Pouch failure in patients with ulcerative colitis

AIM: to assess results of pouch surgery for ulcerative colitis (UC).

PATIENTS AND METHODS: the retrospective single-center study included 144 patients who underwent J-pouch surgery in 2011–2018 (4 patients refused ileostomy closure due to nonmedical reasons and were excluded from analysis). Median follow-up was 32 (20; 43) months. The definition of «pouch failure» (PF) was clarified as a condition, when J-pouch associated complications do not permit ileostomy closure ≥ 12 months or more after pouch surgery.

RESULTS: PF was detected in 30/140 (21.4%) cases and only in 8/140 (5,7%) patients pouch was removed. The most common complication identified by PF was pouch fistula, which was detected in 16/30 (53.3%) patients. Of the 30 patients with PF, 22 (73.3%) managed to “save” the pouch, of which — in 11/30 (36.7%) cases, anal defecation was restored, and in other cases — 11 (36. 7%) the ileostomy was not closed, but the pouch was preserved and is being treated conservatively. In 9/30 (30%) patients, the identified complications were performed by transanal removal of the remaining part of the rectum with the formation of a pouch-anal anastomosis, followed by closure of the ileostomy. In 8/30 (26.6%) cases pouch was removed. The multivariant analysis revealed hypoalbuminemia at the time of pouch surgery (OR = 5.74; 95% CI = 1.83–18.01; p = 0.003) as independent risk factors for PF.

CONCLUSION: the only independent risk factor for complications which lead to PF was hypoalbuminemia. Multi-stage surgical treatment of complications associated with the pouch made it possible to “save” the ileal pouch in 22/30 (73.3%) cases, and completely overcome PF and restore anal defecation in 11/30 (36.7%) cases. In 8/140 (5.7%) patients, the pouch had to be removed and a permanent ileostomy was done.

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