Background:
During the course of their disease, about 30% of patients with ulcerative colitis (uc) will undergo proctocolectomy with ileal pouch-anal anastomosis (ipaa). we evaluated the outcome of ipaa in a belgian referral center.
Methods:
Clinical charts were reviewed for pre- and postoperative disease course, functional outcome, and complications in all patients with uc (n = 182) and indeterminate colitis (n = 2) who underwent ipaa in 1990-2004.
Results:
Follow-up data were available in 173 out of 184 patients (67 female, median age at proctocolectomy 39.0 years). median functional oresland score 1 year after ipaa was 3 (range 0-11). early postoperative complications were seen in 27% of patients. after a median (interquartile range) follow-up of 6.5 (3.4-9.9) years, 35% of patients developed septic and/or obstructive complications. forty-six percent of patients developed at least 1 episode of pouchitis. risk factors for pouchitis were the presence of extraintestinal manifestations (odds ratio [or] 1.92 (1.23-3.01), p = 0.004) and younger age at proctocolectomy (p = 0.004). chronic pouchitis was present in 33 patients and associated with extraintestinal manifestations (or 2.93 (1.13-7.62), p = 0.027), backwash ileitis (or 9.28 (1.71-50.49), p = 0.010), and length of follow-up (p = 0.004). pouch failure occurred in 5% of patients.
Conclusions:
Although proctocolectomy with ipaa surgery has a good functional outcome, postoperative complications, especially pouchitis, remain considerable in patients with uc.