title: Early and late surgical outcomes of ileal pouch-anal anastomosis within a defined population in Sweden.
abstract: OBJECTIVE
  Ileal pouch-anal anastomosis (IPAA), has become the procedure of choice in patients requiring reconstructive surgery for ulcerative colitis or familial adenomatous polyposis. The aim of this population-based study was to present data prospectively registered and retrospectively evaluated on the short-term and the long-term results of 124 consecutive IPAA performed chronologically by three surgeons in a single referral centre.
  
  
  METHODS
  All patients who underwent IPAA from 1993 to 2012 were included. Early and late morbidity and mortality were evaluated.
  
  
  RESULTS
  Early complications were observed in 25 patients. There was one death from cardiac failure, high output stoma occurred in six patients and wound infection occurred in four patients. Complications were associated with higher BMI (P=0.032). Four patients had to be reoperated. Peroperative bleeding was reduced when using an ultrasonically activated scalpel for the perimuscular dissection (P<0.00001). Clavien-Dindo grade III-V affected five patients. Only one patient developed anastomotic leak and septic complications.Late complications occurred in 61 patients. There was no procedure-related mortality. Pouchitis was the most common complication (n=37). Primary sclerosing cholangitis and age younger than 40 years were associated significantly with a three- and two-fold increased risk of pouchitis, respectively. Small bowel obstruction was the second most common complication (n=16), more common in women (P=0.031). The pouch failure rate was low: 2.4%. Clavien-Dindo grade III-V affected 13 patients.
  
  
  CONCLUSIONS
  In the hands of experienced high-volume surgeons, IPAA is a safe procedure associated with a relatively low early morbidity as well as an acceptable late morbidity.
authors.affiliation: Colorectal Unit, Department of Surgery and Urology, Eskilstuna County Hospital, Eskilstuna, Sweden.
authors.forename: George
authors.initials: G
authors.lastname: Dafnis
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D003093:Colitis, Ulcerative / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019449:Pouchitis / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome