{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T14:43:31Z","timestamp":1781189011031,"version":"3.54.1"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T00:00:00Z","timestamp":1737504000000},"content-version":"vor","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Proctocolectomy with ileal pouch-anal anastomosis is the treatment of choice for patients with ulcerative colitis with medical refractory disease or dysplasia. The aim of this research was to describe the evolution of ileal pouch-anal anastomosis surgery and surgical outcomes over a three-decade interval in a high-volume referral centre.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>All consecutive patients undergoing ileal pouch-anal anastomosis for ulcerative colitis between 1990 and 2022 at the University Hospitals of Leuven were retrospectively included. Patients were divided into three interval arms (interval A 1990\u20132000, interval B 2001\u20132010 and interval C 2011\u20132022). The primary outcomes of interest were anastomotic leakage at 30 days and pouch failure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Overall, 492 patients were included. The use of preoperative advanced therapies increased over time (P &amp;lt; 0.001). An increase in laparoscopic procedures (23.2% in interval A, 66.4% in interval B, 86.0% in interval C; P &amp;lt; 0.001) and a shift towards delayed ileal pouch-anal anastomosis (colectomy-first approach with delayed ileal pouch-anal anastomosis construction: 23.0% in interval A, 40.9% in interval B, 85.8% in interval C; P &amp;lt; 0.001) were observed. Anastomotic leakage rate decreased from 16.7% (interval A) to 8.4% (interval C) (P = 0.04). Delayed ileal pouch-anal anastomosis was the most relevant factor in limiting leakage (OR 0.49 (95% c.i. 0.27 to 0.87); P = 0.016). Median follow-up was 7.5 years (interquartile range 2.5\u201316). Cumulative pouch failure incidence was 8.2%, not significantly different between the three intervals (P = 0.580). Anastomotic leakage was the only significant risk factor for pouch failure (HR 2.82 (95% c.i. 1.29 to 6.20); P = 0.010).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Significant changes in the management of ulcerative colitis patients occurred. Despite the widespread use of advanced therapies and the expanded surgical indications, anastomotic leakage rate decreased over time. In the context of a delayed ileal pouch-anal anastomosis, diverting ileostomy could be avoided in selected cases. Anastomotic leakage remains the most relevant risk factor for pouch failure. Pouch failure incidence remained stable over the years.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrae111","type":"journal-article","created":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T15:24:09Z","timestamp":1737559449000},"source":"Crossref","is-referenced-by-count":4,"title":["Ileal pouch-anal anastomosis for ulcerative colitis: 30-year analysis on surgical evolution and patient outcome"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9212-9287","authenticated-orcid":false,"given":"Gabriele","family":"Bislenghi","sequence":"first","affiliation":[{"name":"Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven , Leuven ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Luberto","sequence":"additional","affiliation":[{"name":"Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven , Leuven ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wout","family":"De Coster","sequence":"additional","affiliation":[{"name":"Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven , Leuven ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leen","family":"van Langenhoven","sequence":"additional","affiliation":[{"name":"Interuniversity Center for Biostatistics and Statistical Bioinformatics, KU Leuven , Leuven ,","place":["Belgium"]},{"name":"University of Hasselt , Hasselt ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1200-387X","authenticated-orcid":false,"given":"Albert","family":"Wolthuis","sequence":"additional","affiliation":[{"name":"Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven , Leuven ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1492-0716","authenticated-orcid":false,"given":"Marc","family":"Ferrante","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven , Leuven ,","place":["Belgium"]},{"name":"Department of Chronic Diseases and Metabolism, KU Leuven , Leuven ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Severine","family":"Vermeire","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven , Leuven ,","place":["Belgium"]},{"name":"Department of Chronic Diseases and Metabolism, KU Leuven , Leuven ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"D\u2019Hoore","sequence":"additional","affiliation":[{"name":"Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven , Leuven ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,1,22]]},"reference":[{"key":"2025030423520045600_zrae111-B1","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1097\/00000658-199508000-00003","article-title":"Ileal pouch-anal anastomoses complications and function in 1005 patients","volume":"222","author":"Fazio","year":"1995","journal-title":"Ann Surg"},{"key":"2025030423520045600_zrae111-B2","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1016\/S0002-9610(97)00188-8","article-title":"Outcome of pouch-related complications after ileal pouch-anal anastomosis","volume":"174","author":"Dayton","year":"1997","journal-title":"Am J Surg"},{"key":"2025030423520045600_zrae111-B3","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1007\/s10151-016-1465-z","article-title":"Safety, feasibility, and short-term outcomes in 588 patients undergoing minimally invasive ileal pouch-anal anastomosis: a single-institution experience","volume":"20","author":"Baek","year":"2016","journal-title":"Tech Coloproctol"},{"key":"2025030423520045600_zrae111-B4","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1097\/DCR.0000000000000236","article-title":"Initial surgical management of ulcerative colitis in the biologic era","volume":"57","author":"Geltzeiler","year":"2014","journal-title":"Dis Colon Rectum"},{"key":"2025030423520045600_zrae111-B5","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1097\/01.MIB.0000197547.80558.59","article-title":"Revolution and evolution: 30 years of ileoanal pouch surgery","volume":"12","author":"Bach","year":"2006","journal-title":"Inflamm Bowel Dis"},{"key":"2025030423520045600_zrae111-B6","first-page":"CD006267","article-title":"Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis","volume":"1","author":"Ahmed 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colitis: a modified single stapled technique","volume":"18","author":"de Buck van Overstraeten","year":"2016","journal-title":"Colorectal Dis"},{"key":"2025030423520045600_zrae111-B10","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1007\/s00464-019-06674-5","article-title":"The current state of the transanal approach to the ileal pouch-anal anastomosis","volume":"33","author":"de Lacy","year":"2019","journal-title":"Surg Endosc"},{"key":"2025030423520045600_zrae111-B11","first-page":"1225","article-title":"Decreasing colectomy rate for ulcerative colitis in the United States between 2007 and 2016: a time trend analysis","volume":"26","author":"Barnes","year":"2020","journal-title":"Inflamm Bowel Dis"},{"key":"2025030423520045600_zrae111-B12","doi-asserted-by":"crossref","first-page":"2928","DOI":"10.1111\/ans.18713","article-title":"Reducing rate of total colectomies for ulcerative colitis but higher morbidity in the biologic era: an 18-year linked data study from New South Wales Australia","volume":"93","author":"Giddings","year":"2023","journal-title":"ANZ J Surg"},{"key":"2025030423520045600_zrae111-B13","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"key":"2025030423520045600_zrae111-B14","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1111\/codi.13802","article-title":"Pouch failures following ileal pouch-anal anastomosis for ulcerative colitis","volume":"20","author":"Mark-Christensen","year":"2018","journal-title":"Colorectal Dis"},{"key":"2025030423520045600_zrae111-B15","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.crohns.2014.08.012","article-title":"European evidence based consensus on surgery for ulcerative colitis","volume":"9","author":"\u00d8resland","year":"2015","journal-title":"J Crohns Colitis"},{"key":"2025030423520045600_zrae111-B16","doi-asserted-by":"crossref","first-page":"e074","DOI":"10.1097\/AS9.0000000000000074","article-title":"Ileal pouch-anal anastomosis complications and pouch failure: a systematic review and meta-analysis","volume":"2","author":"Heuthorst","year":"2021","journal-title":"Ann Surg Open"},{"key":"2025030423520045600_zrae111-B17","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1097\/DCR.0000000000001404","article-title":"Increasing incidence of pelvic sepsis following ileal pouch-anal anastomosis for ulcerative colitis in Denmark: a nationwide cohort study","volume":"62","author":"Mark-Christensen","year":"2019","journal-title":"Dis Colon Rectum"},{"key":"2025030423520045600_zrae111-B18","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1097\/DCR.0000000000001629","article-title":"Conditional survival after IPAA for ulcerative and indeterminate colitis: does long-term pouch survival improve or worsen with time?","volume":"63","author":"Feinberg","year":"2020","journal-title":"Dis Colon