Scripties UMCG - Rijksuniversiteit Groningen
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Presence and impact of a (non-) inflamed rectal stump after subtotal colectomy on pouch outcomes in ulcerative colitis patients: a cohort study

(2019) Does de Willebois, E.M.L. van der

Background and aim In patients with medical refractory ulcerative colitis (UC), surgical treatment is required. Nowadays restorative procotolectomy and ileo-anal pouch anastomosis (IPAA) is the standard after subtotal colectomy (STC). When an STC is performed, colitis related proctitis and diversion proctitis may occur in the remaining rectal stump. As non-uniform definitions have been used, the prevalence and impact of an inflamed rectal stump remains unknown. The aim of the study is to define the number of (non-) inflamed rectal stumps after STC. Consequently, to correlate inflamed and non-inflamed rectal stumps to short-term en long-term outcomes.
Methods All consecutive prospectively maintained UC patients who underwent IPAA after a STC between January 1999 and October 2017 were included. Assessment of disease activity was done by histological grading according to the Geboes score (GS). All histological coupes were revised by two authors blinded to outcome. Main outcome was the prevalence of (non-) inflamed rectal stumps after STC and its relation with postoperative complications after IPAA surgery and 10-year pouchitis rate.
Results In total, 192 were included of whom 155 patients (80%) had an inflamed rectal stump. Neither the overall complications (non-inflamed 38% and inflamed 34%; p = 0.705), the suspicion of anastomotic leakage rate specifically (non-inflamed n=5 and inflamed n=25; p = 0.609), nor the pouchitis rate (55% non-inflamed and 51% inflamed; p-log rank=0.538) were significantly different in both groups. Diversion colitis was seen in 85%.
Conclusion This study demonstrated that there is no association between a (non-) inflamed rectal stump and postoperative complications, anastomotic leakage and 10 year pouchitis rate. It seems that in clinical practice, it is not necessary to take it in account whether or not a patient has an inflamed rectal stump.

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