Introduction
Methods
Search strategy
Selection of studies
Inclusion criteria
Exclusion criteria
Outcomes of interest and definitions
Pouch failure | Pouch excision or a nonfunctioning pouch at 12 months after IPAA |
Pelvic sepsis | Pelvic abscess, anastomotic leakage or dehiscence, pelvic/perineal wound infection |
Fistula | Any pouch-related fistula |
Stricture | Anastomotic fibrosis necessitating dilatation |
Mild fecal incontinence | Soiling, spotting in underwear |
Severe fecal incontinence | Regularly severe leakage or fecal loss passive fecal incontinence |
Data extraction
Data of studies published until 2000
Statistical analysis
Results
Selection process
Description of identified studies
Author | Year of publication | Inclusion period | Number of patients | FU (months) | Age | Gender (% female) | Type of disease | Handsewn anastomosis (%) | With diverting ileostoma (%) |
---|---|---|---|---|---|---|---|---|---|
Fonkalsrud et al. [20] | 2000 | 1993–1997 | 77 | 34.5 | 50 | UC | 57.1 | 100 | |
Karlbom et al. [36] | 2000 | 1983–1996 | 168 | 29 | 32 | 39.3 | UC | 58.9 | 70.8 |
Seidel et al. [60] | 2000 | 1985–1996 | 55 | 31.2 | 45.5 | Both | |||
Simchuk [61] | 2000 | 1987–1996 | 114 | 38 | 43.9 | Both | 100 | ||
Gullberg and Liljeqvist [25] | 2001 | 1990–1995 | 86 | 72 | 34.1 | 45.3 | Both | 2.3 | 10.5 |
Barton et al. [5] | 2001 | 1983–2000 | 110 | 30 | 36.8 | Both | 100 | 100 | |
Heuschen et al. [29] | 2001 | 1991–2000 | 171 | 30 | 36.7 | 45.6 | UC | 100 | 66.7 |
Regimbeau et al. [53] | 2001 | 1984–1998 | 172 | 60 | 36 | 47.1 | Both | 100 | 100 |
Blumberg et al. [12] | 2001 | 1982–1995 | 145 | 34 | 49 | Both | 15.2 | ||
Dayton et al. [16] | 2002 | 1982–2001 | 644 | 79 | 37.2 | 39.4 | UC | ||
Rossi et al. [56] | 2002 | 1989–2000 | 75 | 40 | 33.3 | Both | 54.7 | 100 | |
Bullard et al. [13] | 2002 | 1980–1992 | 154 | 151 | 34 | 44.2 | Both | 64 | |
Gignoux et al. [22] | 2002 | 1993–1998 | 84 | 22 | 33 | 42.9 | Both | 100 | |
Mukhtar et al. [47] | 2002 | 1990–1997 | 50 | 35 | 44 | Both | 2 | 98 | |
Rudolph et al. [57] | 2002 | 1991–1999 | 71 | 47 | 38 | 56 | UC | 84.5 | |
Carmon et al. [14] | 2003 | 1990–2001 | 77 | 51 | 38 | 55.8 | UC | 72.7 | |
Teixeira et al. [63] | 2003 | 1986–2000 | 80 | 108 | 50 | UC | 11.3 | 77.5 | |
Michelassi et al. [46] | 2003 | 1987–2002 | 391 | 37 | 33.7 | 44.2 | Both | 29.9 | 65 |
Holubar and Hyman [32] | 2003 | 51 | 85 | 42.1 | 51 | UC | 70.6 | ||
Fowler et al. [21] | 2003 | 1984–2001 | 106 | 40 | 50 | Both | 39.4 | 41.3 | |
Parc et al. [49] | 2004 | 1983–1990 | 110 | 175 | 26.5 | 43.6 | FAP | 100 | |
Lin et al. [43] | 2004 | 1985–2002 | 61 | 60 | 37 | 54 | Both | 67.2 | |
Hueting et al. [34] | 2004 | 1989–2000 | 111 | 42 | 35.4 | 68.5 | UC | ||
Gosselink et al. [23] | 2004 | 1989–2001 | 127 | 56 | 36 | 42.5 | UC | 21.6 | |
Krausz et al. [40] | 2005 | 1984–2004 | 174 | 64 | 34.1 | 47.7 | Both | 54 | 87.4 |
Hallberg et al. [26] | 2005 | 1990–1997 | 100 | 53 | 32 | 39 | UC | 17 | |
Swenson et al. [62] | 2005 | 1995–2003 | 54 | 22 | 35 | 35.2 | 57.4 | ||
Chapman et al. [15] | 2005 | 1981–2000 | 2002 | 121 | 33.5 | 46.6 | Both | 5 | |
Kok Sun Ho et al. [30] | 2005 | 1989–2001 | 330 | 32 | 59.1 | UC | |||
Ikeuchi et al. [35] | 2005 | 1999–2003 | 242 | 32.1 | 50.8 | UC | 100 | 38 | |
Arai et al. [3] | 2005 | 1993–2003 | 296 | 53 | 33.8 | 43.2 | UC | 96.3 | 55.4 |
