J Korean Soc Coloproctol.  2008 Aug;24(4):252-259. 10.3393/jksc.2008.24.4.252.

Risk Factors of Pouch Failure after a Restorative Proctocolectomy

• Shin US
• Yu CS
• Kim DD
• Yoon SN
• Kim JC

• KMID: 2101456
• DOI: http://doi.org/10.3393/jksc.2008.24.4.252

Abstract

PURPOSE: The aim of this study was to analyze the risk factors of pouch failure after a restorative proctocolectomy.
METHODS
A restorative proctocolectomy was performed in 169 patients between November 1989 and May 2007. A retrospective review was done for postoperative complications and follow-up results of pouch failure, and the risk factors of pouch failure were analyzed. Pouch failure was defined as having occurred when a permanent ileostomy was constructed, regardless of pouch removal. The median follow-up was 48 (3~155) months.
RESULTS
Among the 169 cases, 86 cases involved ulcerative colitis (UC group), 70 cases involved familial adenomatous polyposis or attenuated adenomatous polyposis coli (FAP group), and the remaining 13 involved hereditary nonpolyposis colorectal cancer or synchronous colon and rectal caner (CRC group). The sex ratios and the incidences of comorbidity were not significantly different between the groups, but the mean ages were. Complications occurred in 61 patients (36.1%): pelvic sepsis (28 cases), pouchitis (23 cases), desmoid tumor (12 cases), wound infection (10 cases), and anastomosis stricture (4 cases). The 5-year cumulative rate of pouch failure was 9.8%. Presence of a desmoid tumor, pelvic sepsis, and anastomosis stricture were risk factors of pouch failure.
CONCLUSIONS
The cumulative pouch failure rate after a restorative proctocolectomy was 9.8% for 5 years, and pouch failure was associated with the presence of a desmoid tumor, pelvic sepsis, and anastomosis stricture.

Keyword

Restorative proctocolectomy; Ileal pouch failure; Desmoid tumor; Pelvic sepsis

MeSH Terms

Adenomatous Polyposis Coli
Colitis, Ulcerative
Colon
Colorectal Neoplasms, Hereditary Nonpolyposis
Comorbidity
Constriction, Pathologic
Fibromatosis, Aggressive
Follow-Up Studies
Humans
Ileostomy
Incidence
Postoperative Complications
Pouchitis
Proctocolectomy, Restorative
Retrospective Studies
Risk Factors
Sepsis
Sex Ratio
Wound Infection