Abstracts
1999 Digestive Disease Week

# 2087 CAN PREOPERATIVE EXTENT OF CHRONIC ULCERATIVE COLITIS PREDICT POSTOPERATIVE POUCH FUNCTION?
I Hassan, A F Horgan, Santhat Nivatvongs, D R Larson, D M Ilstrup, Mayo Clin, Rochester, MN

INTRODUCTION: In recent years it has been suggested that chronic ulcerative colitis (CUC) is not an uniform disease entity, as the clinical pattern and characteristics differ, based upon the anatomic location of the inflammation. However the impact of this differential colonic involvement in patients who subsequently under go ileal pouch anal anastomosis (IPAA) is unclear.
AIM: The aim of this study was to compare the post operative complications and long term functional outcome of IPAA in patients with pancolitis to those with limited colitis:
METHODS: Data was collected from clinical and pathological records as well as an IPAA database. Patients were grouped into pancolitis and limited colitis, which included extended left colitis (i.e. distil to the hepatic flexure) and left sided colitis (i.e. distil to the splenic flexure).
RESULTS: Between 1990 and 1995, 508 patients underwent IPAA. 169 were determined to have pancolitis, while 85 had limited involvement of the colon, which included 57 with extended-left and 28 with left sided colitis. The mean age, gender, duration of follow-up, pouch design and use of diverting ileostomy for both groups were similar. The rate of complications increased in inverse proportion to the extent of colonic disease, with fewer overall complications in patients with pancolitis compared to those with limited colitis (24.2% vs. 38.7.4%, p=0.02). This included obstruction (8.6% vs. 17.5%, p=0.04), abscess (0.6% vs 6.2%, p=0.01) and fistula formation (0.0% vs 4.2%, p=0.01). In regards to long term functional results, no differences in medication use (45.5% vs. 42.7%, p=0.68), daytime and nighttime incontinence (7.0% vs. 8.8%, p=0.26), frequency of stools per day (5.3 vs. 5.5, p=0.73), and incidence of pouchitis (39.4% vs. 28.7%, p=0.48) were found. In terms of quality of life assessment, patients with left sided colitis noted increased sexual dysfunction (p=0.001) and decreased improvement in their social activities (p=0.001) post operatively.
CONCLUSIONS: We were unable to detect any relationship between the extent of colon involvement and subsequent long term pouch function and pouchitis. Patients with limited colitis have an increased number of post op complications and a significantly less improvement in social and sexual function post-operatively

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