Prospective Study
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World J Gastroenterol. Jun 21, 2014; 20(23): 7488-7496
Published online Jun 21, 2014. doi: 10.3748/wjg.v20.i23.7488
Complications after ileal pouch-anal anastomosis in Korean patients with ulcerative colitis
Seung-Bum Ryoo, Heung-Kwon Oh, Eon Chul Han, Heon-Kyun Ha, Sang Hui Moon, Eun Kyung Choe, Kyu Joo Park
Seung-Bum Ryoo, Heung-Kwon Oh, Eon Chul Han, Heon-Kyun Ha, Sang Hui Moon, Eun Kyung Choe, Kyu Joo Park, Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, South Korea
Eun Kyung Choe, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 135-984, South Korea
Author contributions: Ryoo SB and Park KJ conceived and designed the study; Ryoo SB, Oh HK, Ha HK, Moon SH, Choe EK and Park KJ conducted the research; Ryoo SB, Han EC and Ha HK collected and analyzed the data; Ryoo SB and Park KJ drafted the manuscript; Ryoo SB, Oh HK, Han EC, Moon SH, Choe EK and Park KJ reviewed and modified the manuscript.
Correspondence to: Kyu Joo Park, MD, PhD, Professor, Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul 110-744, South Korea. kjparkmd@plaza.snu.ac.kr
Telephone: +82-2-20722901 Fax: +82-2-7663975
Received: January 14, 2014
Revised: March 17, 2014
Accepted: May 23, 2014
Published online: June 21, 2014
Abstract

AIM: To investigate the outcomes of treatments for complications after ileal pouch-anal anastomosis (IPAA) in Korean patients with ulcerative colitis.

METHODS: Between March 1998 and February 2013, 72 patients (28 male and 44 female, median age 43.0 years ± 14.0 years) underwent total proctocolectomy with IPAA. The study cohort was registered prospectively and analyzed retrospectively. Patient characteristics, medical management histories, operative findings, pathology reports and postoperative clinical courses, including early postoperative and late complications and their treatments, were reviewed from a medical record system. All of the ileal pouches were J-pouch and were performed with either the double-stapling technique (n = 69) or a hand-sewn (n = 3) technique.

RESULTS: Thirty-one (43.1%) patients had early complications, with 12 (16.7%) patients with complications related to the pouch. Pouch bleeding, pelvic abscesses and anastomosis ruptures were managed conservatively. Patients with pelvic abscesses were treated with surgical drainage. Twenty-seven (38.0%) patients had late complications during the follow-up period (82.5 ± 50.8 mo), with 21 (29.6%) patients with complications related to the pouch. Treatment for pouchitis included antibiotics or anti-inflammatory drugs. Pouch-vaginal fistulas, perianal abscesses or fistulas and anastomosis strictures were treated surgically. Pouch failure developed in two patients (2.8%). Analyses showed that an emergency operation was a significant risk factor for early pouch-related complications compared to elective procedures (55.6% vs 11.1%, P < 0.05). Pouchitis was related to early (35.3%) and the other late pouch-related complications (41.2%) (P < 0.05). The complications did not have an effect on pouch failure nor pouch function.

CONCLUSION: The complications following IPAA can be treated successfully. Favorable long-term outcomes were achieved with a lower pouch failure rate than reported in Western patients.

Keywords: Ulcerative colitis, Ileal pouch-anal anastomosis, Complications, Pouch failure, Pouch function

Core tip: There has been a recent increase in the number of ileal pouch-anal anastomosis (IPAA) procedures conducted to treat ulcerative colitis in Asian countries, including Korea. However, the reports on the outcomes of IPAA have been lacking. This study investigated the treatment outcomes for complications associated with ileal pouch formation, including pouch failure. The early postoperative complications included pouch bleeding, pelvic abscess, and anastomosis rupture. The late complications included pouchitis, pouch-vaginal fistula, perianal abscess or fistula, and anastomosis stricture. The post IPAA complications were treatable either medically or surgically with a lower pouch failure rate than previously reported from Western countries.