Outcome Of Ileal Pouch-anal Anastomosis Research Articles

P214 Effects of rectal stump proctitis on short-term postoperative complications after proctectomy and ileal pouch-anal anastomosis for Ulcerative Colitis

Abstract Background Inflammation of the rectal stump (proctitis) after subtotal colectomy with ileostomy for ulcerative colitis (UC) is common. Proctitis may affect the postoperative outcomes of ileal pouch-anal anastomosis (IPAA). This study aims to explore associations between rectal stump proctitis and short-term postoperative complications (POCs) after proctectomy and IPAA for UC. Methods This retrospective single-centre study included patients who underwent proctectomy, IPAA and protective ileostomy for UC from 2000-2023. Data were retrieved from our prospectively-maintained database. Exclusion criteria were dysplasia or cancer (103 pts), missing pathology results (50 pts), undetermined colitis or Crohn’s Disease features at proctectomy (18 pts). All patients underwent three-staged IPAA and were divided into four groups according to the rectal stump proctitis status at pathology: remission, mild, moderate, and severe proctitis. A stepwise binary logistic regression analysis was performed for each short-term outcome. Models included variables with a different distribution according to the outcome (p-value ≤0.1). Results We included 785 patients who underwent proctectomy and IPAA. At pathology, remission was achieved by 162 (20.6%) patients, while proctitis of the rectal stump was mild in 211 (26.9%), moderate in 246 (31.3%), and severe in 166 (21.1%) patients, respectively. Table 1 details population characteristics and outcomes according to the proctitis status. Patients with moderate and severe proctitis received more preoperative biologics and ongoing systemic steroids at surgery. While they underwent previous abdominal surgery less frequently, the laparoscopy rate was lower with a longer postoperative length of stay. At multivariate (Table 2), Medical POCs were independently associated with ongoing antibiotics (OR 2.29 [1.01-5.20] p=0.047) and ASA score≥3 (OR 1.93 [1.11-3.35] p=0.019). Surgical POCs were independently associated with ongoing systemic steroids (OR 2.09 [1.19-3.68] p=0.011, while ongoing antibiotics (OR 0.2 [0.04-0.86] p=0.031) and laparoscopy (OR 0.53 [0.28-1.00] p=0.049) were protective. Intra-abdominal septic complications (IASCs) and abdominal/pelvic abscesses were independently associated with the proctitis status (OR 1.1 [1.06-2] p=0.018 and OR 1.56 [1.08-2.25] p=0.017, respectively). Conclusion Rectal stump proctitis was independently associated with postoperative abdominal and pelvic abscesses and IASCs after proctectomy and IPAA for UC. The association between proctitis and IPAA’s long-term outcomes and pouch failure need to be further explored.

Сomplications and functional outcomes after restorative proctocolectomy with ileal pouch–anal anastomosis in children: A single-center experience

BACKGROUND: Restorative proctocolectomy with ileal pouchanal anastomosis is a prominent treatment for adult patients with ulcerative colitis and familial adenomatous polyposis, with satisfactory functional outcomes. In literature, that technique in pediatric practice is described; however, in the domestic literature, there is no mention of ileal pouchanal anastomosis in children.
 AIM: This study aimed to examine the outcomes of ileal pouchanal anastomosis in pediatric patients.
 MATERIALS AND METHODS: The study comprised 33 patients with an ileal pouchanal anastomosis between January 2019 and June 2023. At the time of the ileal pouchanal anastomosis, the average age was 13 (5) yr. Patients were followed for an average of 17 (14) months.
 RESULTS: Patients with ulcerative colitis underwent three-stage surgical interventions more often than patients with another diagnosis (90% vs. 4%, p 0.0001), and the mean duration of surgery in ulcerative colitis patients was shorter than in patients with polyposis syndromes or total agangliosis: 173 (57) min versus 280 (73) min. Late complications were reported in five (15%) patients undergoing ileal pouchanal anastomosis. After the ileal pouchanal anastomosis, analysis of patient questionnaires revealed that children had satisfactory functional results.
 CONCLUSIONS: Several encouraging studies have confirmed good functional outcomes after ileal pouchanal anastomosis. Our findings suggest that ileal pouchanal anastomosis in children is associated with favorable results.

