Excessive weight gain is associated with an increased risk for pouch failure in patients with restorative proctocolectomy.

Abstract

BACKGROUND:

The aim was to evaluate the impact of weight gain on pouch outcomes after ileostomy closure.

METHODS:

Consecutive inflammatory bowel disease patients with ileal pouches followed up at our subspecialty Pouch Center from 2002 to 2011 were studied. The association of excessive weight gain (defined as a 15% increase the index weight) with pouch outcomes were evaluated using univariate and multivariate analyses.

RESULTS:

A total of 846 patients met inclusion criteria, with 470 (55.6%) being men. The mean age at the diagnosis of inflammatory bowel disease and at pouch surgery was 27.2 ± 11.9 years and 37.8 ± 12.8 years, respectively. Patients with weight gain more likely had mechanical or surgical complications of the pouch (18.4% versus 12.3%, P = 0.049), Crohn's disease of the pouch (30.6% versus 18.5%, P = 0.001), Pouch Center visits (2.0 [1.0-4.0] versus 2.0 [1.0-3.0], P = 0.008), and postoperative pouch-related hospitalization (21.1% versus 10.6%, P < 0.001). After a median follow-up of 9.0 (interquartile range = 4.0-14.0) years, 68 patients (8.0%) developed pouch failure. In the multivariate analysis, excessive weight gain was an independent risk factor for pouch failure with a hazard ratio of 1.69 (95% confidence interval = 1.01-2.84, P = 0.048) after adjusting for preoperative or postoperative use of anti-tumor necrosis factor biologics, postoperative use of immunosuppressants, Crohn's disease of the pouch, mechanical or surgical complications of the pouch, and postoperative pouch-associated hospitalization.

CONCLUSIONS:

Excessive weight gain after closure of the ileostomy is associated with worse pouch outcomes in patients with inflammatory bowel disease. Appropriate weight control may help improve pouch retention.

• Authors: Xian-Rui Wu, Hong Zhu, Ravi P Kiran, Feza H Remzi, Bo Shen
• Journal: Inflammatory bowel diseases (Inflamm Bowel Dis) Vol. 19 Issue 10 Pg. 2173-81 (Sep 2013) ISSN: 1536-4844 [Electronic] England
• PMID: 23899541 (Publication Type: Comparative Study, Journal Article)

Topics

• Adult
• Anastomosis, Surgical
• Case-Control Studies
• Colitis, Ulcerative (complications, pathology, surgery)
• Colonic Pouches (adverse effects)
• Crohn Disease (complications, pathology, surgery)
• Female
• Follow-Up Studies
• Humans
• Male
• Postoperative Complications
• Pouchitis (etiology)
• Proctocolectomy, Restorative (adverse effects)
• Prognosis
• Risk Factors
• Weight Gain