Araki et a l. [4] | 2006 | 1998–2003 | 220 | 34.5 | 46.8 | Both | 47.3 | ||
Rickard et al. [54] | 2006 | 1982–2002 | 516 | 33 | 45.2 | Both | 32.4 | 88 | |
Bednarz et al. [6] | 2007 | 1994–2005 | 108 | 60 | 50 | Both | 18.5 | 100 | |
Berndtsson et al. [8] | 2007 | 1982–1995 | 370 | 180 | 34 | 45.7 | UC | ||
Gualdrini et al. [24] | 2007 | 1987–2005 | 391 | 45.6 | 35.4 | 51.7 | Both | ||
Kiran et al. [38] | 2008 | 2016 | 180 | 37.7 | 43.9 | Both | 15.4 | 85.9 | |
Tulchinsky et al. [66] | 2008 | 1986–2005 | 211 | 124.6 | 35.4 | 58.3 | UC | 16.5 | 79 |
Walker and Bulow [67] | 2008 | 1987–2004 | 178 | 84 | 31 | 44.9 | Both | 6.7 | 100 |
Ferrante et al. [18] | 2008 | 1990–2004 | 173 | 78 | 39 | 38.7 | UC | 2.3 | 85 |
Leal et al. [41] | 2008 | 1984–2006 | 69 | 82 | 29.6 | 59.4 | FAP | 100 | 100 |
Zarate et al. [71] | 2008 | 1984–2006 | 107 | 34.4 | 57 | Both | 12.1 | 100 | |
Pinto et al. [50] | 2009 | 2001–2008 | 66 | 21.1 | 52.8 | 66.7 | Both | 18.2 | 100 |
Leowardi et al. [42] | 2009 | 1988–1996 | 197 | 147.6 | 33 | 45.2 | UC | 100 | 100 |
Norwood et al. [48] | 2009 | 1997–2007 | 107 | 77 | 38 | 45.8 | Both | 99 | |
Loftus et al. [44] | 2009 | 2001–2005 | 237 | 5.9 | 38.9 | 45 | UC | ||
Tekkis et al. [64] | 2009 | 1976–2006 | 2491 | 74.4 | 35.9 | 47.9 | Both | 33.3 | 67.3 |
Scarpa et al. [58] | 2009 | 1984–2004 | 58 | 136 | 38 | 34.5 | UC | 0 | |
Wasmuth et al. [68] | 2009 | 1984–2006 | 304 | 120 | 34.4 | 38.8 | Both | 40.1 | 84 |
Andersson et al. [2] | 2009 | 1984–2003 | 110 | 144 | 35 | 45.5 | Both | 47.3 | |
Fichera et al. [19] | 2009 | 2002–2007 | 106 | 24.8 | 36.9 | 42.2 | UC | 71.6 | |
Rink et al. [55] | 2009 | 1990–2002 | 131 | 85 | 33 | 46.6 | UC | 84 | |
Pricolo [51] | 2009 | 1991–2008 | 312 | 36 | 46.8 | Both | 8 |
Outcomes
Complications
Since 2000 | Before 2000 |
P value | |||||
---|---|---|---|---|---|---|---|
Number of studies | Number of patients | Pooled incidences | Number of studies | No. of patients | Pooled incidences | ||
Complications | % (95% CI) | % (95%CI) | |||||
Pouch failure | 43 | 13,249 | 4.3 (3.5–5.3) | 39 | 8,877 | 6.8 (5.8–8.4) | 0.0038 |
Pouch failure: FU > 5 years | 22 | 9,873 | 4.7 (3.4–6.4) | 11 | 3,198 | 8.5 (5.4–13.2) | |
Pelvic sepsis | 46 | 13,450 | 7.5 (6.1–9.1) | 41 | 9,082 | 9.5 (8.2–10.9) | NS |
Fistula | 38 | 12,398 | 4.5 (3.5–5.7) | 30 | 5,120 | 5.5 (4.3–7.0) | NS |
Stricture | 35 | 12,219 | 10.7 (8.2–13.8) | 28 | 5,185 | 9.2 (6.8–12.4) | NS |
Pouchitis | 39 | 12,685 | 26.8 (21.0–33.5) | 33 | 7,289 | 18.8 (15.7–22.4) | NS |
Sexual dysfunction | 13 | 6,131 | 3.0 (1.7–5.2) | 21 | 5,112 | 3.6 (2.7–4.7) | NS |
Small bowel obstruction | 34 | 11,895 | 11.4 (9.1–14.1) | 27 | 5,853 | 13.1 (11.0–15.7) | NS |
Fecal incontinence | %(95%CI) | % (95%CI) | |||||
Mild day incontinence | 21 | 6,988 | 14.3 (7.3–25.9) | 31 | 4,313 | 17.0 (12.8–22.2) | NS |
Severe day incontinence | 13 | 3,718 | 6.1 (2.9–12.3) | 27 | 3,914 | 3.7 (2.8–4.8) | NS |
Mild night incontinence | 9 | 5,423 | 17.3 (4.7–46.8) | 17 | 2,582 | 13.1 (9.5–17.9) | NS |
Severe night incontinence | 10 | 3,614 | 7.6 (2.5–21.3) | 9 | 1,271 | 4.5 (3.0–6.7) | NS |
Frequency | Mean (95%CI) | Mean (95%CI) | |||||
Frequency day | 26 | 5,321 | 5.7 (4.9–6.7) | 13 | 2,277 | 5.2 (4.0–6.7) | NS |
Frequency night | 22 | 7,117 | 1.5 (1.0–2.1) | 20 | 2,950 | 1.0 (0.6–1.6) | NS |
Frequency 24 h | 26 | 5,132 | 5.9 (5.0–6.9) | 20 | 3,547 | 5.2 (4.4–6.1) | NS |