IPAA Surgery in Patients With Ulcerative Colitis, Obesity Linked to Adverse Outcomes

ulcerative colitis
Researchers compared the outcomes of ileal pouch anal anastomosis construction in patients with vs without obesity who had ulcerative colitis.

Ileal pouch anal anastomosis (IPAA) construction in patients with vs without obesity who have ulcerative colitis (UC) is associated with a decreased QOL and increased risk for long-term pouch failure, according to a study in Diseases of the Colon & Rectum.

Researchers aimed to determine whether obesity vs nonobesity was associated with increased complications resulting in decreased long-term QOL and pouch survival following an IPAA surgical procedure.

Eligible participants from a prospective database had restorative proctocolectomy and a diagnosis of UC or indeterminate colitis, with an index procedure from 1990 to 2018. Patients with vs without obesity were stratified according to body mass index (BMI), with obesity defined as BMI greater than 30 kg/m2.

The primary outcome was long-term pouch survival, and the secondary outcome was overall global QOL.

A total of 3300 patients were included, of whom 2202 completed at least 1 postoperative QOL survey. Of this group, 631 patients had obesity (59.3% men; 32.5% aged >50 years), with a median BMI of 32.4 kg/m2, and 2669 did not have obesity (55.9% men; 22.7% aged >50 years). The median follow-up was 7 years.

Univariate analysis showed that, compared with patients without obesity, patients with obesity were more likely to be older than age 50 years (32.5% vs 22.7%, P <.001), were in American Society of Anesthesiologists class 3 (41.7% vs 27.7%, P <.001), have diabetes (8.1% vs 3.3%, P <.001), receive their surgery in the later biologic era (72.4% vs 66.2%, P =.003), and they were less likely to be receiving preoperative steroids (31.2% vs 37.4%, P =.004).

Index cases for patients with obesity had a 21-minute longer average operating time (P <.001) and a length of stay 0.7 days longer (P =.001). No difference was observed between patients with vs without obesity for complication rates, pouch leaks, or pouch failure. The median time to pouch failure was 8.0 (IQR, 3.0-12.0) years, with no difference between the 2 groups.

According to multivariable analysis, pouch survival was lower in the group with vs without obesity (95.4% vs 99.8%, P =.002).

Obesity was the strongest independent predictor of pouch failure (hazard ratio, 4.24; P =.007), according to Cox proportional multivariable regression. The matched multivariable models also demonstrated that obesity was associated with lower postoperative global QOL scores (relative risk, -0.71; P =.002).

Other secondary multivariable analyses showed that obesity was independently associated with an additional 27 minutes of operating time (P <.001) compared with matched control individuals without obesity. Obesity was not independently associated with the likelihood of a postoperative complication (odds ratio [OR], 1.31; P =.13), length of hospital stay (relative risk, 0.09; P =.79), or pouch anastomotic leak (OR, 1.64; P =.08).

Researchers noted that their retrospective study is limited to the observed consequences of patients who were offered pouch surgery, and missing data affected their ability to include all patients in the multivariable analysis. Also, the findings are based on pouch surgery from a high-volume pouch referral center and may not be generalizable.

“Further investigation is needed to elucidate how visceral adiposity inflammation may play a significant role in patients with IBD,” the researchers wrote. “Obese patients should be counseled about the risk of suboptimal long-term outcomes before undergoing restorative pouch surgery.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Leeds IL, Holubar SD, Hull TL, et al. Short- and long-term outcomes of ileal pouch anal anastomosis construction in obese patients with ulcerative colitis. Dis Colon Rectum. 2022;65(8):e782-e789 doi:10.1097/DCR.0000000000002169