Restorative proctocolectomy with ileal pouch anal anastomosis in obese patients

J. E. Efron, J. P. Uriburu, S. D. Wexner, A. Pikarsky, C. Hamel, E. G. Weiss, J. J. Nogueras

Research output: Contribution to journalArticle

Abstract

Background: Obesity is a relative contraindication to performing restorative proctocolectomy. The aim of this study was to assess the morbidity and functional results after restorative proctocolectomy in obese patients as compared to a matched cohort of non-obese patients. Methods: 334 patients who had restorative proctocolectomy were reviewed; obesity was defined as a body mass index (BMI) greater than or equal to 30 kg/m2. 31 obese patients were matched to 31 non-obese patients for age, gender, steroid use, and diagnosis. Operative time, length of hospitalization, and both perioperative (<6 weeks) and long-term morbidity (>6 weeks), especially sepsis, were evaluated. Results: The BMI was significantly higher in the obese group (33.7 vs 23.2) (p<0.0001), and no difference was found between the obese and non-obese groups relative to the matched parameters of age, gender, steroid use and diagnosis. There was no difference in the rate of mucosectomy performed between the obese and non-obese patients (9.6% vs 3.2%, p=NS). 16% of the obese patients underwent one stage restorative proctocolectomies as compared to 10% in the non-obese group. Operative time was longer in the obese group (229 min vs 196 min; p=0.02), but overall hospital length of stay was similar (9.7 days vs 7.7 days; p=0.13). Perioperative morbidity was higher in obese patients (32% vs 9.6%, p=0.058). However, there was no statistical significance in long-term morbidity (23% vs 32%, p=0.57) at a mean follow-up of 51 months in the obese group and 53 months in the non-obese group. Obese patients had more stomal complications (10 vs 0%) and incisional hernias (13 vs 3%) (p=NS). Overall the pelvic sepsis-rate was significantly higher in the obese group (16 vs 0%; p<0.05). 60% of the obese patients who developed pelvic sepsis had pouch-anal anastomosis performed without proximal fecal diversion. Mean bowel movements/24 hours, pad use, nocturnal evacuation, accidents/24 hours and incontinence scores were not statistically significant between the groups. Conclusion: Obese patients have a higher rate of pelvic sepsis and peri-operative morbidity when compared to a matched non-obese cohort of patients; however, the functional outcome of restorative proctocolectomy in obese patients is not significantly different than in non-obese patients.

Original languageEnglish (US)
Pages (from-to)246-251
Number of pages6
JournalObesity Surgery
Volume11
Issue number3
DOIs
StatePublished - Jul 14 2001
Externally publishedYes

Keywords

  • Ileal pouch anal anastomosis
  • Morbidity
  • Obesity
  • Pouch
  • Restorative proctocolectomy

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

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    Efron, J. E., Uriburu, J. P., Wexner, S. D., Pikarsky, A., Hamel, C., Weiss, E. G., & Nogueras, J. J. (2001). Restorative proctocolectomy with ileal pouch anal anastomosis in obese patients. Obesity Surgery, 11(3), 246-251. https://doi.org/10.1381/096089201321336520