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Association of Decreased Perfusion of the Ileoanal Pouch Mucosa With Early Postoperative Pouchitis and Local Septic Complications
Peter Kienle, MD;
Jürgen Weitz, MD;
Stella Reinshagen, MD;
Achim Magener, MD;
Frank Autschbach, MD;
Axel Benner, MSc;
Josef Stern, MD;
Christian Herfarth, MD
Arch Surg. 2001;136:1124-1130.
Background After ileoanal pouch operation, 5% to 40% of patients with ulcerative colitis and 2% to 8% of patients with familial adenomatous polyposis develop pouchitis. Seven percent to 32% of all patients have local septic complications. Pouch ischemia is discussed as a pathophysiologic factor. Tonometry is a minimally invasive method for estimating intramucosal pH (pHi), with a decreased pHi showing intramucosal acidosis characteristic of hypoperfusion.
Hypothesis Decreased perfusion of the iloanal pouch measured by pHi is associated with local septic complications and the development of pouchitis.
Design Prospective cohort study.
Setting Surgical department of a university hospital.
Patients and Methods The pHi in the ileoanal pouch of 98 patients was measured directly after the pouch procedure and correlated to the clinical course. Endoscopic examination of the pouch with biopsy and blinded histologic assessment, including calculation of a histologic pouchitis score, were routinely performed 3 months postoperatively.
Main Outcome Measures Development of pouchitis and local septic complications in correlation to pHi.
Results A decreased pHi was statistically significantly associated with the development of pouchitis and the rate of local septic complications. All 3 patients with anastomotic stenosis had a pHi less than 7.00. The diagnosis of ulcerative colitis just failed in statistical significance as a risk factor for pouchitis. An increased body mass index just failed as a statistically significant risk factor for complications but was a risk factor for the development of acute pouchitis.
Conclusion Pouch hypoperfusion is a risk factor for the development of pouchitis and local septic complications.
From the Departments of Surgery (Drs Kienle, Weitz, Reinshagen, Stern, and Herfarth) and Pathology (Drs Magener and Autschbach), University of Heidelberg, and Central Unit Biostatistics, German Cancer Research Center (Mr Benner), Heidelberg, Germany.
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