Demographic Analysis of Patients With Ulcerative Colitis Undergoing Restorative Proctocolectomy With Ileal Pouch-Anal Anastomosis: A Single-Center Study Over the Past 12 Years

Background:
Ulcerative colitis (UC) is characterized by chronic inflammation confined to the colon and rectum. Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA) is the preferred elective surgical treatment, offering generally satisfactory quality of life despite potential complications like pouchitis. Advances in surgical techniques, preoperative preparation, and postoperative care are key to enhancing long-term outcomes. The objective of our study was to evaluate and analyze the clinical outcomes and complications in patients with UC who underwent RPC-IPAA in a Coloproctology Service at a tertiary care hospital in Mexico.
Methods:
A retrospective study examined 14 UC patients who underwent RPC-IPAA at the General Hospital of Mexico between 2010 and 2022. Demographic and clinical variables were analyzed from medical records. Statistical analysis included measures of central tendency (mean) and dispersion (standard deviation) for quantitative variables, and frequencies and percentages for qualitative variables. Data were analyzed using SPSS version 29.
Results:
Among the patients included in our study, 57.9% were women. The average age of the patients was 34.86 years, with a standard deviation of 7.94 years. All patients (100%) were diagnosed with UC with E3 extension (pancolitis), according to the Montreal classification. Patients underwent RPC-IPAA due to a lack of response to surgical treatment. The most common surgical technique was total proctocolectomy with a “J” pouch, performed in 13 patients (92.9%). One patient (7.1%) underwent a total proctocolectomy with a “D” pouch. There was 1 case of pouch failure (7.1%), in which the pouch was excised, and a new “W” pouch was constructed. One patient, initially diagnosed with E3 UC, was reclassified as Montreal A2L4B2 Crohn’s disease seventeen years after the pouch creation and is currently being treated with anti-interleukin 12-23 therapy. The time interval between the diagnosis of UC and the creation of the pouch was 3.86 years. The frequency of pouchitis was 28.6%, these patients developed chronic refractory pouchitis while being treated with anti-integrin therapy.
Conclusions:
This study provides an insightful perspective on RPC-IPAA in patients with UC at a tertiary care hospital in Mexico. It highlights the preference for total proctocolectomy with a “J” pouch. Complications such as pouch failure, reclassification to Crohn’s disease, and the presence of chronic refractory pouchitis underscore the challenges in surgical management, the need for more effective treatment strategies, and the importance of continuous monitoring.