S100 Long-Term Outcomes of S-Pouch Configured Ileal Pouch-Anal Anastomosis
Bibliographic record
Abstract
Background: The ileal pouch-anal anastomosis (IPAA) is the gold standard for restoration of intestinal continuity after a total proctocolectomy, with the J-pouch most commonly used. S-pouches are more recently infrequently performed, and often in the setting of mesenteric length problems. We analyzed the indications and outcomes of S-pouches in the prior to and since the 21st century. Methods: A prospectively maintained pouch database (1983 - 2015) was queried to identify patients with an S-pouch with underlying inflammatory bowel disease. The cohort was stratified into groups based on the time of operation: before 2000 (group 1) and after 2000 (group 2). Patients’ demographics, postoperative complications, cumulative Kaplan – Meier pouch survival, function, and quality of life (QoL) were analyzed. Results: A total of 349 patients were identified: group 1 – 314 patients and group 2 – 35 patients. The median follow-up in group 1 was 12 years (16-24) vs 4 (2-10) years in group 2 (P < 0.001). Patients were comparable in terms of age, gender, BMI, and ASA scores (all p>0.05). The histopathological diagnoses were also similar in group 1 (UC 77%, CD 10%, IC 13%) vs group 2 (UC 65%, CD 6%, IC 29%), P = 0.07. The median preoperative duration of IBD was significantly longer in group 2: 11(4 - 18) years vs group 1: 7 (3-11), P < 0.001. Group 1 was treated with steroids more (62% vs 25%, P < 0.001). The majority underwent colectomy for medically refractory disease; however, dysplasia was present more in group 2 (28% vs 14%), P < 0.001. After 2000, the 3-stage approach was utilized more frequently: 18.5% vs 31%; P = 0.01. Single-stage IPAA were more common in group 1 (5% vs 0%), while handsewn anastomoses were more common in group 2: 69% vs 36%, P = 0.003. The majority had challenges reaching the pelvis leading to S-pouch creation with 37% patients in group 2 sighting bulky and short mesentery due to obesity and had proximal stoma creation. The median hospital length of stay was significantly longer in the group 1: 9 (8-11) days compared to group 2: 5 (4-6.5) days, P < 0.001. The overall morbidity was similar between the groups (group 1 vs group 2, 85% vs 74%, P = 0.12). There were significantly more anastomotic separations in group 2: 25% compared to group 1 (5%), P = 0. 001. The rates of anastomotic stricture and fistula were comparable. The estimated Kaplan-Meier pouch survival was better in group 1 compared to group 2: at 1-year (99% vs 90%), 5-years (96% vs 85%), and at 10-years (94% vs 85.3%), respectively, P = 0.001. The number of stools were also comparable between the groups, group 1 vs 2: 6 (4-9) vs 6 (5-9), P = 0.81. The quality of life did not differ in group 2 vs 1: 0.7 (0.6 – 0.9) vs 0.8 (0.7 – 0.9), P = 0.18. Conclusion(s): S-pouches are less frequently used since 2000, with more recent S-pouch construction showing higher rates of leak and pelvic sepsis yet allowing adequate reach to allow pouch construction in most patients.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".