McKenna et al identified risk factors for organ space infection (OSI) following ileal pouch anal anastomosis (IPAA) in a patient with ulcerative colitis. The authors are from the Mayo Clinic in Rochester, Minnesota.
Patient selection: either total proctocolectomy (TPC) or completion proctocolectomy (CP), with ileal pouch anal anastomosis (IPAA)
Completion proctocolectomy is performed after a previous subtotal colectomy.
Outcome: organ space infection within 30 days of surgery
Complications include:
(1) pelvic abscess
(2) anastomotic leak
Risk factors for total proctocolectomy:
(1) obesity (BMI>= 30 kg per square meter)
(2) urgent surgery
These findings would favor subtotal colectomy for an obese patient or a patient needing an urgent resection.
Risk factors for completion proctocolectomy:
(1) operation time >= 275 minutes
The occurrence of pelvic sepsis can result in pouch failure with need for a permanent stoma.
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