Survival of ileal pouch anal anastomosis constructed after colectomy or secondary to a previous ileorectal anastomosis in ulcerative colitis patients: a population-based cohort study

Abstract

Objectives: Ileorectal anastomosis (IRA) affects bowel function, sexual function and reproduction less negatively than ileal pouch anal anastomosis (IPAA), the standard reconstruction after colectomy for ulcerative colitis (UC). In younger UC patients, IRA may have a role postponing pelvic surgery and IPAA. The aim of the present study was to investigate the survival of IPAA secondary to IRA compared to IPAA as primary reconstruction, as this has not previously been studied in UC.

Patients and methods: All patients with UC diagnosis between 1960 and 2010 in Sweden were identified from the National Patient Registry. From this cohort, colectomized patients reconstructed with primary IPAA and patients reconstructed with IPAA secondary to IRA were identified. The survival of the IPAA was followed up until pouch failure, defined as pouchectomy and ileostomy or a diverting ileostomy alone.

Results: Out of 63,796 patients, 1796 were reconstructed with IPAA, either primarily (n = 1720) or secondary to a previous IRA (n = 76). There were no demographic differences between the groups, including length of follow-up (median 12.6 (IQR 6.7–16.6) years and 10.0 (IQR 3.5–15.9) years, respectively). Failure of the IPAA occurred in 103 (6.0%) patients with primary and in 6 (8%) patients after secondary IPAA (P = 0.38 log-rank). The 10-year pouch survival was 94% (95% CI 93–96) for primary IPAA and 92% (81–97) for secondary.

Conclusions: Patients choosing IRA as primary reconstruction do not have an increased risk of failure of a later secondary IPAA in comparison with patients with primary IPAA.

Keywords:

• Ulcerative colitis
• inflammatory bowel disease
• ileal pouch anal anastomosis
• ileoanal pouches
• ileoanal reservoir
• pelvic pouches
• ileorectal anastomosis
• restorative proctocolectomy
• pouch failure
• pouch survival

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Ethical considerations

The study was approved by the Regional Ethical Review Board at Linköping University, Sweden.

Additional information

Funding

This work was supported by grants from Bengt Ihre’s Fund; Medical Research Council of Southeast Sweden; and Futurum − Academy for Health and Care, Region Jönköping County, Sweden. In addition, Kalle Landerholm is a fellow in Bengt Ihre Research Fellowship during 2016 and 2017.