Long-term behavior and functional outcomes of ileal-pouch anal anastomosis in inflammatory bowel disease with changing phenotype

BackgroundIleal-pouch-anal anastomosis is the operation of choice after proctocolectomy for ulcerative colitis; some patients will develop Crohn’s disease. We aim to determine long-term behavior and outcomes of inflammatory bowel disease–ileal-pouch-anal anastomosis after colectomy, where a specialist gastrointestinal pathologist re-evaluated the initial colectomy specimen. MethodsPatients with inflammatory bowel disease–ileal-pouch-anal anastomosis were identified from a single-surgeon prospective database containing 1,165 patients accrued from 1991 to 2017 and invited to complete pouch-function and quality-of-life assessments. Medical records were used to obtain clinical outcomes and subjective functional assessments for those unable to be contacted. Data were compared between patients with and without histological assessment disagreement and subsequent inflammatory bowel disease behavior subgroups. ResultsFor 138 patients included in the analysis, the median follow-up was 22.5 (range: 5–39) years. A total of 39.1% of patients had histologic diagnostic change after gastrointestinal pathologist review, and 19% and 39% developed Crohn’s disease-like disease behavior at 10- and 20-year follow-ups. Pouch function and quality-of-life scores were similar across diagnostic change subgroups. Pouch failure was higher in Crohn’s-like disease (31.1 vs 13.0%, P < .05). Intestinal continuity was maintained in 68.9% of Crohn’s disease-like patients, 57.9% required biologics. Gastrointestinal pathologist review did not alter the time to new diagnosis (P = .419) or time to pouch failure (P = .320), mean: 11.0 and 11.41 years, respectively. ConclusionWe describe equivocal patient-reported outcomes in patients with ileal-pouch-anal anastomosis and changing histologic and clinical diagnosis. Although pouch excision and biologic use rates are higher, many Crohn’s disease-like patients maintain their pouch. Diagnostic change and pouch failure often occur >10 years after ileal-pouch-anal anastomosis creation. This supports the consideration of ileal-pouch-anal anastomosis after colectomy in carefully selected patients with inflammatory bowel disease, even those with ambiguous histology and the need for close long-term follow-up.

Rectal Cancer and Radiation in Colitis.

Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer. When IBD patients develop a rectal cancer, this should be treated with the same oncological principles and guidelines as the general population. Rectal cancer treatment includes surgery, chemotherapy, and radiation therapy (RT). Many IBD patients will require a total proctocolectomy with an ileal-pouch anal anastomosis (IPAA) and others, restoration of intestinal continuity may not be feasible or advisable. The literature is scarce regarding outcomes of IPAA after RT. In the present review, we will summarize the evidence regarding RT toxicity in IBD patients and review surgical strategies and outcomes of IPAA after RT.

Inflammation of the rectal remnant endangers the outcome of ileal pouch-anal anastomosis: a case–control study

BackgroundInflammation of the rectal remnant may affect the postoperative outcome of ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC). We aimed to determine the extent of inflammation in the anastomotic area during IPAA and to investigate the impact of proctitis on postoperative complications and long-term outcomes.MethodsThree hundred thirty-four UC patients with primary IPAA were included in this retrospective case–control study. The histopathologic degree of inflammation in the anastomotic area was graded into three stages of no proctitis (“NOP”), mild to medium proctitis (“MIP”), and severe proctitis (“SEP”). Preoperative risk factors, 30-day morbidity, and follow-up data were assessed. Kaplan–Meier analysis was performed in the event of pouch failure.ResultsThe prevalence of proctitis was high (MIP 40.4%, and SEP 42.8%). During follow-up, the incidence of complications was highest among SEP: resulting in re-intervention (n = 40; 28.2%, p = 0.017), pouchitis (n = 36; 25.2%, p < 0.01), and pouch failure (n = 32; 22.4%, p = 0.032). The time interval to pouch failure was 5.0 (4.0–6.9) years among NOP, and 1.2 (0.5–2.3) years in SEP (p = 0.036). ASA 3, pouchitis, and pouch fistula were independent risk factors for pouch failure.ConclusionProctitis at the time of IPAA is common. A high degree of inflammation is associated with poor long-term outcomes, an effect that declines over time. In addition, a higher degree of proctitis leads to earlier pouch failure.

A systematic review and meta-analysis of the outcome of ileal pouch-anal anastomosis in patients with ulcerative colitis versus patients with familial adenomatous polyposis.

