The Severity of Rectal Inflammation and Pouch Surgery Outcome in Patients with Ulcerative Colitis: A Retrospective Cohort Study.

Background: Pouch failure after ulcerative colitis (UC) necessitates either pouch excision or establishment of a permanent diverting stoma. The aim of this study was to explore if rectal inflammation prior to pouch creation affected the risk of developing pouch failure.

Methods: Patients 18 years and older with ulcerative colitis undergoing J-pouch surgery at Odense University Hospital between 1983 and 2020 were included. Pouch failure was defined as either the presence of ileostomy more than 1 year after ileo pouch-anal anastomosis (IPAA) or pouch removal. Rectal inflammation was defined by 3 measures: using the Nancy index on pathology examination of the resected rectum, endoscopically using latest Mayo score from the year preceding the IPAA, and as active anti-inflammatory treatment four weeks prior to IPAA.

Results: A total of 434 patients met the inclusion criteria, with 66 patients (15%) experiencing pouch failure with mean time of 5.63 years. Acute inflammation (Nancy grade 2-4) was observed in 70% of the patients. Active anti-inflammatory treatment was observed in 37% of patients, and 67% had undergone endoscopy within 1 year prior to IPAA. No significant association was found between the Nancy Index Grade and pouch failure, time to pouch failure, postoperative complications, or long-term pouch complications. Furthermore, neither the Mayo score grade nor active medical UC therapy predicted the risk of pouch failure.

Conclusion: Rectal inflammation prior to IPAA does not increase risk of pouch failure, postoperative complications, or long term pouch dysfunction.