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Complications and Functional Results After Ileoanal Pouch Formation in Obese Patients
Ravi P. Kiran*, Feza H. Remzi, Victor W. Fazio, Ian C. Lavery, Scott a. Strong, James M. Church, Tracy L. Hull
Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH

Objective: Ileoanal pouch formation (IPAA) can be technically challenging in obese patients. We review outcomes after restorative proctocolectomy in patients with a body mass index (BMI) ≥30.
Methods: Retrospective analysis of prospectively accrued data for patients with BMI ≥30 undergoing IPAA. Complications, long term function and quality of life using the Cleveland Global Quality of Life scale (CGQL) determined.
Results: There were 345 patients, mean age 42 years, median BMI 32.7 and 59.4% male. Final pathological diagnosis was inflammatory bowel disease (n=314) and familial adenomatous polyposis (FAP) (n=31). Predominant primary indications were desire for continence after prior colectomy (n=123, 35.7%), steroid dependency/toxicity (n=120, 34.8%), medical treatment failure (n=34, 9.9 %), dysplasia (n=43, 12.3%) and FAP (n=15, 4.3%). 223 patients (64.6%) underwent total proctocolectomy at IPAA while 122 (35.4%) underwent completion proctectomy with J (n=303, 88.3%) or S (n=40, 11.7%) pouch. Anastomosis was stapled in 307 patients (90%) and hand-sewn in 34 (10%). Mucosectomy was performed in 37 patients. 86.4% patients (n=298) underwent diversion proximal to IPAA. One patient died due to anastomotic separation. Estimated risk of complications at 15 years of follow-up was wound infection (19.1%), pouch failure (4.5%), sepsis (9.9%), obstruction (22.3%), fistula (13.4%) and stricture (17.2%). Mean CGQL was 0.78±0.19 six months after surgery and remained stable at 5(0.79±0.17) and 15 years(0.8±0.15). Five years after IPAA most patients did not wear any pads (day: 80%, night: 75.3%). Most denied dietary (79.4%), social (85.2%), work (85.5%) or sexual restrictions (83.2%). 96.6% patients said they would undergo IPAA again and recommended surgery to other patients. At 15 years, most patients did not wear pads (day: 79.5%, night: 68.5%) and the relative number without dietary, social, work or sexual restrictions remained stable.
Conclusions: Although technically demanding, IPAA can be undertaken in obese patients with acceptable morbidity. Good long term functional results and quality of life may be anticipated.

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