The Severity of Rectal Inflammation and Pouch Surgery Outcome in Patients with Ulcerative Colitis: A Retrospective Cohort Study.

BACKGROUND

Pouch failure after ulcerative colitis (UC) necessitates either pouch excision or establishment of a permanent diverting stoma. The aim of this study was to explore if rectal inflammation prior to pouch creation affected the risk of developing pouch failure.

METHODS

Patients 18 years and older with ulcerative colitis undergoing J-pouch surgery at Odense University Hospital between 1983 and 2020 were included. Pouch failure was defined as either the presence of ileostomy more than 1 year after ileo pouch-anal anastomosis (IPAA) or pouch removal. Rectal inflammation was defined by 3 measures: using the Nancy index on pathology examination of the resected rectum, endoscopically using latest Mayo score from the year preceding the IPAA, and as active anti-inflammatory treatment four weeks prior to IPAA.

RESULTS

A total of 434 patients met the inclusion criteria, with 66 patients (15%) experiencing pouch failure with mean time of 5.63 years. Acute inflammation (Nancy grade 2-4) was observed in 70% of the patients. Active anti-inflammatory treatment was observed in 37% of patients, and 67% had undergone endoscopy within 1 year prior to IPAA. No significant association was found between the Nancy Index Grade and pouch failure, time to pouch failure, postoperative complications, or long-term pouch complications. Furthermore, neither the Mayo score grade nor active medical UC therapy predicted the risk of pouch failure.

CONCLUSION

Rectal inflammation prior to IPAA does not increase risk of pouch failure, postoperative complications, or long term pouch dysfunction.