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P359. Risk factors for pouchitis after laparoscopic ileal-pouch-anal anastomosis in patients with ulcerative colitis

R. Gonzalez1, L. Pereyra1, M. Omodeo1, E. Gómez1, J.M. Mella1, G.N. Panigadi1, C. Fischer1, B. Vizcaino1, A. Hadad1, M. Bun2, A. Canelas2, N. Rotholtz2, D.G. Cimmino1, S.C. Pedreira1, L.A. Boerr1, 1Hospital Alemán, Gastroenterology, Buenos Aires, Argentina, 2Hospital Alemán, Colorectal Surgery Section, Buenos Aires, Argentina

Background

Pouchitis is the most common long term complication after ileal-pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC) and causes considerable morbidity. Risk factors for pouchitis should be updated to ensure the management of these patients. The aim of our study was to determine the prevalence and risk factors for pouchitis after laparoscopic ileal-pouch-anal anastomosis (LAP-IPAA) among patients with UC.

Methods

A retrospective analysis was done using a prospective data base. We included adult patients with UC who underwent a LAP-IPAA from January 2003 to June 2013 and had at least six months of follow up. Postoperative complications were classified as major (those which required a surgical, endoscopic or radiological intervention) vs. minor and early (<30 days post surgery) vs. late. Univariate analysis was performed using a Chi square test for dichotomous variables associated with the presence of pouchitis after LAP-IPAA. Risk was measured in odds ratio (OR) and its corresponding confidence intervals 95% (CI). A p value <0.05 was considered statistically significant.

Results

Out of 60 patients with UC who had undergone surgery 45 had follow up and were included. The prevalence of pouchitis was 42% (19/45) and the mean time at diagnosis was 22 months. The mean follow up was 17 (6–31) months. Treatment for pouchitis was antibiotics in 95%, biologics in 32% and thiopurines in 11% of patients. Average age was 36 (16–73) years and 53% were men at surgery. Most patients had pancolitis (42%), less than five years of diagnosis (58%) and 13 patients had moderate or severe activity disease (68%). Five patients (26%) had extraintestinal manifestations. The main indication for surgery was non response to medical therapy in 74% (steroid dependent in 26% and steroid refractory in 48%). Prior to surgery, 26% received oral steroids, 21% intravenous steroids and 5% cyclosporine. Most of procedure were elective (84%) and in two steps (74%). Fifteen patients had postoperative complications; early 79% and minor 58%. On univariate analysis two steps IPAA was associated with pouchitis (p 0.003, OR4.48, CI 1.04–20.27).

Conclusion

Two steps IPAA is associated with the development of pouchits. In our population patients with extraintestinal manifestations of UC or other clinical characteristics were not associated with pouchitis as have been postulated in other studies.