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IMPACT OF BARIATRIC SURGERY ON ILEAL POUCH ANAL ANASTOMOSIS FUNCTIONAL OUTCOMES
Brian Tang
*, Ece Unal, Pavel Lenkov, Olga Lavryk, Arielle E. Kanters, Jeremy M. Lipman, Andrew Strong, Xiaoxi Feng, Ricard Corcelles, Salvador Navarrete, Ali Aminian, Stefan D. Holubar
Cleveland Clinic, Cleveland, OH
Background:
With the increasing rates of obesity, bariatric surgery is increasingly common, with widely published benefits on overall health, metabolic comorbidities, and surgical risk. These benefits are tangible for patients with history of proctocolectomy and ileal pouch anal anastomosis (IPAA) for medically refractory inflammatory bowel disease or familial adenomatous polyposis. However, the operative and functional outcomes of IPAA in patients with bariatric surgery history (gastric bypass or sleeve gastrectomy) remain relatively underexplored in the literature.
Methods:
We performed a retrospective review of adults who underwent IPAA and bariatric surgery, including sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB), between 1977 and 2023. Data collection included demographics, operative data, complications, pouch survival, and functional outcomes.
Results:
A total of 17 patients with a history of IPAA and bariatric surgery were included. Median age was 58 (24-63) years old, and 7 (41%) were male. All patients underwent 3-stage IPAA creation, with 4 (23.5%) completed laparoscopically. Bariatric surgeries included sleeve gastrectomy (n=12, 71%) and gastric bypass (n=5, 29%). One patient underwent open sleeve gastrectomy, the remaining bariatric surgeries were completed laparoscopically. Most bariatric surgeries (n=14, 82%) were completed prior to IPAA creation, with intention to optimize BMI prior to IPAA. The median days from bariatric surgery to IPAA creation was 369 days. Median BMI at time of data collection was 28.7 (26-32.5) with a median BMI loss of 10.4 (7.2-18.1) after bariatric surgery. Pouch failure, requiring excision of IPAA and creation of end ileostomy, occurred in 3 (18%) SG patients and none in RYGB (p=0.54). Etiology of pouch failure included pouch fistulae (2, 66.7%) and chronic pouchitis (1, 33.3%). There was also no significant difference between the two groups in functional outcomes including frequency of bowel movements, seepage, use of supplemental fiber or bowel stoppers, and pouchitis (Table 1).
Conclusion:
In patients with IPAA who underwent bariatric surgery, there was no significant difference in pouch failure and functional outcomes between SG and RYGB. Despite the technical difficulty of IPAA creation after RYGB, this small case series demonstrates likely safety in the concurrent anatomy of these two procedures, which may benefit patients with increased weight loss as well. Although this case series is small, it has prompted larger studies to examine these outcomes in IPAA patients with bariatric surgery.
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