Forty-three studies (n=9,317) were included: 31 retrospective and 21 prospective observation studies.
Pouch-related complications.
The pooled incidence of pouch failure was 6.8% (95% CI: 5.4, 8.4; based on 8,877 patients in 39 studies) rising to 8.5% (95% CI: 5.4, 13.2; based on 3,198 patients in 11 studies) after more than 5 years' follow-up.
The pooled incidence of pelvic sepsis was 9.5% (95% CI: 8.2, 10.9; based on 9,082 patients in 41 studies), fistula 5.5% (95% CI: 4.3, 7.0; based on 5,120 patients in 30 studies), stricture 9.2% (95% CI: 6.8, 12.4; based on 5,185 patients in 28 studies), sexual dysfunction 3.6% (95% CI: 2.7, 4.7; based on 5,112 patients in 21 studies) and pouchitis 18.8% (95% CI: 15.7, 22.4; based on 7,289 patients in 33 studies).
The most common non-pouch related complication was small bowel obstruction, with a pooled incidence of 13.1% (95% CI: 11.0, 15.7; based on 5,835 patients in 27 studies).
Function (36 studies, n=5,215).
The pooled incidence of severe daytime faecal incontinence was 3.7% (95% CI: 2.8, 2.8; based on 3,914 patients in 27 studies), mild daytime faecal incontinence 17% (95% CI: 12.8, 22.2; based on 4,313 patients in 31 studies) and urge incontinence 7.3% (95% CI: 4.5, 11.6; based on 2,165 patients in 16 studies).
The pooled incidence of night-time faecal incontinence was 13.1% (95% CI: 9.5, 17.9; based on 2,582 patients in 17 studies) for mild incontinence and 4.5% (95% CI: 3.0, 11.6; based on 1,271 patients in 9 studies) for severe incontinence.
The mean defecation frequency was 5.2 per 24 hours (95% CI: 4.4, 6.1; based 3,547 patients in 30 studies) with a night-time frequency of 1.0 (95% CI: 0.6, 1.6; based on 2,950 patients in 20 studies).
Overall, the results of pouch failure and pelvic sepsis were not affected by year of publication, duration of follow-up, sample size, surgical technique and use of a diverting ileostomy.