Ileal pouch-anal anastomosis (IPAA) is commonly used to restore gastrointestinal continuity after surgical treatment of mucosal ulcerative colitis (MUC) and familial adenomatous polyposis (FAP). The aim of the present systematic review was to compare the outcomes of patients with MUC and patients with FAP who underwent IPAA. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review was performed. PubMed, Scopus, and Web of Science were searched through December 2021. Cohort and randomized studies were eligible for inclusion if they directly compared patients with MUC and FAP who underwent IPAA. The main outcome measures were pouch failure, complications, and need for pouch excision or revision. ROBINS-I tool was used to assess the risk of bias across the studies. A random-effect meta-analysis was conducted. Twenty-three studies (9200 patients) were included in this meta-analysis. Seven thousand nine hundred fifty (86.4%) had MUC and 1250 (13.6%) hadFAP. The median age of patients was 33.1years. The male to female ratio was 1.4:1. MUC had higher odds of pouchitis (OR 3.9, 95% CI 2.8-5.4, p < 0.001), stricture (OR 1.82, 95% CI 1.25-2.65, p = 0.002), fistula (OR 1.74, 95% CI 1.18-2.54, p = 0.004), and total complications (OR 1.89, 95% CI 1.3-2.77, p < 0.001) as compared to FAP. Both groups had similar odds of pelvic sepsis, leakage, pouch failure, excision, revision, and fecal incontinence. Although patients with MUC undergoing IPAA may be at a higher risk of developing complications, particularly pouchitis, stricture, and fistula; the ultimate and functional outcome of the pouch is similar to patients with FAP. Pouch failure, excision and revision were similar in the two groups.

P288 Is there any value of preoperative small bowel evaluation in patients with ulcerative colitis about to undergo ileal pouch-anal anastomosis?

Ileal pouch-anal anastomosis (IPAA) is the standard operative approach to ulcerative colitis (UC) patients requiring surgery for medically refractory disease or dysplasia. Despite excellent long-term outcomes, pouchitis or de novo Crohn’s disease (CD) are adverse outcomes that occur frequently after IPAA. Little is known regarding the utility of small bowel evaluation (SBE) before IPAA. The aim of this study was to assess the value of preoperative SBE in predicting adverse outcomes in UC patients undergoing IPAA. Consecutive UC patients undergoing IPAA between 2000 and 2017 were identified. SBE included endoluminal imaging via wireless capsule endoscopy (WCE) or radiographic imaging via small bowel follow through (SBFT), magnetic resonance enterography (MRE), or computed tomography enterography (CTE). Abnormal preoperative imaging alone without other clinical manifestations was not sufficient for the diagnosis of CD or inflammatory bowel disease unclassified (IBDU), both of which were excluded. Adverse outcomes were assessed prospectively and included no pouchitis (NP), acute pouchitis (AP; antibiotic responsive), chronic pouchitis (CP; antibiotic dependent/resistant) or de novo CD (five or more mucosal ulcers proximal to the ileal pouch or perianal complication 3 months after ileostomy closure). Of the 328 study patients, 190 (58%) had preoperative SBE and 138 (42%) had no preoperative SBE. Preoperative SBE included WCE (n = 72), SBFT (n = 64), CTE/MRE (n = 54). Only 19 (10%) patients with preoperative SBE had an abnormal study. Clinical and disease characteristics were not statistically different between patient groups with or without preoperative SBE. After a median follow-up of 41 (range 3–260) months, outcomes included AP (n = 58; 18%), CP (n = 27; 8%) and de novo CD (n = 50; 15%). There was no significant difference in AP, CP, or de novo CD between patient groups with or without preoperative SBE (p = 0.17). Additionally, there were no significant associations between any abnormal preoperative SBE study and the incidence of AP, CP and de novo CD (p = 0.19). Figure 1. Adverse pouch outcomes by imaging result. Nml: normal, Abn: abnormal, WCE: wireless capsule endoscopy, SBFT: small bowel follow through, CT/MRE: computed tomography/magnetic resonance enterography, SBE: small bowel evaluation. All p > 0.05. In this largest to date prospective series investigating the value of preoperative SBE in UC, only 10% of patients had an abnormal study. Outcomes of IPAA were not significantly different between UC patients with or without preoperative SBE, nor were they different between patients with abnormal and normal preoperative SBE. Taken together, there appears to be little value in performing preoperative SBE in UC patients about to undergo IPAA.

