Abstracts
2000 Digestive Disease Week

# 2243 Risk of Small Bowel Obstruction (SBO) Following the Pelvic Pouch Procedure (PP).
Anthony R. Maclean, Robin S. McLeod, Erin D. Kennedy, Brenda O’Connor, Davin Mukraj, Helen Macrae, Zane Cohen, Toronto, ON, Canada

Purpose: The aim of this study was to determine the incidence of SBO in patients having a PP, and to identify risk factors for its development. Methods: All patients having a PP at Mount Sinai Hospital (MSH) were included. Data were obtained from the MSH database, patient charts, and a mailed questionnaire. Early SBO was defined as a hospital stay greater than 14 days because of delayed bowel function, or need for re-operation or readmission for SBO within 30 days. All patients readmitted after 30 days with a discharge diagnosis of SBO were included as late SBO. Results: 1137 patients had a PP between 1981 and September1999 (644 males and 493 females; mean age 40.7 years). A total of 330 episodes of SBO were documented in 281 patients over a mean follow-up of 8.7 years (mean 1.17 episodes/patient). 42 patients (15%) had more than one SBO. There were no deaths in the cohort. 162 (49%) of the SBO occurred in the first 30 days (early SBO), while 255 (77 %) occurred in the first post-operative year. The cumulative risk of SBO was 14.2% (95% C.I. 12.2-16.2%) at 30 days, 22.4% (95% C.I. 20-24.8%) at year 1, 27.6% (95%C.I. 24.4-30.8%) at year 5, and 28.9% (95%C.I. 24.1-33.7%) at year 10. The cumulative need for surgery for SBO was 0.6% (95%C.I. 0.2-1%) at 30 days, 2.6% (95%C.I. 1.7-3.5%) at 1 year, 6% (95%C.I. 4.3-7.7%) at 5 years, and 6.4% (95% C.I. 3.8-9%) at 10 years. Seven of the 162 (4.3%) early SBO required laparotomy for management, while 61 of 181 patients (34%) with late SBO required laparotomy. Of the 42 patients who had more than one SBO, 45% required laparotomy, compared to 20.5%(49/239) who had only one SBO. Thirty-one of 128 patients (24%) who had an IAA leak developed SBO, compared to 30% of those with no leak, while 132 of 623 patients (21%) who had had a subtotal colectomy (STC) previously developed SBO, compared to 29% of those whose colectomy was done in conjunction with the PP. 782 of 1137 patients (69%) had an ileostomy created during the PP procedure. Of those with ileostomy, 28% developed a SBO, versus 17% of those with no ileostomy. Conclusion: There is a significant risk of early SBO and SBO up to 1 year following the PP procedure, however most do not require surgical intervention. The long-term risk approaches 30% in this series. Construction of a defunctionning ileostomy is associated with an increased risk of SBO, whereas previous STC and IAA leak have no effect. The need for laparotomy for SBO is much more likely for late SBO to the 5 and 10 year mark, as well as in those patients who develop more than one episode of SBO.