Preoperative anorectal manometry is associated with cuffitis but not proximal pouch inflammation after IPAA creation

Patients undergoing ileal pouch-anal anastomosis (IPAA) for inflammatory bowel disease (IBD) commonly experience postoperative inflammatory complications, including pouchitis and cuffitis. While pelvic floor dysfunction has been associated with these complications, the predictive value of preoperative anorectal manometry (ARM) remains unclear. We evaluated the association between abnormal preoperative ARM and postoperative inflammatory outcomes in IPAA patients.

In this historical cohort study we assessed IPAA patients who underwent preoperative ARM with ileostomy closure during the period from January 2009 to December 2024. Patients were divided into 2 groups-normal vs abnormal pelvic floor function-based on ARM. Primary outcomes were a composite measure of endoscopic inflammatory pouch disease (EIPD) and endoscopic evidence of rectal cuffitis after the perioperative period. Secondary outcomes included individual components of the composite primary outcome. Multivariable logistic regression was used to assess associations while controlling for covariates.

We included 179 patients in this study, 46 (25.7%) with abnormal ARM and 133 (74.3%) with normal ARM. In multivariable regression, abnormal ARM was associated with modestly increased odds of cuffitis (odds ratio [OR], 2.136; 95% CI, 1.050-4.345; P = .037) but was not associated with EIPD (OR, 1.490; 95% CI, 0.710-3.104; P = .287). Secondary outcomes were similar between groups, except for diffuse pouch inflammation, which was more frequently observed among patients with abnormal ARM (P = .024).

Abnormal preoperative ARM was associated with increased odds of postoperative cuffitis but not composite endoscopic pouch inflammation in IPAA patients. Given the modest effect size and limited precision, these findings warrant confirmation in larger, prospective studies.