P451 Long-term surgical outcome of ileal pouch-anal anastomosis when used for well-defined Crohn’s disease

Crohn’s disease (CD) is considered a contraindication to ileal pouch-anal anastomosis (IPAA). A preliminary study from our group in 17 patients showed the intentional use of IPAA in CD compared with ulcerative colitis patients was associated with a higher incidence of postoperative recurrent disease but no significant difference in pouch failure (Le Q et al., Inflamm Bowel Dis 2013;19:30–6). Using a larger sample size, this study sought to extend these findings in a larger patient cohort followed over a longer postoperative time. A prospective inflammatory bowel disease registry was queried for patients with pre-operative CD undergoing IPAA. Patients were considered to have CD before surgery based on a history of perianal disease, small-bowel disease, perianal disease, pre-treatment skip lesions or non-crypt associated granuloma. Patients were prospectively assessed for pouchitis or CD. Pouchitis (acute and chronic), postoperative CD (pouch inflammation into the afferent limb or pouch fistula) or pouch failure (need for permanent diversion) were assessed. Forty patients with pre-operative CD were identified. CD was diagnosed based on perianal disease (n = 13; 32%), small-bowel disease (n = 10; 25%), pre-treatment skip lesions (n = 10; 25%) and noncaseating granuloma (n = 7; 18%). Indications for surgery were medically unresponsive disease (n = 37;93%) or cancer/dysplasia (n = 3; 8%). After a median follow-up time of 61 (range 2–196) months, pouchitis developed in 11 (28%) patients (acute pouchitis (n = 9), chronic pouchitis (n = 2)). Seventeen (43%) patients developed postoperative recurrent CD in the afferent limb (n = 9), pouch fistulising disease (n = 4) or perianal disease (n = 4). Only one patient (3%) required faecal diversion. The incidence of recurrent CD over time is shown in the figure. This largest-ever report examining the intentional use of IPAA in well-defined CD has shown a high (43%) incidence of postoperative disease. However, there is a low (3%) incidence of ultimate pouch failure. Highly motivated patients with colorectal CD involving the more proximal and/or distal gastrointestinal tract may wish to undergo IPAA and avoid a definitive end ileostomy. Incidence of recurrent Crohns disease after IPAA.

Impact of Prostate Cancer and Its Treatment on the Outcomes of Ileal Pouch-Anal Anastomosis

There are scant published data in the impact of prostate cancer and its treatment on functional outcomes and quality of life (QOL) in patients with ileal pouch-anal anastomosis (IPAA). The aim of the study was to evaluate the influence of prostate cancer and its treatment on functional outcomes and QOL in patients with IPAA. Patients with IPAA with prostate cancer were compared to age and pouch duration-matched controls without prostate cancer in a 1:2 ratio. Pouch function and QOL were compared between pretreatment and posttreatment for prostate cancer as well as between subjects and controls. A total of 30 patients with IPAA with prostate cancer and 60 matched controls were included. Treatment modalities of prostate cancer included prostatectomy (n = 22), brachytherapy (n = 5), watchful waiting (n = 2), and hormonal therapy (n = 1). The median length of follow-up was 6 (interquartile range, 2.7-8) years. Permanent fecal diversion was required in 5 (16.7%) patients with prostate cancer who developed pouch failure, as compared with 2 patients in the control group (P = 0.04). In patients who retained their pouches, the pouch functional outcomes at the latest follow-up were similar to that before prostate cancer treatment and to that of the matched controls, in terms of bowel movements, daytime seepage, nighttime bowel movements, nighttime seepage, and QOL score. The risk of pouch failure may be increased after the diagnosis of prostate cancer with or without treatment. However, for those with retained pouches, their pouch function and QOL did not seem to be adversely affected.

Early and late surgical outcomes of ileal pouch-anal anastomosis within a defined population in Sweden

