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

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Journal of Gastrointestinal Surgery



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.


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.


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.


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.

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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)

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Correspondence to Sekhar Dharmarajan.

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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.

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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).

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