Abstracts Only
SSAT residents Corner
Find SSAT on Facebook SSAT YouTube Channel Follow SSAT on Twitter
Back to 2007 Program and Abstracts
Complications and Functional Results After Ileoanal Pouch Formation in Obese Patients
Ravi P. Kiran*, Feza H. Remzi, Victor W. Fazio, Ian C. Lavery, Scott a. Strong, James M. Church, Tracy L. Hull
Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH


Objective: Ileoanal pouch formation (IPAA) can be technically challenging in obese patients. We review outcomes after restorative proctocolectomy in patients with a body mass index (BMI) ≥30.
Methods: Retrospective analysis of prospectively accrued data for patients with BMI ≥30 undergoing IPAA. Complications, long term function and quality of life using the Cleveland Global Quality of Life scale (CGQL) determined.
Results: There were 345 patients, mean age 42 years, median BMI 32.7 and 59.4% male. Final pathological diagnosis was inflammatory bowel disease (n=314) and familial adenomatous polyposis (FAP) (n=31). Predominant primary indications were desire for continence after prior colectomy (n=123, 35.7%), steroid dependency/toxicity (n=120, 34.8%), medical treatment failure (n=34, 9.9 %), dysplasia (n=43, 12.3%) and FAP (n=15, 4.3%). 223 patients (64.6%) underwent total proctocolectomy at IPAA while 122 (35.4%) underwent completion proctectomy with J (n=303, 88.3%) or S (n=40, 11.7%) pouch. Anastomosis was stapled in 307 patients (90%) and hand-sewn in 34 (10%). Mucosectomy was performed in 37 patients. 86.4% patients (n=298) underwent diversion proximal to IPAA. One patient died due to anastomotic separation. Estimated risk of complications at 15 years of follow-up was wound infection (19.1%), pouch failure (4.5%), sepsis (9.9%), obstruction (22.3%), fistula (13.4%) and stricture (17.2%). Mean CGQL was 0.78±0.19 six months after surgery and remained stable at 5(0.79±0.17) and 15 years(0.8±0.15). Five years after IPAA most patients did not wear any pads (day: 80%, night: 75.3%). Most denied dietary (79.4%), social (85.2%), work (85.5%) or sexual restrictions (83.2%). 96.6% patients said they would undergo IPAA again and recommended surgery to other patients. At 15 years, most patients did not wear pads (day: 79.5%, night: 68.5%) and the relative number without dietary, social, work or sexual restrictions remained stable.
Conclusions: Although technically demanding, IPAA can be undertaken in obese patients with acceptable morbidity. Good long term functional results and quality of life may be anticipated.


Back to 2007 Program and Abstracts
Quick Links
About the SSAT
Membership
Pay Membership Dues
Meetings & Education
Awards
Foundation
Publications
Advocacy
Donate Today