Long-Term Outcomes in Indeterminate Colitis Patients Undergoing Ileal Pouch-Anal Anastomosis: Function, Quality of Life, and Complications

Katharine L. Jackson, Luca Stocchi, Leonardo De Castro Duraes, Ahmet Rencuzogullari, Ana E. Bennett, Feza H. Remzi

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: 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). Methods: 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. Results: 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). Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)56-61
Number of pages6
JournalJournal of Gastrointestinal Surgery
Volume21
Issue number1
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Keywords

  • Ileal pouch-anal anastomosis
  • Indeterminate colitis
  • Outcomes
  • Quality of life
  • Restorative proctocolectomy

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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