Long-Term Outcomes in Indeterminate Colitis Patients Undergoing Ileal Pouch-Anal Anastomosis: Function, Quality of Life, and Complications.
It is uncertain whether the outcomes of patients with indeterminate colitis (IC) undergoing ileal pouch-anal anastomosis (IPAA) deteriorate over time. The aim of this study was to determine the long-term pouch function, quality of life, complications, and incidence of Crohn's disease after IPAA for patients with IC compared to ulcerative colitis (UC).



A case matched analysis was performed on patients undergoing IPAA for pathologically confirmed IC or UC, between 1985 and 2014. Patients were case matched for age ± 5 years, gender, date of surgery ± 3 years, type of anastomosis and presence of a diverting loop ileostomy. All patients were followed up for greater than six months.



448 patients were case matched, the average age was 36.8 year old and 52.7 % of patients were male. Mean follow-up was 122.06 months (+/- 80.77 months). There were statistically and clinically comparable number of daytime bowel movements (5.7 v 5.5, p = 0.45), rates of incontinence (26.1 % v 18.3 %, p = 0.09) and nighttime seepage in patients (23.1 % v 28.4 %, p = 0.28) with IC and UC. Quality of life markers and patient restrictions were comparable between the two groups. Rates of pelvic sepsis (IC 8.5 %, UC 8.5 %, p = 0.99) and anastomotic leak (IC 3.1 %, UC 4.0 %, p = 0.61) were similar but fistula formation (IC 15.6 %, UC 8.0 %, p = 0.01) and IPAA Crohn's disease rates (IC 6.7 %, UC 2.7 %, p = 0.04) were significantly increased in IC patients. There was no statistically significant difference in pouch failure rates for IC and UC (5.8 % vs.4.9 %, p = 0.58).



Patients undergoing IPAA for IC have a higher risk of post-operative fistulae and development of Crohn's disease, but comparable morbidity, functional outcomes, quality of life scores and pouch failure rates when compared to UC patients. Long-term data confirms that IPAA is a good surgical option in patients with IC.
Department of Colorectal Surgery, 9500, Euclid Avenue, A30, Cleveland, OH, 44195, USA. kljackson14@hotmail.com.
Katharine L
KL
Jackson
Department of Colorectal Surgery, 9500, Euclid Avenue, A30, Cleveland, OH, 44195, USA.
Luca
L
Stocchi
Department of Colorectal Surgery, 9500, Euclid Avenue, A30, Cleveland, OH, 44195, USA.
Leonardo
L
Duraes
Department of Colorectal Surgery, 9500, Euclid Avenue, A30, Cleveland, OH, 44195, USA.
Ahmet
A
Rencuzogullari
Department of Pathology, 9500, Euclid Avenue, L25, Cleveland, OH, 44195, USA.
Ana E
AE
Bennett
Department of Colorectal Surgery, 9500, Euclid Avenue, A30, Cleveland, OH, 44195, USA.
Feza H
FH
Remzi
D000328:Adult; D003092:Colitis / Q000175:diagnosis / Q000601:surgery*; D003093:Colitis, Ulcerative / Q000175:diagnosis; D003424:Crohn Disease / Q000175:diagnosis; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000009:adverse effects; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult
Ileal pouch-anal anastomosis; Indeterminate colitis; Outcomes; Quality of life; Restorative proctocolectomy