title: Excessive weight gain is associated with an increased risk for pouch failure in patients with restorative proctocolectomy.
abstract: BACKGROUND
  The aim was to evaluate the impact of weight gain on pouch outcomes after ileostomy closure.
  
  
  METHODS
  Consecutive inflammatory bowel disease patients with ileal pouches followed up at our subspecialty Pouch Center from 2002 to 2011 were studied. The association of excessive weight gain (defined as a 15% increase the index weight) with pouch outcomes were evaluated using univariate and multivariate analyses.
  
  
  RESULTS
  A total of 846 patients met inclusion criteria, with 470 (55.6%) being men. The mean age at the diagnosis of inflammatory bowel disease and at pouch surgery was 27.2 ± 11.9 years and 37.8 ± 12.8 years, respectively. Patients with weight gain more likely had mechanical or surgical complications of the pouch (18.4% versus 12.3%, P = 0.049), Crohn's disease of the pouch (30.6% versus 18.5%, P = 0.001), Pouch Center visits (2.0 [1.0-4.0] versus 2.0 [1.0-3.0], P = 0.008), and postoperative pouch-related hospitalization (21.1% versus 10.6%, P < 0.001). After a median follow-up of 9.0 (interquartile range = 4.0-14.0) years, 68 patients (8.0%) developed pouch failure. In the multivariate analysis, excessive weight gain was an independent risk factor for pouch failure with a hazard ratio of 1.69 (95% confidence interval = 1.01-2.84, P = 0.048) after adjusting for preoperative or postoperative use of anti-tumor necrosis factor biologics, postoperative use of immunosuppressants, Crohn's disease of the pouch, mechanical or surgical complications of the pouch, and postoperative pouch-associated hospitalization.
  
  
  CONCLUSIONS
  Excessive weight gain after closure of the ileostomy is associated with worse pouch outcomes in patients with inflammatory bowel disease. Appropriate weight control may help improve pouch retention.
authors.affiliation: Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Xian-Rui
authors.initials: XR
authors.lastname: Wu
authors.forename: Hong
authors.initials: H
authors.lastname: Zhu
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000150:complications* / Q000473:pathology / Q000601:surgery; D039021:Colonic Pouches / Q000009:adverse effects; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D019449:Pouchitis / Q000209:etiology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D011379:Prognosis; D012307:Risk Factors; D015430:Weight Gain