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HYSTERECTOMY AND ITS ROLE IN POUCH PATIENTS – A COMPARATIVE COHORT ANALYSIS
Jessica Stockheim
*, Stefan D. Holubar, Faris S. Almadi, Imran Khan, David Liska, Tracy Hull, Hermann Kessler
Colorectal Surgery, Cleveland Clinic, Cleveland, OH
IntroductionTotal abdominal hysterectomy (TAH) is a standard surgical procedure for gynecological conditions.
Pelvic pouch with ileal-anal anastomosis (IPAA) is used for inflammatory bowel disease or familial adenomatous polyposis to maintain intestinal continuity, especially for young patients and women. This study investigates the relationship between TAH and IPAA, focusing on how TAH affects pouch outcomes and performance based on the timing of these procedures.
MethodsRetrospectively, patients who underwent ileal pouch creation between 1985 and 2022 and, at some point, TAH were included. Patients with a colonic pouch were excluded. Comparison of patients who underwent TAH prior to or concurrently with IPAA creation
(cohort B/S) to those who underwent TAH subsequent to IPAA creation
(cohort A) was conducted.
ResultsAmong the 33 patients meeting the inclusion criteria, 18 (54.5%) underwent TAH either prior to (24.2%, 8/33) or simultaneously with (30.3%, 10/33) IPAA creation, while 15 (45.5%) underwent TAH subsequent to ileal pouch creation. Patients of cohort A were significantly younger at pouch creation (p= 0.018). Intraoperative complications occurred equally in both cohorts (p= 0.639). The 30- and 90-days readmission after pouch did not differ between both cohorts (p> 0.9). Pouch complications (p> 0.9) and pouch dysfunction (p= 0.465) did not differ between cohorts, as shown in
Tab. 1. Crohn’s disease of the pouch was more frequent in cohort A (0 vs. 26.7%, p= 0.038). Pouch failure occurred significantly more often in cohort A (0 vs. 33.3%, p= 0.018). The QoL was similar in both cohorts with exception of a significantly higher sexual restriction in cohort A (0 vs. 33.3%, p= 0.038), illustrated in
Fig. 1.
ConclusionAltering the pelvic anatomy by performing TAH in presence of IPAA is correlated with a worse pouch survival and more sexual restriction, yet with an overall good quality of life.
Figure 1: Quality of Life assessment across the domain of "sexual restriction," comparing both groups ("TAH before / silmutaneous with IPAA" (B/S) vs. A "TAH after IPAA")
Table 1: Readmissions and Pouch Follow-up (complications)
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