Effects of different lengths of J pouch in patients with ulcerative colitis after total proctocolectomy with ileal pouch-anal anastomosis        XU Wei-min *, DING Wen-jun , ZHU Yi-lian, et al.*Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University,School of Medicine, Shanghai 200092, China
Corresponding author: DU Peng, E-mail: dupeng@xinhuamed.com.cn
XU Wei-min and DING Wen-jun are the first authors who contributed equally to the article
Abstract    Objective    To analyze and compare the complications after total proctocolectomy with ileal pouch-anal anastomosis (TPC-IPAA) and long-term quality of life (QOL) in patients with ulcerative colitis (UC) with J pouch configuration of different lengths. Methods Clinical data of 130 UC patients who underwent TPC-IPAA from January 2008 to June 2021 in Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University and Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University were retrospectively collected. The pouches with a length of about  (22 ± 2) cm (76 patients) and (14 ± 2) cm (54 patients) were divided into the short and the long J pouch groups according to the length distribution of pouches. Then the postoperative complications and long-term QOL were analyzed in the two groups. Results    The overall Cleveland Quality of life score (CGQL) and the proportion of patients with CGQL increased by 50% after IPAA were significantly higher in long J pouch group than those in short J pouch group ［(0.700±0.123) vs. (0.756±0.129), t=-2.454, P=0.015; 42.6% vs. 62.5%, χ2=6.117, P=0.013］. The proportion of postoperative long-term complications in the short J pouch group was higher than that in the long J pouch group (51.9% vs. 30.3%, χ2=6.172, P=0.013), which mainly included increased defecation frequency (22.2% vs. 7.9%, χ2=5.433, P=0.020) and pouchitis (40.7% vs. 21.1%, χ2=5.915, P=0.015). Multiple logistic regression analysis showed that pouch length of (14 ± 2) cm was an independent risk factor for impaired long-term QOL and the development of late complications after TPC-IPAA. Kaplan-Meier survival analysis showed that the overall late postoperative complications-free survival after TPC-IPAA was lower in short J pouch group than that in long J pouch group (P<0.0001). Conclusion    The length of J pouch, was associated with the clinical outcomes in patients after TPC-IPAA. A pouch with a length of 22 ± 2 cm could be taken into consideration to create in clinical practice for colorectal surgeons, which could reduce the incidence of late complications and make patients achieve a better long-term prognosis.