Short- and Long-term Outcomes of Ileal Pouch Anal Anastomosis Construction in Obese Patients With Ulcerative Colitis

Leeds, Ira L.; Holubar, Stefan D.; Hull, Tracy L.; Lipman, Jeremy M.; Lightner, Amy L.; Sklow, Bradford; Steele, Scott R.

doi:10.1097/dcr.0000000000002169

Cited by 8 publications

(3 citation statements)

References 26 publications

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“…In a propensity score-matched study including 3300 patients with ulcerative colitis undergoing IPAA, multivariable analysis identified obesity as the strongest independent predictor of pouch failure (hazard ratio, 4.24; P = 0.007), defined as pouch revision, excision, or permanent diversion. Patients with obesity also reported reduced global quality of life with more long-term work restrictions, reduced sexual activity, and increased rates of incontinence and fecal seepage [35 ▪ ]. Obesity did not increase the likelihood of postoperative complications, length of hospital stay, or the frequency of pouch leak [35 ▪ ].…”

Section: Impact Of Obesity On Surgical Management Of Inflammatory Bow...mentioning

confidence: 92%

“…Patients with obesity also reported reduced global quality of life with more long-term work restrictions, reduced sexual activity, and increased rates of incontinence and fecal seepage [35 ▪ ]. Obesity did not increase the likelihood of postoperative complications, length of hospital stay, or the frequency of pouch leak [35 ▪ ]. In a 2022 meta-analysis of 15 studies ( n = 12 622), obesity significantly increased the risk of overall complications, infectious complications, visceral injury, and conversion to laparotomy [36 ▪ ].…”

Section: Impact Of Obesity On Surgical Management Of Inflammatory Bow...mentioning

confidence: 99%

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Reviewing the impact of obesity on inflammatory bowel disease and considerations for optimizing management

Ghusn,

Loftus,

Johnson

2024

Current Opinion in Gastroenterology

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Purpose of review This review examines the complex relationship between obesity and inflammatory bowel disease (IBD), encompassing their potentially shared pathogenesis, the impact of obesity on the natural history and treatment outcomes of IBD, and the management of obesity in the patient with IBD. Recent findings Obesity represents a state of chronic inflammation that may not only contribute to IBD pathogenesis, but also influence disease progression, complications, and response to treatment. Increased visceral adiposity may carry negative prognostic implications for disease and treatment-specific outcomes. Antiobesity medications, endoscopic bariatric therapies, and even bariatric surgery may be effective and well tolerated in selected patients with IBD. Summary The intersection of obesity and IBD presents a significant clinical challenge, with obesity influencing the natural history of IBD and potentially affecting treatment efficacy. As obesity prevalence among IBD patients rises, a tailored approach to management is crucial, taking into account the individualized risks and benefits of various treatment strategies, including lifestyle interventions, pharmacotherapy, endoscopic procedures, and bariatric surgery.

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Section: Impact Of Obesity On Surgical Management Of Inflammatory Bow...mentioning

confidence: 92%

Section: Impact Of Obesity On Surgical Management Of Inflammatory Bow...mentioning

confidence: 99%

Reviewing the impact of obesity on inflammatory bowel disease and considerations for optimizing management

Ghusn,

Loftus,

Johnson

2024

Current Opinion in Gastroenterology

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“…Fourth, obesity was associated with worse outcomes (relatively decreased quality of life and increased risk of long-term pouch failure) for ileal pouch-anal anastomosis in patients with ulcerative colitis 39…”

Section: Obesity May Significantly Impact the Treatment And Complicat...mentioning

confidence: 99%

Ten reasons gastroenterologists and hepatologists should be treating obesity

Camilleri

El-Omar

2023

Gut

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Effect of obesity on postoperative complications in ulcerative colitis: A systematic review and meta‐analysis

Tóth,

Székely,

Rancz

et al. 2024

Annals of Gastroent Surgery

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BackgroundThe prevalence of ulcerative colitis (UC) is around 200/100 000 people. Colectomy is required in 7.5%–40% of patients and 58.8%–94% of these operations are elective. Approximately one in two adults with UC are overweight or obese.ObjectiveOur aim was to compare postoperative complications between obese (defined by a body mass index (BMI) over 30 kg/m2) and non‐obese UC patients who underwent total proctocolectomy with ileal pouch‐anal anastomosis (IPAA).MethodsOur preregistered protocol can be found on PROSPERO (CRD42022377761). We conducted our search in three databases on the 26th of November 2022. PRISMA 2020 guideline and the Cochrane Handbook were applied. We used the GRADEpro program and the QUIPS tool. We applied a random‐effects model to pool effect sizes. We included cohort and case–control studies investigating UC patients undergoing colectomy with IPAA and reported information on postoperative complications in obese and non‐obese patients. We used mean difference (MD) for continuous variables and calculated odds ratio (OR) with a 95% confidence interval (CI) for dichotomous variables.ResultsOf the 6870 hits of our systematic search, we included three retrospective cohort studies for analyses involving 4929 patients in our research. Neither the incidence of complications at 30 days after surgery [OR = 1.08; CI: 0.65–1.79] nor the incidence of septic complications [OR = 1.11; CI: 0.85–1.46] had any clinical relevance, except for the length of hospital stay [MD = 0.36; CI:0.04–0.69]. When we assessed the risk of bias, we found that most of the aspects examined had a moderate overall risk. Our results have very low certainty of evidence.Conclusions and RelevanceOur findings suggest that obesity defined as BMI over 30 kg/m2 may not associated with an increased risk of higher rates of overall postoperative complications compared to non‐obese patients. Obesity with a cut‐off value of 30 kg/m2 does not appear to be a primary reason for prehabilitation.

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Short- and Long-term Outcomes of Ileal Pouch Anal Anastomosis Construction in Obese Patients With Ulcerative Colitis

Cited by 8 publications

References 26 publications

Reviewing the impact of obesity on inflammatory bowel disease and considerations for optimizing management

Reviewing the impact of obesity on inflammatory bowel disease and considerations for optimizing management

Ten reasons gastroenterologists and hepatologists should be treating obesity

Effect of obesity on postoperative complications in ulcerative colitis: A systematic review and meta‐analysis

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