nabeel Khan Journal: Am J Gastroenterol Date: 2014-09-23 Impact factor: 10.864
Authors: Leonardo C Duraes; Jennifer Liang; Scott R Steele; Bora Cengiz; Conor P Delaney; Stefan D Holubar; Emre Gorgun Journal: ANZ J Surg Date: 2022-04-18 Impact factor: 2.025