Outcome after proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis.
BACKGROUND
During the course of their disease, about 30% of patients with ulcerative colitis (UC) will undergo proctocolectomy with ileal pouch-anal anastomosis (IPAA). We evaluated the outcome of IPAA in a Belgian referral center.


METHODS
Clinical charts were reviewed for pre- and postoperative disease course, functional outcome, and complications in all patients with UC (n = 182) and indeterminate colitis (n = 2) who underwent IPAA in 1990-2004.


RESULTS
Follow-up data were available in 173 out of 184 patients (67 female, median age at proctocolectomy 39.0 years). Median functional Oresland score 1 year after IPAA was 3 (range 0-11). Early postoperative complications were seen in 27% of patients. After a median (interquartile range) follow-up of 6.5 (3.4-9.9) years, 35% of patients developed septic and/or obstructive complications. Forty-six percent of patients developed at least 1 episode of pouchitis. Risk factors for pouchitis were the presence of extraintestinal manifestations (odds ratio [OR] 1.92 (1.23-3.01), P = 0.004) and younger age at proctocolectomy (P = 0.004). Chronic pouchitis was present in 33 patients and associated with extraintestinal manifestations (OR 2.93 (1.13-7.62), P = 0.027), backwash ileitis (OR 9.28 (1.71-50.49), P = 0.010), and length of follow-up (P = 0.004). Pouch failure occurred in 5% of patients.


CONCLUSIONS
Although proctocolectomy with IPAA surgery has a good functional outcome, postoperative complications, especially pouchitis, remain considerable in patients with UC.
Ferrante
Marc
M
Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium.
Declerck
Sarah
S
De Hertogh
Gert
G
Van Assche
Gert
G
Geboes
Karel
K
Rutgeerts
Paul
P
Penninckx
Freddy
F
Vermeire
Séverine
S
D'Hoore
Andre
A
D000328:Adult; D000367:Age Factors; D000714:Anastomosis, Surgical / Q000379:methods*; D001530:Belgium / Q000453:epidemiology; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019449:Pouchitis / Q000453:epidemiology; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome