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Meta‐analysis of short‐term and long‐term outcomes of J, W and S ileal reservoirs for restorative proctocolectomy
Author(s) -
Lovegrove R. E.,
Heriot A. G.,
Constantinides V.,
Tilney H. S.,
Darzi A. W.,
Fazio V. W.,
Nicholls R. J.,
Tekkis P. P.
Publication year - 2007
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2006.01093.x
Subject(s) - pouch , medicine , perioperative , proctocolectomy , pouchitis , intubation , defecation , surgery , general surgery , ulcerative colitis , disease
Objective The choice of ileal pouch reservoir has been a contentious subject with no consensus as to which technique provides better function. This study aimed to compare short‐ and long‐term outcomes of three ileal reservoir designs. Method Comparative studies published between 1985 and 2000 of J, W and S ileal pouch reservoirs were included. Meta‐analytical techniques were employed to compare postoperative complications, pouch failure, and functional and physiological outcomes. Quality of life following surgery was also assessed. Results Eighteen studies, comprising 1519 patients (689 J pouch, 306 W pouch and 524 S pouch) were included. There was no significant difference in the incidence of early postoperative complications between the three groups. The frequency of defecation over 24 h favoured the use of either a W or S pouch [J vs S: weighted mean difference (WMD) 1.48, P < 0.001; J vs W: WMD 0.97, P = 0.01]. The S pouch was associated with an increased need for pouch intubation (S vs J: OR 6.19, P = 0.04). The use of a J pouch was associated with a significantly higher prevalence of use of anti‐diarrhoeal medication (J vs S: OR 2.80, P = 0.01; J vs W: OR 3.55, P < 0.001). Conclusion All three reservoirs had similar perioperative complication rates. The S pouch was associated with the need for anal intubation. There was less frequency and less need for antidiarrhoeal agents with the W rather than the J pouch.