The outcome of ileal pouch anal anastomosis in patients with
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Ileal-pouch anal anastomosis is used for the treatment of different conditions, including mucosal ulcerative colitis and familial adenomatous polyposis.

The present systematic review aimed to assess the literature for studies that compared the outcome of ileal-pouch anal anastomosis in patients with obesity versus patients with ideal weight.

A systematic literature search of electronic databases including PubMed, Scopus, Web of Science, and Cochrane library was performed. The main outcome measures were pouch failure, pouch complications, overall complications, operation time, blood loss, and hospital stay. 6 retrospective studies (3,460 patients) were included. Out of the total number of patients, 19.8% had obesity or overweight.

- Patients with obesity were significantly less likely to have laparoscopic ileal-pouch anal anastomosis compared with patients with ideal body mass index.

- The weighted mean operation time and blood loss were significantly longer in the obesity group than the ideal weight group and.

- The obesity group was associated with significantly higher odds of total complications, leak, and incisional hernia.

- The 2 groups had comparable rates of pouch failure, pouchitis, stricture, pelvic sepsis, wound infection, bowel obstruction, ileus, and venous thromboembolism.

- Male sex, longer operation time, and including inflammatory bowel disease patients only were significantly associated with higher complications in the obesity group.

In conclusion, patients with obesity who undergo ileal-pouch anal anastomosis are more likely to have laparotomy rather than a laparoscopic procedure, have longer operation time, greater blood loss, higher overall complications, leak, and incisional hernia, and longer hospital stay.

Surgery
Source: https://doi.org/10.1016/j.surg.2021.06.009
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