Journal Article

P725 Ileal pouch excision: A contemporary observational cohort

G Worley, D Patsouras, K Sahnan, S Adegbola, H Mahmood, O Faiz and S Clark

in Journal of Crohn's and Colitis

Published on behalf of European Crohn's and Colitis Organisation

Volume 12, issue supplement_1, pages S478-S478
Published in print January 2018 | ISSN: 1873-9946
Published online January 2018 | e-ISSN: 1876-4479 | DOI: https://dx.doi.org/10.1093/ecco-jcc/jjx180.852
P725 Ileal pouch excision: A contemporary observational cohort

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  • Medicine and Health
  • Clinical Medicine
  • Gastroenterology
  • Gastro-intestinal and Colorectal Surgery
  • Health, Illness, and Medicine

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Abstract

Background

Pouch excision is required for patients experiencing pouch failure in whom ileostomy alone is inadequate and revision surgery is not appropriate. The published rate of pouch failure is around 10% at 10 years, resulting in a growing cohort of patients requiring excision. We aim to describe the indications for excision and post-operative outcomes at our centre since 2004.

Methods

Patients were identified from a prospectively maintained clinical database at our institution. Extracted data included: demographic and disease variables, intra and post-operative variables, 30 and 90-day morbidity, mortality and perineal wound healing. Kaplan Meier analysis was used for time-dependant survival analysis and multivariate binary logistic regression was used to model variables influencing outcome.

Results

The cohort comprised 93 patients; 83% diagnosed with ulcerative colitis, 15% familial adenomatous polyposis and 2% indeterminate colitis. Specimen histology suggested Crohn’s disease in one patient. Median time from pouch creation to excision was 7 years. The 6-month perineal wound healing rate was 78%. There were significantly improved chances of perineal wound healing for non-infective indications for excision (p = 0.024, OR 14.38 95% CI 1.41–146.73) and more recent procedures (p = 0.037, OR 10.99, 95% CI 1.76–68.57).

Conclusions

This study represents the most contemporary cohort of patients undergoing pouch excision surgery. The procedure retains a high post-operative morbidity but this study demonstrates a learning curve with improving perineal healing over time associated with a high institutional volume. De-functioning ileostomy may improve perineal wound healing in infective cases. Further quality of life investigation is required in future studies.

Journal Article.  0 words.  Illustrated.

Subjects: Medicine and Health ; Clinical Medicine ; Gastroenterology ; Gastro-intestinal and Colorectal Surgery ; Health, Illness, and Medicine

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