Pouch Failures Following Ileal Pouch-anal Anastomosis for Ulcerative Colitis

Anders Mark-Christensen, Rune Erichsen, Søren Brandsborg, Frederik Rønne Pachler, Charlotte Buchard Nørager, Niels Johansen, Jørn Helmut Pachler, Ole Thorlacius-Ussing, Mie Dilling Kjaer, Niels Qvist, Louise Preisler, Jens Hillingsø, Jacob Rosenberg, Søren Laurberg

69 Citationer (Scopus)


BACKGROUND: The ileal pouch-anal anastomosis is a procedure offered to patients with ulcerative colitis who opt for restoration of bowel continuity. The aim of this study was to determine the risk of pouch failure and ascertain risk factors associated with failure.

METHOD: 1,991 patients with ulcerative colitis operated with ileal pouch-anal anastomosis in Denmark in the period 1980-2013 were included. Pouch failure was defined as excision of the pouch or presence of a stoma un-reversed within one year after its creation. We used Cox proportional hazards regression to explore the association between pouch failure and age, gender, synchronous colectomy, primary fecal diversion, annual hospital volume (very low=1-5 cases/year, low=6-10/year, intermediate=11-20/year, high>20/year), calendar year, laparoscopy, and primary sclerosing cholangitis.

RESULTS: Over a median 11.4 years, 295 failures occurred, corresponding to 5-, 10-, and 20-year cumulative risks of 9.1%, 12.1%, and 18.2%, respectively. The risk of failure was higher for females (adjusted hazard ratio [aHR] 1.39, 95% CI: 1.10-1.75). Primary non-diversion (aHR 1.63, 95% CI: 1.11-2.41) and a low hospital volume (aHR, very low-volume vs. high-volume 2.30, 95% CI: 1.26-4.20) were also associated with a higher risk of failure. The risk of failure was not associated with calendar year, primary sclerosing cholangitis, synchronous colectomy, or laparoscopy.

CONCLUSION: In a cohort of patients with ulcerative colitis and ileal pouch-anal anastomosis from Denmark, where pouch surgery is centralized, females had a higher risk of pouch failure. Of modifiable factors, low hospital volume and non-diversion were associated with a higher risk of pouch failure. This article is protected by copyright. All rights reserved.

TidsskriftColorectal Disease
Udgave nummer1
Sider (fra-til)44-52
StatusUdgivet - jan. 2018


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