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* = Presenting author

P348 How could female infertility be reduced after open IPAA

T. Emmanouil*1, C. Christou2, A. Chatziioannou3, E. Falidas2, C. Vardas2, N. Kontoravdis2, S. Baratsis2

1Iaso General Hospital, Department of Gastroenterology and Surgery, Athens, Greece, 2Iaso General Hospital, Department of Gastroenterology and Surgery, Athens, Greece, 3National Hellenic Research Foundation, Institute of Biological Research &Biotechnology, Athens, Greece

Background

Ulcerative colitis (UC) and Familial Adenomatous Polyposis (FAP) affect mainly young people of reproductive age and when surgical treatment is indicated proctocolectomy with ileo-anal pouch anastomosis (IPAA) is the treatment of choice. IPAA is highly associated with post-operative infertility due to adhesions at the fallopian tubes and ovaries, especially after hand-sewn open technique compare to laparoscopy.

Aim of this study is to present data from young women operated with IPAA with regard to fertility and to propose surgical measures for prevention of female infertility.

Methods

We retrospectively collected data from young women (15-44 years of age) operated with IPAA for UC or FAP based on structure telephone interview regarding their reproductive behavior and we compared them with those of the general population. We finally present surgical strategies for minimal formation of adhesions into the pelvis.

Results

Over a period of 30 years (1983-2013) 680 patients were submitted to IPAA for UC or FAP. In a total number of 426 patients we selected 104 young female patients (90 UC/14 FAP) of reproductive age. 72 answered to the questionnaire regarding their reproductive status and they were included in the final analysis. Twenty one females (29, 16%) were able to take over 1 or 2 full-term deliveries while 51 (70, 83%) answered negatively including women lacking willingness to deliver a baby. We propose surgical techniques such as wrapping of the ovaries and fallopian tubes, use of adhesion preventing membranes, omental plug and vacuum suction in the pelvis for the prevention of infertility in this group of patients.

Conclusion

This is the largest Greek retrospective analysis of patients operated with IPAA by a single surgeon. Although the limited number of female patients included in this series, it seems that preventing measures perioperatively can reduce infertility in young women of reproductive age and reaching to acceptable fertility levels compare to the general population.