Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis in Obese Patients

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Abstract
Background: Obesity is a relative contraindication to performing restorative proctocolectomy. The aim of this study was to assess the morbidity and functional results after restorative proctocolectomy in obese patients as compared to a matched cohort of non-obese patients. Methods: 334 patients who had restorative proctocolectomy were reviewed; obesity was defined as a body mass index (BMI) greater than or equal to 30 kg/m2. 31 obese patients were matched to 31 non-obese patients for age, gender,steroid use, and diagnosis. Operative time, length of hospitalization, and both perioperative (6 weeks), especially sepsis, were evaluated. Results: The BMI was significantly higher in the obese group (33.7 vs 23.2) (p<0.0001), and no difference was found between the obese and non-obese groups relative to the matched parameters of age, gender, steroid use and diagnosis.There was no difference in the rate of mucosectomy performed between the obese and non-obese patients (9.6% vs 3.2%, p=NS). 16% of the obese patients underwent one stage restorative proctocolectomies as compared to 10% in the non-obese group. Operative time was longer in the obese group (229 min vs 196 min; p=0.02), but overall hospital length of stay was similar (9.7 days vs 7.7 days; p=0.13). Perioperative morbidity was higher in obese patients (32% vs 9.6%, p=0.058). However, there was no statistical significance in long-term morbidity (23% vs 32%, p=0.57) at a mean follow-up of 51 months in the obese group and 53 months in the non-obese group. Obese patients had more stomal complications (10 vs 0%) and incisional hernias (13 vs 3%) (p=NS). Overall the pelvic sepsis-rate was significantly higher in the obese group (16 vs 0%; p<0.05). 60% of the obese patients who developed pelvic sepsis had pouchanal anastomosis performed without proximal fecal diversion. Mean bowel movements/24 hours, pad use, nocturnal evacuation, accidents/24 hours and incontinence scores were not statistically significant between the groups. Conclusion: Obese patients have a higher rate of pelvic sepsis and peri-operative morbidity when compared to a matched non-obese cohort of patients; however,the functional outcome of restorative proctocolectomy in obese patients is not significantly different than in non-obese patients.

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