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Risk factors of small bowel obstruction following total proctocolectomy and ileal pouch anal anastomosis with diverting loop-ileostomy for ulcerative colitis.

ABSTRACT: Small bowel obstruction (SBO) often occurs after total proctocolectomy and ileal pouch anal anastomosis with diverting loop-ileostomy for ulcerative colitis. Little is known about the association between SBO and surgical procedures for diverting loop-ileostomy. We conducted a multicenter, retrospective questionnaire survey. Unlinkable anonymized data on ileostomy procedures and ileostomy-related complications including SBO were collected from institutions specializing in surgery for inflammatory bowel disease. In total, 515 patients undergoing total proctocolectomy and ileal pouch anal anastomosis with loop-ileostomy among 1022 patients with ulcerative colitis undergoing surgery during a 3-year period between 2012 and 2014 were analyzed. Twenty-nine patients without information on complications were excluded. Incidence of ileostomy-related complications and factors associated with the development of small bowel obstruction were determined in 486 patients. The most common complications were parastomal dermatitis (n=169, 34.8%), SBO (n=111, 22.8%), mucocutaneous dehiscence (n=59, 12.1%), stoma prolapse (n=21, 4.3%), parastomal hernia (n=12, 2.5%), and stoma retraction (n=11, 2.3%). Incidence of small bowel obstruction was significantly higher in patients with distance from the ileal pouch to the ileostomy of less than 30 cm and in patients undergoing laparoscopic surgery. Procedures for diverting loop-ileostomy after surgery for ulcerative colitis varied among institutions. Incidence of small bowel obstruction was high after total proctocolectomy and ileal pouch anal anastomosis with diverting loop-ileostomy. Shorter distance between the pouch and the stoma and the laparoscopic surgery were risk factors for SBO in univariate analysis.

SUBMITTER: Mizushima T

PROVIDER: S-EPMC5881312 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Risk factors of small bowel obstruction following total proctocolectomy and ileal pouch anal anastomosis with diverting loop-ileostomy for ulcerative colitis.

Mizushima Tsunekazu T Kameyama Hitoshi H Watanabe Kazuhiro K Kurachi Kiyotaka K Fukushima Kouhei K Nezu Riichiro R Uchino Motoi M Sugita Akira A Futami Kitaro K

Annals of gastroenterological surgery 20170612 2

Small bowel obstruction (SBO) often occurs after total proctocolectomy and ileal pouch anal anastomosis with diverting loop-ileostomy for ulcerative colitis. Little is known about the association between SBO and surgical procedures for diverting loop-ileostomy. We conducted a multicenter, retrospective questionnaire survey. Unlinkable anonymized data on ileostomy procedures and ileostomy-related complications including SBO were collected from institutions specializing in surgery for inflammatory ...[more]

PMID: 29863130

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Project description:ObjectivesPouchitis is a major complication after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC). Although there have been many investigations of the neutrophil-to-lymphocyte ratio (NLR) in various diseases, its role in predicting the development of pouchitis remains unclear. We aimed to evaluate the clinical utility of the NLR for predicting the development of pouchitis after IPAA in UC patients.Materials and methodsUC patients who underwent IPAA at Osaka City University Hospital between May 2006 and March 2019 were included. The incidence of pouchitis was estimated using the Kaplan-Meier method. Potential preoperative, intraoperative, and postoperative predictors for pouchitis, including various demographic and clinical variables, were analyzed. The combined impact of the NLR and other known prognostic factors were investigated using Cox proportional hazard regression with inverse probability of treatment weighting (IPTW).ResultsForty-nine patients with UC who underwent IPAA were included. The median follow-up period was 18.3 months (interquartile range: 10.7-47.2 months). Eighteen patients (36.7%) developed pouchitis. The incidence of pouchitis was 19.2%, 32.6%, and 45.9% at 1, 2, and 5 years, respectively. NLR was significantly associated with the development of pouchitis in the univariate Cox regression analysis (hazard ratio (HR), 1.14; 95% confidence interval (CI), 1.01-1.28; P = 0.03). The NLR cutoff value of 2.15 was predictive of the development of pouchitis according to receiver operating characteristic analysis (specificity: 67.7%, sensitivity: 72.2%). The incidence of pouchitis was significantly lower in the low NLR group than that in the high NLR group (P = 0.01, log-rank test). Cox regression analyses using IPTW also identified NLR as a prognostic factor for the development of pouchitis by statistically adjusting for background factors (HR, 3.60; 95% CI, 1.31-9.89; P = 0.01).ConclusionsNLR may be a novel and useful indicator for predicting the development of pouchitis after IPAA in UC and should be introduced in clinical practice.

Dataset Information

Risk factors of small bowel obstruction following total proctocolectomy and ileal pouch anal anastomosis with diverting loop-ileostomy for ulcerative colitis.

Publications

Risk factors of small bowel obstruction following total proctocolectomy and ileal pouch anal anastomosis with diverting loop-ileostomy for ulcerative colitis.

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