Below is a summary of “Ileal sac syndrome is common and associated with significant disability in patients with ulcerative colitis receiving IPAA,” published in the December 2022 issue. diseases of the colon and rectum by Li et al.
After ileoanal pouch surgery, a new syndrome called ileoanal pouch syndrome (IPS) has been postulated and described based on a range of symptoms and complications experienced by patients. The aim of this study was to investigate the frequency of IPS in ulcerative colitis (UC) patients undergoing ileal pouch anal anastomosis (IPAA) and its impact on postoperative quality of life. This study design was a cross-sectional analysis. The investigators for this study chose to conduct the study at a tertiary care facility. From October 2014 to May 2021, information was collected on 128 of his IPAAs associated with UC.
The main outcome was the frequency with which IPS was seen. The median postoperative follow-up time for the 138 patients recruited was 2.64 (interquartile range). [IQR]: 1.31-3.80) years. Long-term follow-up after ileostomy reversal is associated with a decrease in the incidence of IPS and its symptoms and complications. Pad use and fecal incontinence affected quality of life in 29% and 31% of patients. The IBD disability index was significantly higher in the IPS group (27.25 vs. 12.15, P.<0.001) than the non-IPS group. Four symptoms (faecal incontinence, clustering, fragmentation, incomplete elimination, and nocturnal symptoms) and two outcomes (pad use, negative mental changes) were associated with a higher IBD disability index (P.<0.05) in multivariate analysis.
Multivariate analysis revealed male sex (OR, 4.485; 95% CI, 1.354-14.857; P.=0.014), preoperative disease duration (OR, 1.013; 95% CI, 1.001–1.025; P.=0.031), and postoperative follow-up (OR, 0.462; 95% CI, 0.244–0.876; P.=0.049) was independently associated with IPS in patients followed for more than 2 years. Unlike future large multisite longitudinal studies, this only included a single center. IPS is a common problem that adversely affects the quality of life of ulcerative colitis patients with IPAA, but its proportion decreased over time when ileal pouch surgery was performed.