S1530 Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: A 35-Year Analysis on Clinical Outcomes, Pouchoscopy Features, and Postoperative Quality of Life in a Tertiary Care Center

Introduction: Ileal pouch-anal anastomosis (IPAA) remains the definitive surgical treatment for patients with ulcerative colitis (UC). The management of IPAA has thoroughly evolved, driven by advancements in perioperative care, medical therapy, and integration of pouchoscopy. This 35-year study aims to evaluate long-term outcomes, pouchoscopy features, and quality of life (QoL) in UC patients with IPAA. Methods: Medical records and pouchoscopy reports of UC patients who had IPAA at a tertiary care center from 1990 to 2025 were reviewed, including diagnostic/surgical timelines and endo-histologic features from routine surveillance pouchoscopies for dysplasia. Introduced in 2021, fifty patients scored QoL through one-time administration of the validated Cleveland Global Quality of Life questionnaire (Fazio Score), rating QoL, quality of health and energy level using a 1-10 scale. Descriptive metrics were analyzed. The study is IRB-approved. Results: A total of 103 UC patients who underwent IPAA were identified (49M/54F, mean age 40.9 ± 14.0); 81.6% had severe UC as a colectomy indication, 11.7% dysplasia, and 6.7% as other. Median interval from UC diagnosis to colectomy was 7.4 years; 100% had a J-pouch. Post-surgical specimen revealed dysplasia in 22.3% of patients. Median interval from IPAA to recorded surveillance pouchoscopy was 37.9 months. Pouchoscopy revealed ulceration in 30.9%, friability in 18.1%, edema in 16.0%, and increased vascularity in 3.2%; pouchitis was identified in 28.1%. Pouch biopsies showed inflammatory and neutrophilic infiltrates in 57.6% and 54.4%, respectively. Post-IPAA complications included ileoanal pouch-related strictures in 12.3% and fistula formation in 8.2%; 9.6% experienced pouch failure and 6.8% developed Crohn’s disease of the pouch. In reference to the Fazio Score, 79.6% rated quality of health between 7-10, 75.5% for QoL, and 74.0% for energy levels. Conclusion: This study confirms that IPAA remains an effective surgical option for patients with UC. One key finding is the prolonged disease course prior to surgery, reflecting both the chronic nature of UC and a greater focus on medical therapies to achieve remission and delay surgery. Dysplasia was observed at twice the rate in the post-surgical specimen as opposed to pre-operative findings, highlighting the limitations of current surveillance protocols. Observed endoscopic inflammation underscores the common occurrence of pouchitis. QoL outcomes were favorable, emphasizing IPAA’s success for long-term wellbeing.