Surgical Outcomes of Ileal Pouch Anal Anastomosis (IPAA) in a Community Based Hospital.

Nezar Jrebi, MD, Theodor Asgeirsson, MD, Martin Luchtefeld, MD, Rebecca Hoedema, Ryan Figg, MD, Heather Slay, MD, Nadav Dujovny, MD. Ferguson Clinic.

Background: Ileal pouch anal anastomosis (IPAA) is the treatment of choice for chronic, medically refractory ulcerative colitis (CUC), familial adenomatous polyposis (FAP), and selective cases of Crohn disease

Aim: The aim of this study is to evaluate the outcome of IPAA in a community based hospital.

Methods: A retrospective chart review was performed on patients who underwent IPAA between Jan 2005-Dec 2012. Data gathered included, patient demographics, indications, pouch related complications, and pouch excision. Statistical analysis was performed with Fischer’s Exact Test and Pearson Chi-Square with statistical significance set at p<0.05. 

Results: A total of 149 patients were indentified. Indications were CUC (81.2%), FAP (15.4%), Crohn disease (0.6%) and Lynch Syndrome (1.3%). Pouch related complications: abscess (16.2%), pouchitis (15.5%), fistulae (6.7%), leak (4.6%) and stricture (2.6%). Interestingly there were a statistically higher percentage of patients on steroids that had no pouch related complications (38% vs 16%, p=0.005). Pouch excision was performed in 7 (4.6%) patients and was related to chronic abscesses with fistulae (57%), Crohn disease (28.5%) and anal squamous cell cancer (14%). Overall mortality rate was 0%.

Conclusion: Community based hospital can provide outcomes comparable to high volume centers with regards to pouch related complications and failure rates.

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