Skip to main content

Advertisement

Log in

Obesity Increases Risk for Pouch-Related Complications Following Restorative Proctocolectomy with Ileal Pouch–Anal anastomosis (IPAA)

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Purpose

Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the preferred surgical treatment for patients with ulcerative colitis and familial adenomatous polyposis. As obesity is becoming more epidemic in surgical patients, the aim of this study was to investigate if obesity increases complication rates following IPAA.

Methods

This study was conducted as a retrospective review of patients undergoing IPAA between January 1990 and April 2011. Patients were categorized by body mass index (BMI): BMI < 30 (non-obese) and BMI ≥ 30 (obese). Preoperative patient demographics, operative variables, and postoperative complications were recorded through chart review. The primary outcome studied was cumulative complication rate.

Results

A total of 103 non-obese and 75 obese patients were identified who underwent IPAA. Obese patients had an increased rate of overall complications (80 % vs. 64 %, p = 0.03), primarily accounted for by increased pouch-related complications (61 % vs. 26 %, p < 0.01). In particular, obese patients had more anastomotic/pouch strictures (27 % vs. 6 %, p < 0.01), inflammatory pouch complications (17 % vs. 4 %, p < 0.01) and pouch fistulas (12 % vs. 3 %, p = 0.03). In a regression model, obesity remained a significant risk factor (odds ratio [OR] = 2.86, p = 0.01) for pouch-related complications.

Conclusions

Obesity is associated with an increased risk of overall and pouch-related complications following IPAA. Obese patients should be counseled preoperatively about these risks accordingly.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kohler LW, Pemberton JH, Hodge DO, Zinsmeister AR, Kelly KA. Long-term functional results and quality of life after ileal pouch–anal anastomosis and cholecystectomy. World J Surg 1992;16:1126–1131.

    Article  CAS  PubMed  Google Scholar 

  2. Becker JM. Surgical management of inflammatory bowel disease. Curr Opin Gastroenterol 1993;9:600–615.

    Article  Google Scholar 

  3. Wells AD, McMillan I, Price AB, Ritchie JK, Nicholls RJ. Natural history of indeterminate colitis. Br J Surg 1991;78:179–181.

    Article  CAS  PubMed  Google Scholar 

  4. Yu CS, Pemberton JH, Larson D. Ileal pouch–anal anastomosis in patients with indeterminate colitis: long-term results. Dis Colon Rectum 2000; 43:1487–1496.

    Article  CAS  PubMed  Google Scholar 

  5. Kartheuser A, Stangherlin P, Brandt D, Remue C, Sempoux C. Restorative proctocolectomy and ileal pouch–anal anastomosis for familial adenomatous polyposis revisited. Fam Cancer 2006;5:241–260.

    Article  PubMed  Google Scholar 

  6. Hartley JE, Fazio VW, Remzi FH, Lavery IC, Church JM, Strong SA, Hull TL, Senagore AJ, Delaney CP. Analysis of the outcome of ileal pouch–anal anastomosis in patients with Crohn’s disease. Dis Colon Rectum 2004;47:1808–1815.

    Article  CAS  PubMed  Google Scholar 

  7. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity in the United States, 2009–2010. NCHS data brief, no 82. Hyattsville, MD: National Center for Health Statistics. 2012.

    Google Scholar 

  8. Mokdad AH, Ford ES, Bowman BA, Dietz WA, Vinicor F, Bales VS, Marks JS. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003;289:76–79.

    Article  PubMed  Google Scholar 

  9. Long MD, Crandall WV, Leibowitz IH, Duffy L, del Rosario F, Kim SC, Integlia MJ, Berman J, Grunow J, Colletti RB, Schoen BT, Patel AS, Baron H, Israel E, Russell G, Ali S, Herfarth HH, Martin C, Kappelman MD. Prevalence and epidemiology of overweight and obesity in children with inflammatory bowel disease. Inflamm Bowel Dis 2011;17:2162–2168.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Alexander F. Complications of ileal pouch anal anastomosis. Seminars in Pediatric Surgery 2007;16:200–204.

