SSAT Home  |  Past Meetings
Society for Surgery of the Alimentary Tract

Back to 2022 Abstracts


PREDICTORS OF POUCH FAILURE: A TERTIARY CARE IBD CENTER EXPERIENCE
Alison Ricardo*, Maia Kayal, Michael C. Plietz, Sergey Khaitov, Patricia Sylla, Marla C. Dubinsky, Alexander Greenstein
Gastroenterology, Icahn School of Medicine Mount Sinai Hospital, New York, NY

Background: Approximately 15% of patients with ulcerative colitis (UC) require surgery during their disease course, most commonly the staged total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA). Pouch failure occurs in 5-10% of patients and is defined as either pouch excision or permanent intestinal diversion. The aim of this study was to investigate the incidence and associated risk factors of pouch failure in a single, tertiary care center.
Methods: Data was obtained from an institutional database containing UC or IBD-Unspecified (IBDU) patients who underwent IPAA for medically refractory disease or dysplasia between 2008 and 2017. Patients <18 years old or with a baseline diagnosis of Crohn's disease before colectomy were excluded. The primary outcome was pouch failure. Descriptive statistics were performed to describe baseline characteristics of the study population and are reported as proportions or medians (with interquartile range, IQR) for categorical and continuous variables. Univariable and multivariable cox regression for the primary outcome of pouch failure was performed. Hazard ratios (HR) and 95% confidence intervals (CI) are reported.
Results: A total of 667 patients were included, of which 51 (7.7%) underwent one-stage, 172 (25.8%) underwent two-stage, 67 (10.0%) underwent modified-two-stage, and 377 (56.5%) underwent three-stage IPAA. Pouch failure occurred in 36 (5.4%) patients a median 2.0 [IQR 1.2-4.9] years after final surgical stage. Surgical revision was attempted in 14 (38. 9%) patients before eventual pouch failure. Of the 36 patients who experienced pouch failure, 16 (44.4%) underwent pouch excision and 20 (55.6%) underwent permanent diverting ileostomy construction. The main indications for pouch failure were Crohn's disease-like pouch inflammation (CDLPI) (n=16, 44.4%), chronic pouchitis and/or cuffitis (n=8, 22.2%), post-operative complications such as anastomotic leak or pouch dehiscence (n=3, 8.3%), and anastomotic stricture (n=2, 5.6%).
Complications within the immediate post-operative 30 days occurred in 316 (47.6%) patients, specifically in 23 (63.9%) patients who later had pouch failure. Among all patients, the most common 30-day complications were obstruction (n=129, 40.8%), abscess (n=65, 20.6%), leak (n=44, 13.9%), and portomesenteric venous thrombosis (n=42, 13.3%). CDLPI occurred in 64 (9.6%) patients, specifically in 16 (44.4%) who later had pouch failure.
On multivariable analysis, CDLPI (HR 4.3 CI 2.1-8.8) was significantly associated with an increased risk of pouch failure. Age, gender, and postoperative complications within 30 days were not associated with an increased risk of pouch failure (Table 1).
Conclusions: CDLPI is significantly associated with an increased risk of pouch failure. Reassuringly, postoperative complications within 30 days do not seem to increase the risk of pouch failure.



Back to 2022 Abstracts