P578 Changes of practice in ileoanal pouch surgery in a single referral centre
A. Germain*1, A. de Buck van Overstraeten2, A. Wolthuis2, A. D’Hoore2
1University Hospital of Nancy, Department of Digestive Surgery, Nancy, France, 2University Hospitals Leuven, Department of Abdominal Surgery, Leuven, Belgium
Ileal pouch-anal anastomosis (IPAA) has become the standard of care for the 20%–25% of patients with ulcerative colitis (UC) who will undergo surgery during their disease course despite protracted medical therapy. This study aims to assess changes in surgical techniques and outcome in a single centre over a 25-year period.
Demographic, perioperative, and follow-up data of patients with a restorative proctocolectomy, for UC from 1990 to 2015, in UZ Leuven, were analysed from a database to audit our 25-year experience with this technique. Primary outcomes are leakage and ultimate pouch failure. The year of pouch construction was dichotomised according to 3 periods (Group A 1990–1999; Group B 2000–2009; Group C 2010–2015).
Between 1990 and 2015, 337 patients with a median age of 40.3 years (interquartile range: 32–49 years) (males = 58.4%) underwent an IPAA for UC. Further, 125 patients had surgery before 2000; 125 patients were operated during the second time period; and 87 patients were operated during the last period. Patients were younger at the time of surgery in Group A (36.5 years vs 41.1 years vs 43.6 years [p < 0.001]), duration disease was shorter in Group A (6.6 years vs 8.7 years vs 11.2 years [p < 0.001]). The overall rate of defunctioning ileostomies evolved from 94.0% in the early period to 13.9% in the late period (p < 0.001). There was an important evolution in surgical management over the studied period. We described an important shift from restorative proctocolectomy, with derivative ileostomy to colectomy and completion proctectomy without ileostomy (2.6% in Group A vs 29.4% in Group B vs 62.4% in Group C) (p < 0.001). The 3-staged procedure was performed in 20.5% of the cases in Group A, whereas only 8.4% of the patients underwent this sequence in Group B, and 4.9% in Group C. These technical evolutions did influence, however, not significantly, the leakage rate, which decreased from 13.6% to 5.9% (p = 0.25), with a more pronounced decrease in clinically significant leakages. The overall pouch failure rate was 5.9% with an important decrease in the latest period (7.7% in the early period versus 0.9% in the late period), but this difference was not statistically significant (p = 0.13).
Different important aspects of IPAA surgery changed over time and seem to reduce early postoperative morbidity. Septic complications decrease over time and suggest an ongoing learning curve.