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Pouch functional outcomes after restorative proctocolectomy with ileal-pouch reconstruction in patients with ulcerative colitis: Japanese multi-center nationwide cohort study

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Although several complications capable of causing pouch failure may develop after restorative proctocolectomy (RPC) for ulcerative colitis (UC), the incidences and causes are conflicting and vary according to country, race and institution. To avoid pouch failure, this study aimed to evaluate the rate of pouch failure and its risk factors in UC patients over the past decade via a nationwide cohort study.


We conducted a retrospective, observational, multicenter study that included 13 institutions in Japan. Patients who underwent RPC between January 2005 and December 2014 were included. The characteristics and backgrounds of the patients before and during surgery and their postoperative courses and complications were reviewed.


A total of 2376 patients were evaluated over 6.7 ± 3.5 years of follow-up. Twenty-seven non-functional pouches were observed, and the functional pouch rate was 98.9% after RPC. Anastomotic leakage (odds ratio, 9.1) was selected as a risk factor for a non-functional pouch. The cumulative pouch failure rate was 4.2%/10 years. A change in diagnosis to Crohn’s disease/indeterminate colitis (hazard ratio, 13.2) was identified as an independent risk factor for pouch failure.


The significant risk factor for a non-functional pouch was anastomotic leakage. The optimal staged surgical procedure should be selected according to a patient’s condition to avoid anastomotic failure during RPC. Changes in diagnosis after RPC confer a substantial risk of pouch failure. Additional cohort studies are needed to obtain an understanding of the long-standing clinical course of and proper treatment for pouch failure.

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  1. Bach SP, Mortensen NJ. Revolution and evolution: 30 years of ileoanal pouch surgery. Inflamm Bowel Dis. 2006;12:131–45.

    Article  PubMed  Google Scholar 

  2. Tulchinsky H, Hawley PR, Nicholls J. Long-term failure after restorative proctocolectomy for ulcerative colitis. Ann Surg. 2003;238:229–34.

    PubMed  PubMed Central  Google Scholar 

  3. Lepisto A, Luukkonen P, Jarvinen HJ. Cumulative failure rate of ileal pouch-anal anastomosis and quality of life after failure. Dis Colon Rectum. 2002;45:1289–94.

    Article  PubMed  Google Scholar 

  4. Andersson P, Norblad R, Soderholm JD, et al. Ileorectal anastomosis in comparison with ileal pouch anal anastomosis in reconstructive surgery for ulcerative colitis—a single institution experience. J Crohns Colitis. 2014;8:582–9.

    Article  PubMed  Google Scholar 

  5. Delaney CP, Fazio VW, Remzi FH, et al. Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch–anal anastomosis. Ann Surg. 2003;238:221–8.

    PubMed  PubMed Central  Google Scholar 

  6. Hahnloser D, Pemberton JH, Wolff BG, et al. Results at up to 20 years after ileal pouch–anal anastomosis for chronic ulcerative colitis. Br J Surg. 2007;94:333–40.

    Article  CAS  PubMed  Google Scholar 

  7. Nordenvall C, Olén O, Nilsson PJ, et al. The fate of reconstructive surgery following colectomy for inflammatory bowel disease in Sweden: a population-based cohort study. J Crohns Colitis. 2016;10:1165–71.

    Article  PubMed  Google Scholar 

  8. Meagher AP, Farouk R, Dozois RR, et al. J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients. Br J Surg. 1998;85:800–3.

    Article  CAS  PubMed  Google Scholar 

  9. Elder K, Lopez R, Kiran RP, et al. Endoscopic features associated with ileal pouch failure. Inflamm Bowel Dis. 2013;19:1202–9.

    Article  PubMed  Google Scholar 

  10. Prudhomme M, Dehni N, Dozois RR, et al. Causes and outcomes of pouch excision after restorative proctocolectomy. Br J Surg. 2006;93:82–6.

    Article  CAS  PubMed  Google Scholar 

  11. Fazio VW, Kiran RP, Remzi FH, et al. Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg. 2013;257:679–85.

    Article  PubMed  Google Scholar 

  12. Braveman JM, Schoetz DJ Jr, Marcello PW, et al. The fate of the ileal pouch in patients developing Crohn’s disease. Dis Colon Rectum. 2004;47:1613–9.

    Article  PubMed  Google Scholar 

  13. Alexander F, Sarigol S, DiFiore J, et al. Fate of the pouch in 151 pediatric patients after ileal pouch anal anastomosis. J Pediatr Surg. 2003;38:78–82.

    Article  PubMed  Google Scholar 

  14. Truelove SC, Witts LJ. Cortisone in ulcerative colitis. BMJ. 1955;2:1041–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Ikeuchi H, Uchino M, Matsuoka H, et al. Surgery for ulcerative colitis in 1,000 patients. Int J Colorectal Dis. 2010;25:959–65.

