Factors affecting pouch-related outcomes after restorative proctocolectomy.

Gyoung Tae Noh,Kang Young Lee,Jeonghee Han,Nam Kyu Kim,Min Soo Cho,Hyuk Hur,Byung Soh Min,Emiko Mizoguchi

doi:10.1371/journal.pone.0186596

Gyoung Tae Noh, Kang Young Lee + Show 6 more

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https://doi.org/10.1371/journal.pone.0186596

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Journal: PloS one	Publication Date: Oct 19, 2017
Citations: 3	License type: CC BY 4.0

Affiliation: Yonsei University

Abstract

PurposesRestorative proctocolectomy (RPC) with ileal pouch anal anastomosis (IPAA) is the procedure of choice for patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC) despite morbidities that can lead to pouch failure. We aimed to identify factors associated with pouch-related morbidities.MethodsA retrospective analysis of patients who underwent RPC with IPAA was performed. To investigate the factors associated with pouch-related morbidities, patients' preoperative demographic and clinical factors, and intraoperative factors were included in the analysis.ResultsA total of 49 patients with UC, FAP, and colorectal cancer were included. Twenty patients (40.8%) experienced leakage-related, functional, and/or pouchitis-related morbidities. Patients with American Society of Anesthesiologists (ASA) grade 2 or 3 had a higher risk of functional morbidity than those with grade 1. Intraoperative blood loss exceeding 300.0 mL was associated with an increased risk of pouchitis-related morbidity.ConclusionsOur study demonstrated associations of higher ASA grade and increased intraoperative blood loss with poor functional outcomes and pouchitis, respectively.

Highlights

Intraoperative blood loss exceeding 300.0 mL was associated with an increased risk of pouchitis-related morbidity
Our study demonstrated associations of higher American Society of Anesthesiologists (ASA) grade and increased intraoperative blood loss with poor functional outcomes and pouchitis, respectively
Restorative proctocolectomy (RPC) with ileal pouch anal anastomosis (IPAA) is the procedure of choice for patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC), and it is performed in selected cases of dysplasia or carcinoma of the colon or rectum [1, 2]

Summary

Introduction

Restorative proctocolectomy (RPC) with ileal pouch anal anastomosis (IPAA) is the procedure of choice for patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC), and it is performed in selected cases of dysplasia or carcinoma of the colon or rectum [1, 2]. The shift in the surgical paradigm to minimally invasive surgery led to the introduction of a laparoscopic approach to RPC, which had initially been performed via an open approach and accompanied diverting ileostomy. This shift resulted in fewer long-term complications and even the avoidance of diverting ileostomy in select cases [5,6,7]. Pouch failure after IPAA has been reported to occur in 5–10% of patients due to anastomotic complications, pouch dysfunction, recalcitrant pouchitis, and other emergency presentations such as bowel ischemia and obstruction [14, 16,17,18]

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