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P179. Outcome of pouch surgery for ulcerative colitis in 124 Egyptian patients

N. GadEl Hak, A.A. ElGeidie, M. El Hemaly, A. Monier, Mansoura University, Gastroenterology Surgical Center, Mansoura, Egypt

Background

The purpose of the present study is to present the experience of a single Egyptian center in surgical management of ulcerative colitis patients focusing on the outcome of pouch surgery.

Methods

A retrospective analysis of the data of all patients who underwent surgical treatment for ulcerative colitis (UC) at Gastroenterology Surgical Center, Mansoura University was conducted. Patients who had pouch surgery were asked to come for follow-up to assess outcome and quality of life.

Results

Between 1999 and 2013, 124 Egyptian patients had been submitted for surgical management of UC. The most common indication for surgery was failure of medical treatment (n = 77, 62.1%). The most common surgical procedure performed was total proctocolectomy with ileal pouch-anal anastomosis (IPAA) (n = 107, 86.3%). Other procedures were total proctocolectomy with terminal ileostomy (n = 12, 9.6%) and ileo-anal anastomosis without pouch construction (n = 5, 4.1%). IPAA was carried out as a single-stage in all patients except for three (2.4%) patients who had two-stage approach. The surgical approach for IPAA was via laparotomy in all patients except for 7 (5.6%) patients who had the operation by hand-assisted laparoscopic technique. All patients had j-shaped pouch configuration. A defunctioning ileostomy was added in the majority of IPAA patients (n = 98, 79%). Postoperative pathology confirmed the diagnosis in all patients except two of them who had Crohn's disease. There were two operative deaths. Early complications after IPAA included pelvic sepsis (n = 6), pouch hemorrhage (n = 1) for whom pouch excision was done, wound sepsis (n = 5). Sixty-seven (54%) patients came for follow up visits. Pouch failure and excision had been reported in two patients due to severe pouchitis in one patient and severe uncontrolled pouch bleeding in another patient. Pouchitis was reported in 19 (28.4%) patients and it was treated medically in all patients but one who required pouch excision. Anastomotic stricture occurred in 12 (18%) patients and was treated by anal dilatation under anesthesia as an outpatient procedure. Median post-IPAA stool frequency was 5.1 motions at daytime and 1.3 at nighttime. Three patients (4.4%) had fecal incontinence. Poucho-vaginal fistula occurred in two patients and perineal fistula in one patient.

Conclusion

IPAA is a major surgery that attains many complications. However, long term results and patient's satisfaction are reasonable.