Pouchitis Incidence Following IPAA: Multicenter comparison of Open and Minimally Invasive Surgical Approaches

Pouchitis is the most common long-term complication following ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) and is a leading cause of chronic morbidity and pouch failure. We sought to examine whether the surgical approach, open versus minimally invasive (MIS), may influence the incidence of pouchitis post-IPAA surgery in patients with UC.

We conducted a retrospective cohort study using the Epic COSMOS electronic health record database (2016-2025) to identify UC patients who underwent IPAA. The cohort was stratified by open vs MIS. Demographics were compared and the incidence of post-operative pouchitis was analyzed using Poisson regression, chi-square tests with 95% confidence intervals, and Mantel-Haenszel tests; significance was set at p < 0.05.

A total of 2,821 patients who underwent IPAA treatment for UC were identified, including 1,001 patients who had an open surgical approach versus 1,820 MIS patients. Absolute pouchitis incidence was 44.8% after open surgery versus 36.8% following MIS. Employing MIS was associated with a decrease in relative risk of developing pouchitis compared to open when adjusting for age, sex, and race using Poisson regression (0.795, 95% CI 0.703-0.899, p = 0.0003).

Minimally invasive IPAA shows a significant reduced risk of developing pouchitis as compared to an open surgical approach. Our findings are consistent with prior literature and warrant prospective trials comparing surgical approach and later development of pouchitis complications.