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Risk factors for failure of ileal pouch-anal anastomosis in patients with refractory ulcerative colitis

  • Jan P. Frese
    Correspondence
    Reprint requests: Jan P. Frese, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of General, Visceral, and Vascular Surgery, Berlin, Germany, Hindenburgdamm 30, 12200 Berlin, Germany.
    Affiliations
    Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Department of General, Visceral, and Vascular Surgery, Berlin Institute of Health, Berlin, Germany
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  • Jörn Gröne
    Affiliations
    Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Department of General, Visceral, and Vascular Surgery, Berlin Institute of Health, Berlin, Germany

    Department of General and Visceral Surgery, St. Joseph Krankenhaus, Berlin, Germany
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  • Johannes C. Lauscher
    Affiliations
    Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Department of General, Visceral, and Vascular Surgery, Berlin Institute of Health, Berlin, Germany
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  • Frank Konietschke
    Affiliations
    Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Biometrics and Clinical Epidemiology, Berlin, Germany
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  • Martin E. Kreis
    Affiliations
    Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Department of General, Visceral, and Vascular Surgery, Berlin Institute of Health, Berlin, Germany
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  • Claudia Seifarth
    Affiliations
    Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Department of General, Visceral, and Vascular Surgery, Berlin Institute of Health, Berlin, Germany
    Search for articles by this author
Published:August 12, 2021DOI:https://doi.org/10.1016/j.surg.2021.07.004

      Abstract

      Background

      Proctocolectomy with ileal pouch-anal anastomosis is the standard surgical procedure for ulcerative colitis refractory to medical treatment. In a few cases, ileal pouch-anal anastomosis cannot be completed due to intraoperative technical problems. The aim of this single-center study was to identify risk factors for a technically failed ileal pouch-anal anastomosis.

      Methods

      In total, 391 patients with ulcerative colitis who received ileal pouch-anal anastomosis were identified. Clinical and perioperative data from patients with successful ileal pouch-anal anastomosis (IPAA+) were compared to data from failed ileal pouch-anal anastomosis (IPAA-). Definition of failed ileal pouch-anal anastomosis was intraoperative failure to perform ileal pouch-anal anastomosis. Risk factors for failed ileal pouch-anal anastomosis were assessed by logistic regression. Cut-off values were calculated on the basis of receiver operating characteristic curves and the Youden Index.

      Results

      The rate of failed ileal pouch-anal anastomosis was 26 of 391 (6.6%). In 22 of 26 cases (84.6%), there was an insufficient length of the small intestinal mesentery. Patients with failed ileal pouch-anal anastomosis were more often male (80.8% vs 54.5%, P = .009), older (47.1 ± 14.1 vs 39.2 ± 12.8 years, P = .007), had a higher body mass index 27.2 ± 4.5 vs 23.7 ± 4.3 kg/m2, P < .001), and had extraintestinal manifestations more frequently (65.4% vs 26.3%, P < .001). Further risk factors for failed ileal pouch-anal anastomosis were hypertension and Cushing’s syndrome.

      Conclusion

      Technical failure of ileal pouch-anal anastomosis is elevated in patients with higher body mass index, with refractory ulcerative colitis, and/or extended immunosuppressive medication. Three-staged ileal pouch-anal anastomosis and optimizing preoperative conditions may help to elevate the rate of successful ileoanal pouch construction in these patients.
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