Ileal pouch-anal anastomosis (IPAA), has become the procedure of choice in patients requiring reconstructive surgery for ulcerative colitis or familial adenomatous polyposis. The aim of this population-based study was to present data prospectively registered and retrospectively evaluated on the short-term and the long-term results of 124 consecutive IPAA performed chronologically by three surgeons in a single referral centre. All patients who underwent IPAA from 1993 to 2012 were included. Early and late morbidity and mortality were evaluated. Early complications were observed in 25 patients. There was one death from cardiac failure, high output stoma occurred in six patients and wound infection occurred in four patients. Complications were associated with higher BMI (P=0.032). Four patients had to be reoperated. Peroperative bleeding was reduced when using an ultrasonically activated scalpel for the perimuscular dissection (P<0.00001). Clavien-Dindo grade III-V affected five patients. Only one patient developed anastomotic leak and septic complications.Late complications occurred in 61 patients. There was no procedure-related mortality. Pouchitis was the most common complication (n=37). Primary sclerosing cholangitis and age younger than 40 years were associated significantly with a three- and two-fold increased risk of pouchitis, respectively. Small bowel obstruction was the second most common complication (n=16), more common in women (P=0.031). The pouch failure rate was low: 2.4%. Clavien-Dindo grade III-V affected 13 patients. In the hands of experienced high-volume surgeons, IPAA is a safe procedure associated with a relatively low early morbidity as well as an acceptable late morbidity.

Su1794 Impact of Prostate Cancer Treatment on the Outcome of Ileal Pouch-Anal Anastomosis

Su1794 Impact of Prostate Cancer Treatment on the Outcome of Ileal Pouch-Anal Anastomosis

Clinical outcome of ileal pouch-anal anastomosis for chronic ulcerative colitis in China

Background The incidence of chronic ulcerative colitis (CUC) in China is remarkably increasing, while little information on surgical treatment has been reported. This study aimed to completely describe and analyze the clinical outcome of restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) for CUC in China. Methods Ninety-five consecutive patients, who suffered CUC and had surgical indications, were carefully selected. All patients underwent IPAA. Data on patient characteristics, surgical indications, surgical details, postoperative complications, functional outcome, and quality of life were collected. Results The mean patient age at the time of the operation was 32 years. Twenty-nine (31%) patients underwent an emergency operation, and 66 (69%) underwent elective procedures. Four patients with severe dysplasia underwent operations, but no carcinoma was histologically confirmed. A two-stage operation was performed in 87 (92%) patients, and a hand-sewn technique was applied in 88 (93%) patients. Sixteen patients (17.0%) experienced early complications, and there was a significant difference between the emergency surgery group and the elective group (31.0% vs. 10.6%, respectively; P&lt;0.01). Five (5.3%) patients developed pouchitis as a late complication. The mean stool frequency after the operation was 4.6 (2-11) during the first 24 hours and 1.5 (0-4) overnight. According to the Kirwan grading scale, 87 (91.8%) patients showed satisfactory anal continence function. The quality of life improved significantly from a preoperative mean value of 0.28-0.61 before ileostomy closure to 0.78 after ileostomy closure (P &lt;0.01) according to the Cleveland Global Quality of Life index. Conclusions IPAA is an effective and safe surgical procedure for patients with CUC in China. However, some characteristics, such as the low incidence of pouchitis, require further study.

Ileal pouch anal anastomosis with modified double-stapled mucosectomy-the experience in China

To investigate the feasibility and long-term functional outcome of ileal pouch-anal anastomosis with modified double-stapled mucosectomy. From January 2002 to March 2011, fourty-five patients underwent ileal pouch anal anastomosis with modified double-stapled mucosectomy technique and the clinical data obtained for these patients were reviewed. Patients with ulcerative colitis (n = 29) and familial adenomatous polyposis (n = 16) underwent ileal pouch-anal anastomosis with modified double-stapled mucosectomy. Twenty-eight patients underwent one-stage restorative proctocolectomy, ileal pouch anal anastomosis, protective ileostomy and the ileostomy was closed 4-12 mo postoperatively. Two-stage procedures were performed in seventeen urgent patients, proctectomy and ileal pouch anal anastomosis were completed after previous colectomy with ileostomy. Morbidity within the first 30 d of surgery occurred in 10 (22.2%) patients, all of them could be treated conservatively. During the median follow-up of 65 mo, mild to moderate anastomotic narrowing was occurred in 4 patients, one patient developed persistent anastomotic stricture and need surgical intervention. Thirty-five percent of patients developed at least 1 episode of pouchitis. There was no incontinence in our patients, the median functional Oresland score was 6, 3 and 2 after 1 year, 2.5 years and 5 years respectively. Nearly half patients (44.4%) reported "moderate functioning", 37.7% reported "good functioning", whereas in 17.7% of patients "poor functioning" was observed after 1 year. Five years later, 79.2% of patients with good function, 16.7% with moderate function, only 4.2% of patients with poor function. The results of ileal pouch anal anastomosis with modified double-stapled mucosectomy technique are promising, with a low complication rate and good long-term functional results.

