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Surgery. 2018 Mar;163(3):535-541. doi: 10.1016/j.surg.2017.11.014. Epub 2018 Jan 8.

Long-term outcomes following ileal pouch-anal anastomosis in patients with indeterminate colitis.

Author information

1
Price Institute of Surgical Research, The Hiram C. Polk Jr., MD Department of Surgery, University of Louisville, Louisville, KY, USA; Department of Surgery A, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
2
Price Institute of Surgical Research, The Hiram C. Polk Jr., MD Department of Surgery, University of Louisville, Louisville, KY, USA; Department of General Surgery, Wishaw General Hospital, Lanarkshire, Scotland, UK.
3
Price Institute of Surgical Research, The Hiram C. Polk Jr., MD Department of Surgery, University of Louisville, Louisville, KY, USA.
4
Ameripath, Oakwood Village, OH, USA.
5
Price Institute of Surgical Research, The Hiram C. Polk Jr., MD Department of Surgery, University of Louisville, Louisville, KY, USA. Electronic address: s0gala01@louisville.edu.

Abstract

BACKGROUND:

The advisability of performing ileal pouch-anal anastomosis for patients with indeterminate colitis is debated. Indeterminate colitis is found in up to 15% of inflammatory bowel disease colectomy specimens. We determined long-term outcomes in patients diagnosed with indeterminate colitis undergoing ileal pouch-anal anastomosis.

METHODS:

Fifty-six patients were included with a mean follow-up of 14 ± 7 years. Long-term behavior was defined based on surgeon assessment as "Crohn disease-like" in patients who subsequently developed clear signs of Crohn disease and as "non-Crohn disease-like." Long-term function was assessed using the Cleveland Global Quality of Life and Pouch Functional Score.

RESULTS:

Thirty-nine percent of patients developed Crohn disease-like behavior, and 61% developed non-Crohn disease-like behavior. Both groups experienced a high rate of pouchitis (57%). Crohn disease-like patients required more anti-inflammatory/immunomodulatory medications (95% vs 18%, P < .001), dilatations for afferent-limb strictures (41% vs 0%, P < .001), and pouch reoperations (32% vs 6%, P = .02). Eight patients required pouch excision or diversion (7 with Crohn disease-like behavior). The Pouch Functional Score was equivalent between groups.

CONCLUSION:

Long-term function after ileal pouch-anal anastomosis for the majority of indeterminate colitis patients was good. Approximately 40% eventually exhibited Crohn disease-like behavior, but the majority had acceptable function and quality of life. Ileal pouch-anal anastomosis is an appropriate surgical option for indeterminate colitis patients after informed consent.

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PMID:
29325789
DOI:
10.1016/j.surg.2017.11.014
[Indexed for MEDLINE]

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