    Article  PubMed  Google Scholar 

  11. Efron JE, Uriburu JP, Wexner SD, Pikarsky A, Hamel C, Weiss EG, Nogueras JJ. Restorative proctocolectomy with ileal pouch anal anastomosis in obese patients. Obes Surg 2001;11:246–251.

    Article  CAS  PubMed  Google Scholar 

  12. Kiran RP, Remzi FH, Fazio VW, Lavery IC, Church JM, Strong SA, Hull TL. Complications and functional results after ileoanal pouch formation in obese patients. J Gastrointest Surg 2008;12:668–674.

    Article  CAS  PubMed  Google Scholar 

  13. Canedo JA, Pinto RA, McLemore EC, Rosen L, Wexner SD. Restorative proctectomy with ileal pouch–anal anastomosis in obese patients. Dis Colon Rectum 2010;53:1030–1034.

    Article  PubMed  Google Scholar 

  14. Subramanian V, Pollok RC, Kang JY, Kumar D. Systematic review of postoperative complications in patients with inflammatory bowel disease treated with immunomodulators. Br J Surg 2006; 93:793–9.

    Article  CAS  PubMed  Google Scholar 

  15. Dindo D, Muller MK, Weber M, Clavien PA. Obesity in general elective surgery. Lancet 2003;361:2032–2035.

    Article  PubMed  Google Scholar 

  16. Jiganti JJ, Goldstein WM, Williams CS. A comparison of the perioperative morbidity in total joint arthroplasty in the obese and nonobese patient. Clin Orthop 1993;289:175–179.

    PubMed  Google Scholar 

  17. Chapman GW, Mailhes JB, Thompson HE. Morbidity in obese and nonobese patients following gynecologic surgery for cancer. J Natl Med Assoc 1988;80:417–420.

    PubMed  Google Scholar 

  18. Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc 2001;15:986–989.

    Article  CAS  PubMed  Google Scholar 

  19. Benoist S, Panis Y, Alves A, Valleur P. Impact of obesity on surgical outcomes after colorectal resection. Am J Surg 2000;179:275–281.

    Article  CAS  PubMed  Google Scholar 

  20. Fazio VW, Ziv Y, Church JM, Oakley JR, Lavery IC, Milsom JW, Schroeder TK. Ileal pouch–anal anastomoses complications and function in 1005 patients. Ann Surg 1995;222:120–127.

    Article  CAS  PubMed  Google Scholar 

  21. Fazio VW, Kiran RP, Remzi FH, Coffey JC, Heneghan HM, Kirat HT, Manilich E, Shen B, Martin ST. Ileal pouch–anal anastomosis analysis of outcome and quality of life in 3707 patients. Ann Surg 2013;257:679–685.

    Article  PubMed  Google Scholar 

  22. Berndtsson I, Lindholm E, Oresland T, Börjesson L. Long-term outcome after ileal pouch–anal anastomosis: function and health-related quality of life. Dis Colon Rectum 2007;50:1545–1552.

    Article  PubMed  Google Scholar 

  23. Leowardi C, Hinz U, Tariverdian M, Kienle P, Herfarth C, Ulrich A, Kadmon M. Long-term outcome 10 years or more after restorative proctocolectomy and ileal pouch–anal anastomosis in patients with ulcerative colitis. Langenbecks Arch Surg 2010;395:49–56.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors acknowledge the assistance of Mikhail Gincherman and Bart Freer for assistance with database management, data extraction and IRB approval. Grant Support: American Society of Colon and Rectal Surgeons Research Foundation Career Development Award (SD), NCI Centers for Transdisciplinary Research on Energetics and Cancer (TREC) (U54CA155496) Pilot Project Award (SD)

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sekhar Dharmarajan.

Additional information

This paper was presented as a poster at the annual meeting of the American Society of Colon and Rectal Surgeons, April 27–May 1, 2013, Phoenix, AZ, USA.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Klos, C.L., Safar, B., Jamal, N. et al. Obesity Increases Risk for Pouch-Related Complications Following Restorative Proctocolectomy with Ileal Pouch–Anal anastomosis (IPAA). J Gastrointest Surg 18, 573–579 (2014). https://doi.org/10.1007/s11605-013-2353-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-013-2353-8

Keywords

Navigation