Diversion proctitis during staged restorative proctocolectomy with ileal pouch anal anastomosis is not associated...

The aim of this study was to assess the impact of diversion proctitis (DP) between the first and second surgical stage on pouch outcomes in patients with ulcerative colitis (UC) who underwent three-stage restorative proctocolectomy (RPC) with ileal pouch anal anastomosis (IPAA).

We conducted a retrospective chart review of patients with UC who underwent three stage RPC with IPAA followed by at least one pouchoscopy at Mount Sinai Hospital between 1/2008 and 12/2020. DP was defined as the presence of mucosal atrophy and lymphoid hyperplasia on proctectomy specimen as noted by the reporting pathologist. The primary outcome was cuffitis defined as ulceration of the cuff as reported during pouchoscopy. Continuous and categorical variables were analyzed with t-tests and chi-squared tests, respectively.

Of the 281 patients included in this study, 68 (24.2%) were found to have DP. Age, sex, race, ethnicity, anastomosis type, and disease duration were not significant risk factors for DP development. More patients with vs without DP had evidence of severe disease pre-colectomy with admission for acute severe ulcerative colitis, steroids, and infliximab, though this did not reach statistical significance. A significantly greater proportion of patients with vs without DP required rectal therapy between the first and second surgical stages (32.4% vs 19.2%, p = 0.02). There was no significant difference in the development of cuffitis among patients with vs without DP (19.1% vs 14.1%, p = 0.32).

The occurrence of DP between the first and second surgical stage of RPC with IPAA is significantly associated with the need for rectal therapy; however, is not associated with subsequent cuffitis.