    Article  PubMed  Google Scholar 

  16. Du P, Sun C, Ashburn J, et al. Risk factors for Crohn’s disease of the neo-small intestine in ulcerative colitis patients with total proctocolectomy and primary or secondary ileostomies. J Crohns Colitis. 2015;9:170–6.

    Article  PubMed  Google Scholar 

  17. Buckman SA, Heise CP. Nutrition considerations surrounding restorative proctocolectomy. Nutr Clin Pract. 2010;25:250–6.

    Article  PubMed  Google Scholar 

  18. Markel TA, Lou DC, Pfefferkorn M, et al. Steroids and poor nutrition are associated with infectious wound complications in children undergoing first stage procedures for ulcerative colitis. Surgery. 2008;144:540–5.

    Article  PubMed  Google Scholar 

  19. Skowron KB, Lapin B, Rubin M, et al. Clostridium difficile infection in ulcerative colitis: can alteration of the gut-associated microbiome contribute to pouch failure? Inflamm Bowel Dis. 2016;22:902–11.

    Article  PubMed  Google Scholar 

  20. Wu XR, Zhu H, Kiran RP, et al. Excessive weight gain is associated with an increased risk for pouch failure in patients with restorative proctocolectomy. Inflamm Bowel Dis. 2013;19:2173–81.

    Article  PubMed  Google Scholar 

  21. Robbins L, Zaghiyan K, Melmed G, et al. Outcomes with anti-tumour necrosis factor-alpha therapy and serology in patients with de novo Crohn’s disease after ileal pouch anal anastomosis. J Crohns Colitis. 2017;11:77–83.

    Article  PubMed  Google Scholar 

  22. Dayton MT, Larsen KR, Christiansen DD. Similar functional results and complications after ileal pouch-anal anastomosis in patients with indeterminate vs ulcerative colitis. Arch Surg. 2002;137:690–4.

    Article  PubMed  Google Scholar 

  23. Delaney CP, Remzi FH, Gramlich T, et al. Equivalent function, quality of life and pouch survival rates after ileal pouch-anal anastomosis for indeterminate and ulcerative colitis. Ann Surg. 2002;236:43–8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Colombel JF, Ricart E, Loftus EV Jr, et al. Management of Crohn’s disease of the ileoanal pouch with infliximab. Am J Gastroenterol. 2003;98:2239–44.

    Article  CAS  PubMed  Google Scholar 

  25. Uchino M, Ikeuchi H, Bando T, et al. Clinical features of refractory pouchitis with penetrating lesions and the efficacy of infliximab treatment for patients with ulcerative colitis after restorative proctocolectomy. Digestion. 2015;92:147–55.

    Article  CAS  PubMed  Google Scholar 

  26. Herfarth HH, Long MD, Isaacs KL. Use of biologics in pouchitis: a systematic review. J Clin Gastroenterol. 2015;49:647–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Haveran LA, Sehgal R, Poritz LS, et al. Infliximab and/or azathioprine in the treatment of Crohn’s disease-like complications after IPAA. Dis Colon Rectum. 2011;54:15–20.

    Article  PubMed  Google Scholar 

  28. Pellino G, Selvaggi F. Outcomes of salvage surgery for ileal pouch complications and dysfunctions the experience of a referral centre and review of literature. J Crohns Colitis. 2015;9:548–57.

    Article  PubMed  Google Scholar 

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This work was supported in part by Health and Labor Science Research Grants for research on intractable diseases from the Ministry of Health, Labor and Welfare of Japan. M. Itabashi received an honorarium from Bayer Yakuhin, Ltd., and a research grant from Takeda Parmaceutical Co. and Chugai Pharmaceutical Co., Ltd. T. Watanabe received a research grant from Mitsubishi Tanabe Pharm. Y. Suzuki received an honorarium from Mitsubishi Tanabe Pharma Corp., ZERIA Pnarmaceutical Co., Ltd., and AbbVie GK., Eisai Co., Ltd., KYORIN Pharmaceutical Co., Ltd.

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MU, HI, AS, KF, TW and KF designed the study and wrote the initial draft of the manuscript. MU contributed to the analysis and interpretation of data and assisted in the preparation of the manuscript. All other authors contributed to data collection and interpretation and reviewed the manuscript. The final version of the manuscript was approved by all authors.

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Correspondence to Motoi Uchino.

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Uchino, M., Ikeuchi, H., Sugita, A. et al. Pouch functional outcomes after restorative proctocolectomy with ileal-pouch reconstruction in patients with ulcerative colitis: Japanese multi-center nationwide cohort study. J Gastroenterol 53, 642–651 (2018).

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