Ileal pouch-anal anastomosis for ulcerative colitis: a Canadian institution's experience.

Abstract

We aimed to summarize the outcomes of ulcerative colitis (UC) patients receiving an ileal pouch-anal anastamosis (IPAA) over an 11-year period at a high-volume Canadian inflammatory bowel disease (IBD) center. A retrospective chart review was performed for subjects with UC who underwent IPAA between 2002 and 2013. Patient charts were reviewed for demographic data, clinical characteristics, preoperative medical treatment, and surgical outcomes. Univariate and multivariate logistic regression modeling were used to determine significant factors in postoperative outcomes. Seven hundred fifty-eight were included from the IBD database. The median age at the time of surgery was 37.1 (±12.1). Mean preoperative disease duration was 8.1years (±8.7). Three hundred sixty-nine patients (48.7%) had systemic corticosteroids (>15mg/day) within 30days prior to surgery. Of these, 286 patients had high dose (>30mg/day) corticosteroids within 7days of their first surgery. One hundred nine (14.0%) IPAA procedures were performed laparoscopically. Pelvic pouches were created in traditional 2 (n=460) and 3 (n=285) stages; the remainder (n=13) was performed in non-traditional staged operations. Early complications, defined as occurring within the same stay in hospital, consisted of pelvic abscess (n=135, 17.8%), small bowel obstruction (n=134, 17.7%), wound infection (n=108, 14.3%), and deep vein thrombosis (n=33, 4.4%). The overall pouch leak rate was 92 (12.1%). There was one death in our study. The median length of stay was 10.3days (SD6.0). Late complications, defined as occurring after discharge from hospital, consisted of anal stricture (n=55, 7.3%), pouch fistula (n=26, 3.4%), and functional pouch failure (n=7, 0.9%). IPAA has been found to be a safe and effective method of surgical management of UC patients in a high-volume IBD center.