title: The diameter of the ileal J-pouch-anal anastomosis as an important risk factor of pouchitis - clinical observations.
abstract: BACKGROUND
  Patients' quality of life after restorative proctocolectomy depends on the potential complications. Stricture of the ileal pouch-anal anastomosis is one of the complications following restorative proctocolectomy.
  
  
  METHODS
  We analyzed the correlation between the diameter of the anastomosis and clinical parameters, including pouchitis disease activity index (PDAI), the activity of fecal M2-pyruvate kinase and maximum tolerable volume of the pouch. The study group consisted of 31 patients in whom covering ileostomy had been closed 72 ± 50 months before enrolement to the study. Restorative proctocolectomy for ulcerative colitis or familial adenomatous polyposis coli had been performed in this group.
  
  
  RESULTS
  The study did not show any correlation between the diameter of the anastomosis and primary indication for surgery, the time elapsed after restoration of the bowel continuity, the activity of fecal M2-pyruvate kinase, or maximum tolerable volume. However, meaningful correlations between the stricture of the anastomosis and the presence and activity of pouchitis, together with the ileal villi atrophy, were detected.
  
  
  CONCLUSIONS
  Stricture of the anastomosis appears to be an important factor increasing the incidence of pouchitis, and is independent of the underlying condition and time after the operation. Dilation of the anastomosis and prevention of stricture should constitute a permanent element of postoperative follow-up.
authors.affiliation: Department of General, Gastroenterological and Endocrynological Surgery, K. Marcinkowski University of Medical Sciences, Poznan, Poland. tbanasiewicz@op.pl
authors.forename: Tomasz
authors.initials: T
authors.lastname: Banasiewicz
authors.forename: Ryszard
authors.initials: R
authors.lastname: Marciniak
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Kaczmarek
authors.forename: Wiktor
authors.initials: W
authors.lastname: Meissner
authors.forename: Piotr
authors.initials: P
authors.lastname: Krokowicz
authors.forename: Jacek
authors.initials: J
authors.lastname: Paszkowski
authors.forename: Jarosław
authors.initials: J
authors.lastname: Walkowiak
authors.forename: Przemysław
authors.initials: P
authors.lastname: Majewski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Marszałek
authors.forename: Michał
authors.initials: M
authors.lastname: Drews
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000473:pathology / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001284:Atrophy; D039021:Colonic Pouches / Q000009:adverse effects* / Q000473:pathology*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D019449:Pouchitis / Q000209:etiology*; D016737:Proctocolectomy, Restorative; D012307:Risk Factors