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P150. Female fertility after pouch surgery

S.A.L. Bartels1, M.S. Vlug1, A.J. Bensdorp1, M.A. Cuesta2, W.A. Bemelman1

1Academic Medical Centre, Amsterdam, The Netherlands; 2VU University Medical Centre, Amsterdam, The Netherlands

Aim: Postoperative adhesions to the Fallopian tubes are thought to be the cause of infertility in patients that underwent restorative proctocolectomy with ileo pouch anal anastomosis (IPAA). Earlier studies have shown that there is less adhesion formation after laparoscopic colectomy. The aim of this study is to determine if pregnancy rate is higher in females after laparoscopic IPAA compared to open.

Materials and Methods: A questionnaire was developed and sent to all female patients over 18 years that underwent IPAA surgery under age 41 in two academic centres between 1993 and 2009.

Results: Of the 111 eligible patients 95 (86%) responded. Following surgery, 28 (30%) patients attempted to conceive. Twelve (43%) of these patients underwent open and 16 (57%) underwent laparoscopic surgery. Baseline data was similar between the groups, except that more one-stage IPAAs had been carried out laparoscopically. Median age at attempt to conceive was 29 [IQR 27–33]. Table 1 shows the cumulative number of pregnancies. Log rank for all natural pregnancies between the groups showed no significant difference (P = 0.141). Pregnancy rates in a Dutch reference population of 3300 females matched for age were higher at all time intervals (6, 12 and 24 months).

Conclusion: There is no significant difference in fertility after laparoscopic or open IPAA surgery. Pregnancy rate is lower compared to general population.

Table 1 Cumulative number of pregnancies after IPAA
 Open n = 12Laparoscopy n = 16
 Pregnanciesn at risk (%)Pregnanciesn at risk (%)
T = 6 months4 (33)12 (100)6 (43)14 (88)
T = 1 year5 (42)12 (100)8 (57)14 (88)
T = 2 year7 (64)11 (92)10 (77)12 (82)
T = 3 year7 (64)11 (92)12 (92)13 (82)