Analysis on the short-term complications of total proctocolectomy and ileal pouch anal anastomosis in the treatment of ulcerative colitis and familial adenomatous polyposis

Abstract

Objective To investigate the short-term complications and outcomes of the total proctocolectomy (TPC) and ileal pouch anal anastomosis (IPAA) in the treatment of ulcerative colitis (UC) and familial adenomatous polyposis (FAP) . Methods Clinical data of 92 patients with UC or FAP undergoing total proctocolectomy and ileal pouch-anal anastomosis during January 2006 to March 2016 were collected to observe short-term complications within three months after IPAA. Results Thirteen of 92 patients (14.1%) had short-term complications after IPAA. Three patients (3.3%) were complicated with pelvic infection or abscess, who were healed after anti-infection, low pressure rinse of the pelvic cavity with drainage tube, and closure of the distal cavity. Three patients (3.3%) were hemorrhage, including 1 of pouch-anal anastomotic bleeding and 2 of the staple line side bleeding, whose bleeding was stopped after using irrigation of the pouch with adrenaline and thrombin solution for 2 patients and taking out the titanium-screw with endoscope for the other one. Two patients (2.2%) were complicated with strictures within one month and were cured by early anal dilatation. Five patients (5.4%) had pouch-related fistulas, including 2 (2.2%) of pouch-stump leak, 2 (2.2%) of pouch-vaginal fistula and 1 (1.1%) of anastomotic leak, who were cured by closure of distal stoma, lower pressure rinse of pelvic cavity with drainage tube, and rectovaginal rinsing. Conclusions The morbidity of short-term complication of TPC-IPAA in the treatment of UC and FAP is low. Pouch-related fistula is the most common complication with good prognosis. Key words: Total proctocolectomy; Ileal pouch-anal anastomosis; Ulcerative colitis; Familial adenomatous polyposis; Complication