OUTCOME OF POUCH RELATED COMPLICATIONS AFTER ILEAL POUCH-ANAL ANASTOMOSIS

BACKGROUND: Creation of a small intestinal reservoir after ileal pouch -anal anastomosis (IPAA) results in an improved quality of life becaus e of significantly diminished stool frequency. However, a number of co mplications associated with the pouch may jeopardize these sphincter-s paring procedures and occasionally result in permanent ileostomy. This study was conducted to assess the incidence, risk factors, clinical c haracteristics, management strategies, and outcome of pouch-related co mplications after IPAA. METHODS: Data on all patients undergoing IPAA with a J pouch between 1983 and Spring 1997 were prospectively gathere d. Patients with pouch-specific complications were identified, and bot h inpatient and outpatient records analyzed in detail. When necessary, telephone contact was made to update functional data. Other parameter s evaluated included age, gender, diagnosis, medication history, diagn ostic modalities, laboratory values, time course, management strategie s, reoperative procedures, and final results. RESULTS: Some 510 IPAA p rocedures were performed between 1983 and Spring 1997; 87% of patients had inflammatory bowel disease. Operative mortality was 0%. In the en tire series, 27 (5.3%) had complications related to the J pouch. Of th ose, 22 (81%) had ulcerative colitis and were on a mean dose of 32 mg/ day of prednisone. Computed tomography scan made the diagnosis in 18 ( 67%) and the mean white blood cell count on admission was 14,400. In 1 1 (41%), the complications occurred after IPAA whereas in the other 16 (59%) it occurred after ileostomy closure. In 5 (19%), the complicatio n resolved with intravenous antibiotics and percutaneous drainage, and 22 (81%) required reoperation. Proximal (11, or 41%) and distal (8, o r 30%) pouch leaks or cuff abscesses were the most common complication and accounted for 19 (70%) of the complications observed. In this ser ies, 3 patients (11%) had complications severe enough to warrant J pou ch excision, and 1 patient had a permanent ileostomy without excision. Overall pouch excision/failure in this series was 0.78%. CONCLUSION: Complications involving the J pouch are a seemingly unavoidable part o f sphincter-sparing surgery for colonic mucosal diseases. However, if therapy is timely, aggressive, and judicious for these complex patient s, pouch loss should be uncommon and long-term results acceptable. (C) 1997 by Excerpta Medica, Inc.