Inflammation of the rectal remnant endangers the outcome of ileal pouch-anal anastomosis: a case–control study View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2022-06-17

AUTHORS

Jan P. Frese, Jörn Gröne, Johannes C. Lauscher, Martin E. Kreis, Benjamin Weixler, Katharina Beyer, Claudia Seifarth

ABSTRACT

BackgroundInflammation of the rectal remnant may affect the postoperative outcome of ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC). We aimed to determine the extent of inflammation in the anastomotic area during IPAA and to investigate the impact of proctitis on postoperative complications and long-term outcomes.MethodsThree hundred thirty-four UC patients with primary IPAA were included in this retrospective case–control study. The histopathologic degree of inflammation in the anastomotic area was graded into three stages of no proctitis (“NOP”), mild to medium proctitis (“MIP”), and severe proctitis (“SEP”). Preoperative risk factors, 30-day morbidity, and follow-up data were assessed. Kaplan–Meier analysis was performed in the event of pouch failure.ResultsThe prevalence of proctitis was high (MIP 40.4%, and SEP 42.8%). During follow-up, the incidence of complications was highest among SEP: resulting in re-intervention (n = 40; 28.2%, p = 0.017), pouchitis (n = 36; 25.2%, p < 0.01), and pouch failure (n = 32; 22.4%, p = 0.032). The time interval to pouch failure was 5.0 (4.0–6.9) years among NOP, and 1.2 (0.5–2.3) years in SEP (p = 0.036). ASA 3, pouchitis, and pouch fistula were independent risk factors for pouch failure.ConclusionProctitis at the time of IPAA is common. A high degree of inflammation is associated with poor long-term outcomes, an effect that declines over time. In addition, a higher degree of proctitis leads to earlier pouch failure. More... »

PAGES

1647-1655

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00384-022-04195-7

DOI

http://dx.doi.org/10.1007/s00384-022-04195-7

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1148759744

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/35713723


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