Rectum"},{"key":"2025030423520045600_zrae111-B19","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1093\/ecco-jcc\/jjz093","article-title":"Endo-sponge assisted early surgical closure of ileal pouch-anal anastomotic leakage preserves long-term function: a cohort study","volume":"13","author":"Wasmann","year":"2019","journal-title":"J Crohns Colitis"},{"key":"2025030423520045600_zrae111-B20","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1097\/DCR.0000000000000282","article-title":"National trends of 3- versus 2-stage restorative proctocolectomy for chronic ulcerative colitis","volume":"58","author":"Bikhchandani","year":"2015","journal-title":"Dis Colon Rectum"},{"key":"2025030423520045600_zrae111-B21","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1007\/s00384-017-2836-2","article-title":"Total abdominal colectomy vs. restorative total proctocolectomy as the initial approach to medically refractory ulcerative colitis","volume":"32","author":"Gu","year":"2017","journal-title":"Int J Colorectal Dis"},{"key":"2025030423520045600_zrae111-B22","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1097\/DCR.0b013e3182a0e702","article-title":"Operative strategy modifies risk of pouch-related outcomes in patients with ulcerative colitis on preoperative anti-tumor necrosis factor-alpha therapy","volume":"56","author":"Gu","year":"2013","journal-title":"Dis Colon Rectum"},{"key":"2025030423520045600_zrae111-B23","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1186\/s12893-019-0657-7","article-title":"Is diverting loop ileostomy necessary for completion proctectomy with ileal pouch-anal anastomosis? A multicenter randomized trial of the GETAID Chirurgie group (IDEAL trial): rationale and design (NCT03872271)","volume":"19","author":"Beyer-Berjot","year":"2019","journal-title":"BMC Surg"},{"key":"2025030423520045600_zrae111-B24","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1111\/codi.16836","article-title":"Routine diversion following delayed IPAA construction does not reduce the incidence of pouch-related sepsis or failure in patients with ulcerative colitis","volume":"26","author":"Pooni","year":"2024","journal-title":"Colorectal Dis"},{"key":"2025030423520045600_zrae111-B25","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1093\/ecco-jcc\/jjv201","article-title":"Defunctioning ileostomy is not associated with reduced leakage in proctocolectomy and ileal pouch anastomosis surgeries for IBD","volume":"10","author":"Sahami","year":"2016","journal-title":"J Crohns Colitis"},{"key":"2025030423520045600_zrae111-B26","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1111\/codi.13699","article-title":"Restorative proctocolectomy: an example of how surgery evolves in response to paradigm shifts in care","volume":"19","author":"Remzi","year":"2017","journal-title":"Colorectal Dis"},{"key":"2025030423520045600_zrae111-B27","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.cgh.2022.04.015","article-title":"Increasing incidence of pouchitis between 1996 and 2018: a population-based Danish cohort study","volume":"21","author":"Barnes","year":"2023","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2025030423520045600_zrae111-B28","doi-asserted-by":"crossref","first-page":"848","DOI":"10.14309\/ajg.0000000000002099","article-title":"Increased proportion of colorectal cancer in patients with ulcerative colitis undergoing surgery in The Netherlands","volume":"118","author":"Heuthorst","year":"2023","journal-title":"Am J Gastroenterol"},{"key":"2025030423520045600_zrae111-B29","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1111\/codi.15231","article-title":"Increasing experience of modified two-stage transanal ileal pouch-anal anastomosis for therapy refractory ulcerative colitis. What have we learned? A retrospective analysis on 75 consecutive cases at a tertiary referral hospital","volume":"23","author":"Bislenghi","year":"2021","journal-title":"Colorectal Dis"}],"container-title":["BJS Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/9\/1\/zrae111\/61557150\/zrae111.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/9\/1\/zrae111\/61557150\/zrae111.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T23:52:21Z","timestamp":1741132341000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjsopen\/article\/doi\/10.1093\/bjsopen\/zrae111\/7972470"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,30]]},"references-count":29,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,12,30]]}},"URL":"https:\/\/doi.org\/10.1093\/bjsopen\/zrae111","relation":{},"ISSN":["2474-9842"],"issn-type":[{"value":"2474-9842","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,2]]},"published":{"date-parts":[[2024,12,30]]},"article-number":"zrae111"}}