FUNCTION AND OUTCOMES OF ILEAL POUCH-ANAL ANASTOMOSIS IN PATIENTS WITH CONNECTIVE TISSUE DISORDERS

Introduction: Ileal-pouch anal anastomosis (IPAA) is a widely preferred surgical intervention for patients with medically refractory ulcerative colitis, familial adenomatous polyposis, and indeterminate colitis. Concerns have been raised regarding the impact of connective tissue disorders on the outcomes of IPAA due to potential alterations in collagen metabolism. To date, there is a lack of studies assessing the feasibility, long-term viability and pouch function of IPAA in patients with connective tissue disorders. We hypothesized that the presence of a connective tissue disorder might be associated with a higher rate of pouch complications and failure.

Methods: Data were collected from a prospectively maintained pouch database and chart reviews. Patients with connective tissue disorders were propensity score matched in a 1:5 ratio with control pouch patients without connective tissue disorder. A comparative analysis of demographics, long-term complications, functional outcomes, and quality of life was conducted.

Results: A total of 19 patients with connective tissue disorders were matched to 95 control pouch patients. The postoperative diagnoses were ulcerative colitis (82.5%), indeterminate colitis (7%), constipation (5.3%), Crohn's disease (4.4%), and familial adenomatous polyposis (1%) Connective tissue disorders identified, included unspecified diffuse connective tissue disorders (26.3%), Ehlers-Danlos syndromes (15.7%), Sjogren's syndromes (15.7%), and others. Patients with connective tissue disorders were more likely to experience pouchitis (79% vs. 56%, p=0.04). Differences in rates of pouch prolapses (10.5% vs. 4.2%, p=0.26) and of pouch failure (26.3% vs. 13.7%; p=0.17) was present but failed to achieve statistical significance. Functional outcomes, and quality of life were similar in both groups.

Conclusion: IPAA remains a feasible surgical option for patients with connective tissue disorders, offering comparable functional outcomes and quality of life. Physicians treating patients with these disorders should be aware of a potentially elevated risk of pouchitis, pouch prolapse and pouch failure.