Background: Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the procedure of choice for patients with ulcerative colitis who require colectomy for medically refractory disease or other complications such as dysplasia. The aim of this study was to evaluate the long term course of patients undergoing IPAA for ulcerative colitis, and to assess the occurrence of pouchitis and other complications.
Methods: A retrospective analysis of all records of patients admitted at “Villa Sofia-Cervello” Hospital from 1988 to 2016 who underwent proctocolectomy with IPAA for ulcerative colitis was performed. At least one endoscopic evaluation during follow-up was available for all patients.
Results: Among 1,490 patients with ulcerative colitis admitted at “Villa Sofia-Cervello” Hospital during the study period, the records of 71 patients (4.8%) undergoing IPAA were analyzed. The surgical procedure was performed in two stages in the majority of cases (76.0%), and the median time to recanalization was 6 months (I.Q.I. 6.5). The mean duration of follow-up after IPAA procedure was 110±77 months. The occurrence of pouchitis was reported in 48 (67.6%) patients. The time between IPAA and the diagnosis of pouchitis ranged from 1 to 120 months, with a median of 12 months. In addition, 33 out of 48 patients (68.8%) developed chronic pouchitis, while Crohn's disease of the pouch was diagnosed in four patients (8.3%). The stenosis of the anastomosis was reported in 18 patients (37.5%), and the presence of abscesses/fistula in 11 (22.9%). The occurrence of pouch failure was observed in 6 patients (12.5%), all of them suffering from chronic pouchitis complicated by fistulizing disease. No dysplasia nor Cytomegalovirus infection of the pouch were reported. Subgroup analysis of patients developing pouchitis revealed that only the chronic form of this condition was associated with the stenosis of the anastomosis, which conversely was rarely observed when the pouchitis was episodic and did not became chronic (88.9% vs. 11.1%, p=0.04).
Conclusions: Our cohort with long term follow-up showed that pouchitis and chronic pouchitis are very frequent events. Conversely, Crohn's disease of the pouch is rare, and no cases of Cytomegalovirus infection of the pouch were reported.