Perineal salvage surgery for prolapse of ileal pouch anal anastomosis: Systematic review and meta-analysis.

Abstract

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; I² = 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.