Appropriate J-pouch volume associated with improved clinical outcomes and long-term quality of life in patients with ulcerative colitis after ileal pouch-anal anastomosis: results from China UC Pouch Center Union.

BACKGROUND/AIMS: A well-functioning and well-constructed pouch is crucial for the long-term quality of life (QOL) in ulcerative colitis (UC) patients after ileal pouch-anal anastomosis (IPAA). What pouch volume is appropriate to construct to maintain satisfactory pouch function for better long-term prognosis remains unknown.

METHODS

UC patients who underwent IPAA from January 2008 to January 2024 in our pouch surgery centers affiliated with the China UC Pouch Center Union were enrolled. The primary outcomes were the occurrence of postoperative complications and impaired long-term QOL.

RESULTS

A total of 222 eligible UC patients with a median follow-up time of 8.0 years (interquartile range, 4.0-10.3 years) were enrolled. Among the patients, 117 (52.7%) had a pouch with volume <120 mL, whereas 105 (47.3%) had a pouch volume ≥120 mL. We found that patients with pouch volume ≥ 120 mL were more likely to achieve significantly improved long-term QOL (P= 0.013), better bowel function (P= 0.030) as well as have decreased risk of late postoperative complications (P= 0.005), mainly presented as pouchitis (P= 0.039). Furthermore, we demonstrated that a small pouch with volume < 120 mL is an independent risk factor for the development of late postoperative complications (odds ratio, 2.157; P= 0.013) and impaired long-term QOL (odds ratio, 2.049; P= 0.018).

CONCLUSIONS

A J-pouch volume ≥ 120 mL could be a considerable option for colorectal surgeons in pouch configurations to achieve better long-term prognosis.