title: Treatment strategy for preventing pouchitis as a postoperative complication of ulcerative colitis: the significance of the management of cuffitis.
abstract: OBJECTIVE
  The aim of this study was to examine the risk factors for and to evaluate strategies for preventing pouchitis as a postoperative complication of ulcerative colitis (UC).
  
  
  METHODS
  A total of 119 cases of UC in which restorative proctocolectomy with an ileal pouch-anal anastomosis (IPAA) was performed at our institution between 2000 and 2012 was investigated; nine patients in whom it was impossible to close the ileostomy due to an intractable anal fistula or pelvic abscess were excluded.
  
  
  RESULTS
  The cumulative risk of developing pouchitis 5 years after IPAA with stoma closure was 31.0%. Significant relationships with pouchitis were found for the surgical indication (p = 0.0126) and surgical method (p = 0.0214). A significant correlation was found between pouchitis and cuffitis. Pouchitis was significantly more common in the cases with cuffitis than in those without (p = 0.0002). There was also a significantly different cumulative incidence observed between the cases with and without cuffitis (p < 0.0001). In addition, pouchitis had a greater tendency to recur in the cases with cuffitis than in those without (p = 0.2730).
  
  
  CONCLUSIONS
  The cumulative incidence rate of pouchitis was 10.6% at 1 year, 15.1% at 2 years and 31.0% at 5 years. Controlling cuffitis is important to prevent pouchitis.
authors.affiliation: Department of Surgery II, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan, hashizou@m3.dion.ne.jp.
authors.forename: Takuzo
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Michio
authors.initials: M
authors.lastname: Itabashi
authors.forename: Shinpei
authors.initials: S
authors.lastname: Ogawa
authors.forename: Tomoichiro
authors.initials: T
authors.lastname: Hirosawa
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Bamba
authors.forename: Sanae
authors.initials: S
authors.lastname: Kaji
authors.forename: Mamiko
authors.initials: M
authors.lastname: Ubukata
authors.forename: Sayumi
authors.initials: S
authors.lastname: Nakao
authors.forename: Shingo
authors.initials: S
authors.lastname: Kameoka
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000473:pathology* / Q000601:surgery; D000714:Anastomosis, Surgical; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D019449:Pouchitis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016737:Proctocolectomy, Restorative / Q000379:methods; D012307:Risk Factors; D055815:Young Adult