Abstracts
1999 Digestive Disease Week

# 2202 DO PATIENTS WITH "SEVERE" COLITIS HAVE A HIGHER COMPLICATION RATE AFTER ILEAL POUCH-ANAL ANASTOMOSIS (IPAA)?
Merril T Dayton, Kenneth L Larsen, Univ of Utah Sch of Medicine, Salt Lake City, UT

IPAA offers a sphincter-sparing treatment option to patients with ulcerative colitis who have indications for operative therapy. However, the patients who present for surgery have inflammation that covers a broad spectrum with regards to severity of disease. It has been suggested by some authors that patients with "severe" disease who are on high steroids should undergo colectomy only followed by IPAA at a later date when there is less inflammation, no steroid risk and generally improved nutrition. Few series have specifically addressed the above issue. This study was conducted to ascertain whether patients with "severe" colitis (SC) have a higher complication rate and poorer functional outcome after IPAA than those with "mild" colitis (MC). Between 1983 and 1998, 594 patients underwent IPAA at this institution, 516 of which had ulcerative colitis. At the time of admission, all patients underwent flexible sigmoidoscopy and the severity of their disease was classified as "mild", "moderate", or "severe" based on the endoscopic appearance. For the purposes of this study, the patients with SC (121 patients) were compared with those patients with MC (310 patients). Patients with SC had more bleeding (95% v. 84%), rectal pain (15% v. 7%), fever (17% v. 8%), and weight loss (43% v. 23%) than those with MC. Only 1% of SC patients had "no symptoms" compared to 65% of MC patients. Some 69% of SC patients were on high-dose steroids (>40 mg/d) at the time of surgery compared to 45% of MC patients. Patients with SC had a higher WBC (9,900 v. 8,200) and lower serum albumin (3.85 v. 4.12) than the MC group. Surprisingly, operation length, blood loss, and amount of contamination were similar in the two groups. Patients with SC did spend more days in the hospital (11.9 v. 10) postoperatively. Post-IPAA, SC patients had a higher incidence of ileus (17% v. 5%), wound infection (7% v. 2.9%), abdominal abscess (2% v. 0.65%), and stricture (5% v. 1.6%). Post-ileostomy closure, the only differences observed with a higher nonsurgical bowel obstruction incidence (17% v. 8%) and anastomotic leak rate (3% v. 0%) in the MC group. At 9 months post-ileostomy closure, stool frequency, daytime incontinence, and nighttime incontinence were not significantly different between the two groups. We conclude that while there is a slightly higher incidence of some post-operative complications in SC patients after IPAA, the differences are not large and, because there is no difference in functional outcome, IPAA can be safely offered to patients with "severe" ulcerative colitis with expectation of a good outcome.

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