Ileal Pouch-Anal Anastomosis for Indeterminate Colitis and Crohn's Disease

Although ileal pouch-anal anastomosis (IPAA) is the standard of care surgery for patients with ulcerative colitis, the role of this procedure in patients with indeterminate colitis and Crohn's disease (CD) is more controversial. Recent studies have shown no significant adverse surgical outcome of IPAA in patients with indeterminate colitis. The outcome of IPAA in patients with CD seems to depend on when the diagnosis of CD is established. Although Crohn's colitis patients with bowel inflammation and/or anal disease should not be encouraged to have an IPAA, carefully selected CD patients without small-bowel inflammation or anal disease may safely undergo an IPAA. Patients in whom the diagnosis of CD is made on the basis of the resected colon fare well after IPAA. CD that develops months or years after IPAA has an aggressive disease course, and it seems to respond favorably to biological therapies such as infliximab.

Long‐term functional outcome after restorative proctocolectomy in patients with ulcerative colitis

The aim of this study was to evaluate the long-term functional outcome of ileal pouch-anal anastomosis for ulcerative colitis and to compare symptoms over time. In all, 188 patients were operated with an ileal pouch-anal anastomosis. Short-term functional outcome has previously been evaluated with a symptom questionnaire. The same questionnaire was sent to the 162 patients who were alive and had an intact pouch. A symptom index was studied over time and in relation to early complications and pouchitis. The response rate of the questionnaire was 139/162 at a median of 12.5 (9.5-21) years postoperatively. Overall, the symptom index remained unchanged over time but both the frequency of night-time defaecation and episodes of night-time incontinence increased. Patients' global assessment was unchanged with approximately 80% stating an excellent or a good result. Frequency of pouchitis doubled in 10 years. Symptom index for patients with episodic pouchitis [median 40 (8-89), P = 0.018] and recurrent/chronic pouchitis [71 (8-136), P < 0.001] was higher than in patients without pouchitis [29 (0-105)]. Early complications did not affect the symptom index. The overall functional outcome of ileal pouch-anal surgery for ulcerative colitis is stable over time. Patients' satisfaction with outcome remains high. Pouchitis is a determinant of functional outcome.

Factors Associated With Surgical Outcome of Ileal Pouch-Anal Anastomosis When Intentionally Used in Crohn's Disease

Factors Associated With Surgical Outcome of Ileal Pouch-Anal Anastomosis When Intentionally Used in Crohn's Disease

A Prospective Analysis of Clinical Variables, Serologic Factors, and Outcome of Ileal Pouch-Anal Anastomosis in Patients With Backwash Ileitis

The outcome of ileal pouch-anal anastomosis in patients with backwash ileitis is controversial. We prospectively compared the outcomes of ileal pouch-anal anastomosis in colitis patients with backwash ileitis and colitis patients without backwash ileitis. Consecutive colitis patients undergoing ileal pouch-anal anastomosis were reviewed. All patients were classified after surgery as being either backwash ileitis-positive or backwash ileitis-negative. Serum drawn preoperatively was assayed, using enzyme-linked immunosorbent assay, for anti-Saccharomyces cerevisiae, anti-outer membrane of porin C, anti-CBir1, anti-I2, and perinuclear anti-neutrophil cytoplasmic antibody. Outcomes included acute pouchitis (antibiotic responsive), chronic pouchitis (antibiotic dependent or refractory), or de novo Crohn's disease (small inflammation above the pouch inlet or pouch fistula). Out of 334 patients, 39 (12%) were backwash ileitis-positive. Compared with backwash ileitis-negative patients, backwash ileitis-positive patients had a higher incidence of pancolitis (100% vs 74%; P = .0001), primary sclerosing cholangitis (15% vs 2%; P = .001) and high-level (>100 enzyme-linked immunosorbent assay units/ml) perinuclear anti-neutrophil cytoplasmic antibody expression (29% vs 9%; P = .001). After a median follow-up of 26 months, 53 patients (16%) developed acute pouchitis, 37 (11%) developed chronic pouchitis, and 40 (12%) developed de novo Crohn's disease. There was no significant difference between the backwash ileitis-positive and backwash ileitis-negative patient groups in the incidence of acute pouchitis, chronic pouchitis, or de novo Crohn's disease. There was a significantly higher incidence of pancolitis, primary sclerosing cholangitis, and high-level perinuclear anti-neutrophil cytoplasmic antibody expression in backwash ileitis-positive patients than in backwash ileitis-negative patients. The incidence of acute pouchitis, chronic pouchitis, and de novo Crohn's disease after ileal pouch-anal anastomosis does not differ significantly between backwash ileitis-positive and backwash ileitis-negative patients.

