Predictors of permanent ileostomy after restorative proctocolectomy.
BACKGROUND
Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a surgical approach for ulcerative colitis and familial adenomatous polyposis. This study evaluated predictors of the need for a permanent ileostomy to identify patients at high risk of IPAA failure.


METHODS
This was a retrospective analysis of patients who underwent proctocolectomy and IPAA between 1997 and 2008. A logistic regression model was used for multivariable analysis of potential risk factors.


RESULTS
Proctocolectomy was combined with IPAA in 185 patients, of whom 169 had a loop ileostomy formed. IPAA and ileostomy closure were successful in 162 patients (87.6 per cent). Reasons for not closing the ileostomy included pouch failure (16 patients), patient choice (5) and death (2). Thus one in eight patients had a permanent ileostomy after planned IPAA. Age was the major predictor of the need for a permanent ileostomy in multivariable analysis (P = 0.002) with a probability of more than 25 per cent in patients aged over 60 years. However, advancing age was associated with colitis, co-morbidity, obesity and corticosteroid use.


CONCLUSIONS
The probability of the need for a permanent ileostomy after IPAA increases with age.
Wibmer
A G
AG
Department of General, Visceral, Vascular and Thoracic Surgery, Charité, Campus Benjamin Franklin, Berlin, Germany.
Kroesen
A J
AJ
Gröne
J
J
Slavova
N
N
Weinhold
A
A
Buhr
H J
HJ
Ritz
J-P
JP
D011125:Adenomatous Polyposis Coli / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D003093:Colitis, Ulcerative / Q000503:physiopathology / Q000601:surgery*; D039021:Colonic Pouches; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011475:Prosthesis Failure; D012189:Retrospective Studies; D016896:Treatment Outcome