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Long-Term Outcomes in Indeterminate Colitis Patients Undergoing Ileal Pouch-Anal Anastomosis: Function, Quality of Life and Complications
Katharine Jackson*1, Luca Stocchi2, Ana Bennett3, Ahmet Rencuzogullari2, Feza H. Remzi2
1Surgery, Confluence Health, Wenatchee, WA; 2Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH; 3Pathology, Cleveland Clinic Foundation, Cleveland, OH
Background: 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 1985-2014. Patients were case matched for age ± 5 years, gender, BMI ± 3, 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 38 year old and 52% of patients were male. Mean follow up was 9.2 years and comparable between the two groups (range 183-9597 days, p=0.82). There were statistically and clinically comparable number of daytime bowel movements (5.5 v 5.0, p=0.50), rates of incontinence (18% v 6.5%, p=0.09) and nighttime seepage in patients (23.1% v 19.6%, p=0.67) with IC and UC. The Cleveland Global Quality of Life score was statistically higher in the UC patients, but other quality of life markers were similar (Table). Rates of pelvic sepsis (IC 8.5%, UC 8.5%, p=0.99) and anastomotic leak (IC 4.5%, UC 1.8%, p=0.10) were similar but fistula formation was significantly increased in IC patients (IC 13.8%, UC 7.6%, p=0.03). There was no statistically significant difference in IPAA Crohn's disease rates for IC and UC (5.8% vs.2.9%, p=0.16).
Conclusions: Patients undergoing IPAA for IC have a higher risk of postoperative fistulae, but comparable morbidity, functional outcomes, Crohn's disease and quality of life scores when compared to UC patients. Long-term data confirms that IPAA is a good option in patients with IC.
Quality of Life in IC and UC Patients Undergoing IPAA
| | Indeterminate Colitis | Ulcerative Colitis | p value | | Quality of Life (0-10) | 8.2 | 7.7 | 0.18 | | Quality of Health (0-10) | 7.8 | 7.7 | 0.91 | | Level of Energy (0-10) | 6.8 | 7.0 | 0.43 | | CGQL Score (0-1) | 0.2 | 0.3 | 0.04 | | Experience Social Restrictions (%) | 10 | 14 | 0.53 | | Happy to Undergo IPPA Again (%) | 91 | 100 | 0.07 |
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