Post-Procedural Gain in Body Mass Index Is Associated With the Risk of Pouch Anastomotic Sinus Recurrences

Abstract

Introduction: Excessive gain in body mass index (BMI) is associated with a poor pouch outcome. The aim of this study was to evaluate whether increase in BMI is associated with recurrences of chronic pouch sinus. Methods: All consecutive patients with a pouch sinus successfully treated with either endoscopic sinusotomy or redo surgery from 2006 to 2016 were identified from our IRB approved, prospectively maintained Pouch Registry and Colorectal Surgery Pouch Database. The excessive gain in BMI was defined as an increase in BMI≥10%. The primary outcomes were sinus recurrence. Sinus recurrence was defined as the diagnosis of sinus recurring after 6 months from the inception time. Results: This retrospective study included a total of 171 patients. Sinus recurrence was seen in 48 (28.1%) patients. A higher rate of BMI increase≥10% was found in patients with recurrence (22.9% vs. 8.9%, P=0.01). Consequently, patients with an excessive increase in BMI had a lover recurrence-free survival in Kaplan Meier analysis (P=0.10). In multivariate analysis, excessive BMI increase (odd ratio [OR]: 3.0, 95% confidence interval [CI]: 1.0-9.0) and Crohn's disease of pouch (OR: 2.9, 95% CI: 1.0-8.1) was independently related to sinus recurrence. In patients with a recurrent sinus, a similar healing rate was shared between those who had an excessive increase BMI and those who maintained a relatively stable weight (63.6% vs. 70.3%, P=0.81). However, the recurrent-sinus-related pouch failure rate was higher in patients with excessive weight gain (36.4% vs. 16.2%, P=0.31). Conclusion: Excessive gain in BMI after initial successful pouch sinus treatment is associated with an increased risk for sinus recurrence. Appropriate attention towards weight control may help decrease pouch sinus recurrence.802_A Figure 1. Patient and pouch sinus characteristics.802_B Figure 2. Multivariate analysis for risk factors associated with pouch sinus recurrence.802_C Figure 3. Kaplan Meier curve- recurrence-free survival for patients with and without an increase in body mass index≥10%.