P360. Risk factors for complications 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
Although most patients with ulcerative colitis (UC) are managed successfully with medical therapy, there are a number of patients who require a surgical treatment. The restorative proctocolectomy is the procedure of choice. In the last years the laparoscopic approach has gain more popularity but there are few studies that examined clinical risk factors for laparoscopic postoperative complications. The aim of our study was to determine the prevalence and risk factors for complications after laparoscopic ileal-pouch-anal anastomosis (LAP-IPAA) among patients with UC.
A retrospective analysis was done using a prospective data base. Adult patients with UC who underwent a LAP-IPAA from January 2003 to June 2013 were included. 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 to assess risk factors for these complications using a Chi square test. Risk was measured in odds ratio (OR) and its corresponding confidence intervals 95% (CI). A p value <0.05 was considered statistically significant.
Sixty patients were included; 48% of them had less than five years since diagnosis. The average age was 35 (16–73) years, 62% were men and 79% had body mass index (BMI) <25. Most patients had pancolitis (60%) and 46 had a moderate or severe activity disease (77%). Fifteen patients (25%) had extraintestinal manifestations. The main indication for surgery was no response to medical therapy in 77% (steroid dependent in 35% and steroid refractory in 65%). Other indications were colorectal cancer/dysplasia in 12 (20%) patients and refractory colonic stricture in 2 (3%). Prior to surgery, 27% received intravenous steroids, 32% oral steroids, 8% thiopurines, 7% cyclosporine and 2% biologic therapy. Most of procedures were elective (70%) and performed in two steps (53%). Fifteen patients (25%) presented major postoperative complications. The prevalence of minor postoperative complications was 50%. Early postoperative complications were present in 39 patients (65%) and late in 10 (17%). BMI <25 was associated with early postoperative complications (OR 4.08, CI 0.57–15.35, p 0.02). The use of thiopurines and cyclosporine prior to surgery was associated with fewer postoperative complications: OR 0.082 (CI 0.03–0.83, p 0.016) and OR 0.109 (CI 0.00–1.18, p 0.004), respectively.
Patients with BMI <25 have higher chances to have postoperative complications after LAP-IPAA. The majority of these complications are minor and occur in the early outcome.