Steroid Therapy Does Not Increase Risk of Ileal Pouch Anal Anastomosis Leak Rates
Abstracts
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PURPOSE: The relationship between steroid therapy and postoperative complications remains controversial. The aim of this study was to assess whether high dose preoperative steroid therapy increases postoperative morbidity in patients undergoing restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA). We hypothesized that more than 20mg of prednisone per day would increase anastomotic complications. METHODS: We reviewed 100 consecutive patients who underwent restorative Proctocolectomy and IPAA for ulcerative colitis, familial adenomatous polyposis, or Crohn's. Factors influencing complications of IPAA were analyzed by univariate analysis. RESULTS: Of the 100 patients, 57 were taking steroids. An overall complication rate of 15% was identified and equally distributed between patients receiving steroids and those not receiving steroids. Four patients had anastomotic leak, 10 had pouch stricture, and one had pouch mucosal prolapse. Overall complication rates had no significant association with sex, age, use of steroid, dose of steroid, presence or absence of protective ileostomy, duration of disease, comorbidity, albumin level, or presence of backwash ileitis. Anastomotic leak specific complication rate was higher in patients who underwent IPAA without protective ileostomy than with ileostomy (14.4% versus 1.41%). Amongst the 4 patients having an anastomotic leak, there was no apparent dose relationship to steroid use. CONCLUSION: Use of high dose steroid therapy in patients undergoing proctocolectomy and IPAA with diversion was not associated with an increased incidence of anastomotic leaks. We could not confirm the previous report or our hypothesis, that the use of prednisone is positively related to anastomotic complications. |
