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Inflammation of the rectal remnant endangers the outcome of ileal pouch-anal anastomosis: a case–control study

BACKGROUND: Inflammation of the rectal remnant may affect the postoperative outcome of ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC). We aimed to determine the extent of inflammation in the anastomotic area during IPAA and to investigate the impact of proctitis on post...

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Autores principales: Frese, Jan P., Gröne, Jörn, Lauscher, Johannes C., Kreis, Martin E., Weixler, Benjamin, Beyer, Katharina, Seifarth, Claudia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9262783/
https://www.ncbi.nlm.nih.gov/pubmed/35713723
http://dx.doi.org/10.1007/s00384-022-04195-7
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author Frese, Jan P.
Gröne, Jörn
Lauscher, Johannes C.
Kreis, Martin E.
Weixler, Benjamin
Beyer, Katharina
Seifarth, Claudia
author_facet Frese, Jan P.
Gröne, Jörn
Lauscher, Johannes C.
Kreis, Martin E.
Weixler, Benjamin
Beyer, Katharina
Seifarth, Claudia
author_sort Frese, Jan P.
collection PubMed
description BACKGROUND: Inflammation of the rectal remnant may affect the postoperative outcome of ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC). We aimed to determine the extent of inflammation in the anastomotic area during IPAA and to investigate the impact of proctitis on postoperative complications and long-term outcomes. METHODS: Three hundred thirty-four UC patients with primary IPAA were included in this retrospective case–control study. The histopathologic degree of inflammation in the anastomotic area was graded into three stages of no proctitis (“NOP”), mild to medium proctitis (“MIP”), and severe proctitis (“SEP”). Preoperative risk factors, 30-day morbidity, and follow-up data were assessed. Kaplan–Meier analysis was performed in the event of pouch failure. RESULTS: The prevalence of proctitis was high (MIP 40.4%, and SEP 42.8%). During follow-up, the incidence of complications was highest among SEP: resulting in re-intervention (n = 40; 28.2%, p = 0.017), pouchitis (n = 36; 25.2%, p < 0.01), and pouch failure (n = 32; 22.4%, p = 0.032). The time interval to pouch failure was 5.0 (4.0–6.9) years among NOP, and 1.2 (0.5–2.3) years in SEP (p = 0.036). ASA 3, pouchitis, and pouch fistula were independent risk factors for pouch failure. CONCLUSION: Proctitis at the time of IPAA is common. A high degree of inflammation is associated with poor long-term outcomes, an effect that declines over time. In addition, a higher degree of proctitis leads to earlier pouch failure.
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spelling pubmed-92627832022-07-09 Inflammation of the rectal remnant endangers the outcome of ileal pouch-anal anastomosis: a case–control study Frese, Jan P. Gröne, Jörn Lauscher, Johannes C. Kreis, Martin E. Weixler, Benjamin Beyer, Katharina Seifarth, Claudia Int J Colorectal Dis Original Article BACKGROUND: Inflammation of the rectal remnant may affect the postoperative outcome of ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC). We aimed to determine the extent of inflammation in the anastomotic area during IPAA and to investigate the impact of proctitis on postoperative complications and long-term outcomes. METHODS: Three hundred thirty-four UC patients with primary IPAA were included in this retrospective case–control study. The histopathologic degree of inflammation in the anastomotic area was graded into three stages of no proctitis (“NOP”), mild to medium proctitis (“MIP”), and severe proctitis (“SEP”). Preoperative risk factors, 30-day morbidity, and follow-up data were assessed. Kaplan–Meier analysis was performed in the event of pouch failure. RESULTS: The prevalence of proctitis was high (MIP 40.4%, and SEP 42.8%). During follow-up, the incidence of complications was highest among SEP: resulting in re-intervention (n = 40; 28.2%, p = 0.017), pouchitis (n = 36; 25.2%, p < 0.01), and pouch failure (n = 32; 22.4%, p = 0.032). The time interval to pouch failure was 5.0 (4.0–6.9) years among NOP, and 1.2 (0.5–2.3) years in SEP (p = 0.036). ASA 3, pouchitis, and pouch fistula were independent risk factors for pouch failure. CONCLUSION: Proctitis at the time of IPAA is common. A high degree of inflammation is associated with poor long-term outcomes, an effect that declines over time. In addition, a higher degree of proctitis leads to earlier pouch failure. Springer Berlin Heidelberg 2022-06-17 2022 /pmc/articles/PMC9262783/ /pubmed/35713723 http://dx.doi.org/10.1007/s00384-022-04195-7 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Frese, Jan P.
Gröne, Jörn
Lauscher, Johannes C.
Kreis, Martin E.
Weixler, Benjamin
Beyer, Katharina
Seifarth, Claudia
Inflammation of the rectal remnant endangers the outcome of ileal pouch-anal anastomosis: a case–control study
title Inflammation of the rectal remnant endangers the outcome of ileal pouch-anal anastomosis: a case–control study
title_full Inflammation of the rectal remnant endangers the outcome of ileal pouch-anal anastomosis: a case–control study
title_fullStr Inflammation of the rectal remnant endangers the outcome of ileal pouch-anal anastomosis: a case–control study
title_full_unstemmed Inflammation of the rectal remnant endangers the outcome of ileal pouch-anal anastomosis: a case–control study
title_short Inflammation of the rectal remnant endangers the outcome of ileal pouch-anal anastomosis: a case–control study
title_sort inflammation of the rectal remnant endangers the outcome of ileal pouch-anal anastomosis: a case–control study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9262783/
https://www.ncbi.nlm.nih.gov/pubmed/35713723
http://dx.doi.org/10.1007/s00384-022-04195-7
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