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Diverted versus undiverted restorative proctocolectomy for chronic ulcerative colitis: an analysis of long-term outcomes after pouch leak short title: outcomes after pouch leak

  • Maria Widmar
  • Jordan A. Munger
  • Alex Mui
  • Stephen R. Gorfine
  • David B. Chessin
  • Daniel A. Popowich
  • Joel J. BauerEmail author
Original Article
  • 19 Downloads

Abstract

Background

The safety of undiverted restorative proctocolectomy (RPC) is debated. This study compares long-term outcomes after pouch leak in diverted and undiverted RPC patients.

Methods

Data were obtained from a prospectively maintained registry from a single surgical practice. One-stage and staged procedures with an undiverted pouch were considered undiverted pouches; all others were considered diverted pouches. The outcomes measured were pouch excision and long-term diversion defined as the need for loop ileostomy at 200 weeks after pouch creation. Regression models were used to compare outcomes.

Results

There were 317 diverted and 670 undiverted pouches, of which 378 were one-stage procedures. Pouch leaks occurred in 135 patients, 92 (13.7%) after undiverted, and 43 (13.6%) after diverted pouches. Eighty-six (64%) leaks were diagnosed within 6 months of pouch creation. Undiverted patients underwent more emergent procedures within 30 days of pouch creation (p < 0.01). Pouch excision occurred in 14 (33%) diverted patients and 13 (14%) undiverted patients (p = 0.01). Thirteen (32%) diverted patients and 18 (21%) undiverted patients (p = 0.17) had ileostomies at 200 weeks after surgery. In multivariable analyses, diverted patients had a higher risk of pouch excision (HR 3.67 p < 0.01), but similar rates of ileostomy at 200 weeks (HR 1.8, p = 0.19) compared to undiverted patients.

Conclusions

Despite a likely selection bias in which “healthier” patients undergo an undiverted pouch, our data suggest that diversion does not prevent pouch excision and the need for long-term diversion after pouch leak. These findings suggest that undiverted RPC is a safe procedure in appropriately selected patients.

Keywords

Ulcerative colitis Restorative proctocolectomy Ileostomy 

Notes

Author’s contribution

Conception or design: Widmar, Munger, Gorfine, Chessin, Popowich

Bauer acquisition, analysis, or interpretation of data: Widmar, Munger, Gorfine

Drafting of manuscript: Widmar, Munger, Mui, Gorfine, Chessin, Popowich, Bauer

Critical revision: Widmar, Munger, Mui, Gorfine, Chessin, Popowich, Bauer

Compliance with ethical standards

The institutional review board of the Icahn School of Medicine at Mount Sinai approved this study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.New YorkUSA

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