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Observational Study
. 2023 Jan;46(1):39-47.
doi: 10.1016/j.gastrohep.2022.05.005. Epub 2022 May 20.

Ileal reservoir-associated complications in ulcerative colitis versus familial adenomatous polyposis: Impact on patient quality of life

[Article in English, Spanish]
Rodrigo Castaño Llano  1 , Sandra Patricia Molina Meneses  2 , Juan Darío Puerta  3 , René Marcelo Escobar  4 , Santiago Salazar Ochoa  5 , Juan Esteban Puerta  6 , Manuel Barreiro-de Acosta  7
Affiliations
Observational Study

Ileal reservoir-associated complications in ulcerative colitis versus familial adenomatous polyposis: Impact on patient quality of life

[Article in English, Spanish]
Rodrigo Castaño Llano et al. Gastroenterol Hepatol. 2023 Jan.

Abstract

Background: Proctocolectomy with ileal reservoir is the surgical procedure of choice for patients with ulcerative colitis and familial adenomatous polyposis.

Objectives: To evaluate long-term postoperative complications (1994-2019) in patients operated for familial adenomatous polyposis (FAP) and ulcerative colitis (UC) and the degree of satisfaction with the procedure.

Methods: Observational study based on the analysis of a retrospective database with prospective follow-up in 115 consecutive patients: 79 with UC and 36 with FAP. A total of 88 patients were followed up, 60 with UC and 28 with PFA.

Results: 48 males (54.4%) with a mean age of 44.8 ± 10.6 years were evaluated. Indications for surgery were intractable disease in 54 patients (47%), dysplasia/cancer in 43 (37%), severe bleeding in 4 (4%) and perforation in 3 (3%). A proctectomy and mucosectomy of the rectal stump was performed in 67 (76.1%), and a double stapling technique in 21. A protective ileostomy was performed in all patients with UC and FAP. No differences were found in early complications between the two groups. Late complications showed a higher rate of reservoritis in UC patients compared to FAP (44.9 vs. 14.3%, p = 0.001), with more refractory reservoritis in the UC group (13.3 vs. 0%, p = 0.04) with no differences in bowel obstruction, strictures, or anastomotic fistulas. Overall satisfaction and adaptation were considered good in 87% of UC patients and only 57% in the FAP group (p < 0.01).

Conclusions: Proctocolectomy with ileal reservoir has comparable morbidity and mortality, except for the higher rate of reservoritis in patients with a history of UC, despite this contingency there is a better quality of life and greater acceptance of surgery in UC patients than in FAP patients.

Keywords: Bolsa ileal; Colitis ulcerosa; Familial adenomatous polyposis; Ileal pouch; Poliposis adenomatosa familiar; Pouchitis; Proctocolectomy; Proctocolectomía; Reservoritis; Ulcerative colitis.

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