Ray-Offor Emeka, Garoufalia Zoe, Emile Sameh Hany, Rogers Peter, Horesh Nir, Gefen Rachel, Zhou Peige, DaSilva Giovanna, Strassmann Victor, Wexner Steven D
Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA.
Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria.
Colorectal Dis. 2025 Sep;27(9):e70202. doi: 10.1111/codi.70202.
Ileal pouch anal anastomosis (IPAA) prolapse is a rare mechanical complication, with a paucity of literature on frequency and management. This study aimed to assess the prevalence and management outcomes of perineal salvage procedures (SPs) for IPAA prolapse.
Systematic search conducted in PubMed and Scopus with an additional search of relevant cross-referenced literature on experimental and observational human studies involving IPAA for ulcerative colitis or familial adenomatous polyposis from database inception to March 2023. Risk of bias assessment was performed using the NIH quality assessment tool for observational cohort and cross-sectional studies. Meta-analysis was performed by standard methodology using a random-effect model. Main outcome measure was the success rate of perineal SPs for pouch prolapse.
Seventy-two publications were screened; 3 observational studies met the inclusion criteria. Included studies comprised 27,061 patients who underwent IPAAs over a 37-year study period. Ninety-five patients had IPAA prolapse and pooled prevalence of 0.4% (95% CI: 0.3-0.4; I = 0%). Patient age ranged from 31.6 to 38 years with a male-to-female ratio of 1.2:1. Time to prolapse from primary IPAA construction was heterogeneously reported as 2.6 years [<2 years (48%), and ≥3 years (47%)]. Pouch advancement was most frequently reported (88.4%; 95% CI: 77.5-99.3). Overall morbidity and success rates were 23% and 90.5%, respectively.
Studies were heterogeneous. Perineal SPs were infrequently performed for the uncommon IPAA complication of prolapse, with good outcomes in mucosal prolapse. There is insufficient evidence on functional status and quality of life following perineal SPs for full-thickness prolapse.
回肠贮袋肛管吻合术（IPAA）脱垂是一种罕见的机械性并发症，关于其发生率及处理的文献较少。本研究旨在评估会阴挽救手术（SPs）治疗IPAA脱垂的患病率及治疗效果。
在PubMed和Scopus中进行系统检索，并额外检索从数据库建立至2023年3月有关涉及溃疡性结肠炎或家族性腺瘤性息肉病的IPAA的实验性和观察性人体研究的相关交叉参考文献。使用美国国立卫生研究院观察性队列和横断面研究质量评估工具进行偏倚风险评估。采用随机效应模型通过标准方法进行荟萃分析。主要结局指标是会阴SPs治疗贮袋脱垂的成功率。
筛选了72篇出版物；3项观察性研究符合纳入标准。纳入的研究包括在37年研究期间接受IPAA手术的27,061例患者。95例患者发生IPAA脱垂，汇总患病率为0.4%（95%CI：0.3-0.4；I=0%）。患者年龄在31.6至38岁之间，男女比例为1.2:1。初次IPAA构建至脱垂的时间报告不一，为2.6年[<2年（48%），≥3年（47%）]。最常报告的是贮袋推进术（88.4%；95%CI：77.5-99.3）。总体发病率和成功率分别为23%和90.5%。
研究存在异质性。会阴SPs很少用于治疗罕见的IPAA脱垂并发症，对黏膜脱垂效果良好。关于会阴SPs治疗全层脱垂后功能状态和生活质量的证据不足。
