Risk Factors for the Development of Complications of Ileal Pouch in Patients With Ulcerative Colitis

Abstract

AIM: to reveal risk factors of complications after ileal pouch-anal anastomosis (IPAA) in ulcerative colitis (UC).PATIENTS AND METHODS: from September 2011 by July 2018, 144 patients, who underwent IPAA surgery for UC were included in the study. Univariate and multivariate analyses were performed to reveal the risk factors for complication of IPAA, such as pouchitis, cuffitis, pouch fistulas, anastomotic stricture, pouch leakage, bleeding from IPAA, incontinence and small bowel obstruction (SBO).RESULTS: multivariate regression analysis showed that left-sided UC (OR=12,5, 95% CI 1,7-92, p=0,01), patient's age ≤33 years (OR=5,7, 95% CI 1,54-21,3, p=0,009) and hormone-free period before the IPAA ≤10 months (OR=6,86, 95% CI 1,49-31,56, p=0,01) were associated with cuffitis. The fibrotic changes/wound infection in the anal canal (OR=5,02, 95% CI 1,02-24,69, p=0,04) and albumin <35 g/l (OR=8,11, 95% CI 2,12-30,99, p=0,002) were associated with fistulas. Time between IPAA formation and preventive ileostomy closure >5,6 months was associated with SBO (OR=2,82, 95% CI 1,01-8,31, p=0,0495). Steroid therapy at the time of IPAA surgery was associated with pouch leakage (OR=15,62, 95% CI 2,09116,64, p=0,007). Hand-sewn IPAA (OR=42,54, 95% CI 3,51-516,43, p=0,003) were associated with incontinence. Ulcerative defects in the distal part of the rectum according to transrectal ultrasound were associated with anastomotic stricture (OR=10,46, 95% CI 1,52-71,75, p=0,017). There were no statistically significant risk factors for pouchitis and IPAA bleeding.CONCLUSION: determination of the risk factors for complications of IPAA is a crucial clinical issue for patients with UC. We identified several factors associated with increased risk of complications after pouch formation. Nevertheless, it seems promising to continue the study in order to create the mathematical model that predicts the development of a specific pouch-related complication and determines a group of patients with UC in whom the formation of IPAA is not recommended due to high risk of complications and impaired quality of life.