Restorative Proctectomy With Ileal Pouch-Anal Anastomosis in Obese Patients

The aim of this study was to assess outcomes of ileal pouch-anal anastomosis in obese patients compared with a matched cohort of nonobese patients. A review of all obese patients who underwent ileal pouch-anal anastomosis from 1998 to 2008 was performed. Obesity was defined as body mass index >or=30 kg/m. A matched control group of patients with body mass index within 18.5 to 25 kg/m was created. Primary end points included operative time, length of hospital stay, operative blood loss, and early (<or=6 wk) and long-term (>6 wk) postoperative complications. Sixty-five obese patients (mean body mass index, 34.3 +/- 0.51 kg/m) underwent proctectomy with ileal pouch-anal anastomosis or proctocolectomy with ileal pouch-anal anastomosis. Mean body mass index of the control group was 22.45 +/- 0.2 kg/m (P < .0001). The most common diagnosis was mucosal ulcerative colitis (84.6%), followed by familial adenomatous polyposis (13.9%) and Crohn's disease (1.5%). The obese population had a higher incidence of cardiorespiratory comorbidities (P = .044), and a trend for steroid and immunosuppressive therapy (P = .06) preoperatively. Obese patients required longer operative time (P = .001) and longer hospital stay (P = .009). Early postoperative complications were comparable (P > .05). Long-term outcomes were also similar, except for a higher incidence of incisional hernia in the obese group (P = .01). The overall postoperative complication rate in obese patients undergoing ileal pouch-anal anastomosis was similar to a matched nonobese cohort of patients. However, longer operative time, longer length of stay, and a higher rate of incisional hernia were noted in the obese population. Obese patients should be appropriately consulted about these issues before undergoing ileal pouch-anal anastomosis.

Preoperative Wireless Capsule Endoscopy Does Not Predict Outcome After Ileal Pouch-Anal Anastomosis

The extent of preoperative small-bowel mucosal inflammation may be an important predictor of pouchitis after ileal pouch-anal anastomosis. This study examined the value of preoperative wireless capsule endoscopy in predicting outcome of ileal pouch-anal anastomosis in patients with ulcerative colitis or indeterminate colitis. Patients undergoing complete wireless capsule endoscopy before ileal pouch-anal anastomosis were identified. Findings on wireless capsule endoscopy were classified as positive (erosions, ulcers or erythema) or negative. Outcome was assessed prospectively and included no pouchitis, acute pouchitis, chronic pouchitis, or de novo Crohn disease. Patients with acute pouchitis, chronic pouchitis, or de novo Crohn disease were considered to have pouch inflammation. The 68 study patients (48 ulcerative colitis; 20 indeterminate colitis) had a median age of 38 years and included 34 males. Median follow-up time after ileostomy closure was 12 months (range, 3-63 months). Wireless capsule endoscopy was positive in 15 patients (22%) and negative in 53 patients (78%). Pouch inflammation was observed in 23 patients (34%), and included 8 patients with acute pouchitis, 3 patients with chronic pouchitis, and 12 patients with de novo Crohn disease. The incidence of acute pouchitis, chronic pouchitis, de novo Crohn disease, and pouch inflammation in the wireless capsule endoscopy-positive patient group was 7%, 7%, 20%, and 33% compared with 13%, 4%, 17%, and 34% in the wireless capsule endoscopy-negative patient group (all P = NS). There was no statistical association between the results of preoperative wireless capsule endoscopy and outcome after ileal pouch-anal anastomosis in patients with ulcerative colitis or indeterminate colitis. There seems to be little value of wireless capsule endoscopy in the preoperative evaluation of these patients.

A Prospective Evaluation of the Long-Term Outcome of Ileal Pouch-Anal Anastomosis in Patients with Inflammatory Bowel Disease-Unclassified and Indeterminate Colitis

A Prospective Evaluation of the Long-Term Outcome of Ileal Pouch-Anal Anastomosis in Patients with Inflammatory Bowel Disease-Unclassified and Indeterminate Colitis