S1599 Post-Operative Pelvic Floor Dysfunction on Anorectal Manometry Is Associated With Pouch Ulceration After Ileal Pouch-Anal Anastomosis

Introduction: Anorectal manometry (ARM) is commonly performed in patients with inflammatory bowel disease (IBD) undergoing an ileal pouch-anal anastomosis (IPAA). We previously demonstrated patients with abnormal sphincter function on pre-operative ARM have a higher prevalence of pouch ulceration (P = 0.016), rectal cuff inflammation (P = 0.001), and pouch excision (P = 0.019). For the present study, we hypothesize post-operative ARM (conducted after completion of surgical series) will similarly be predictive of inflammatory outcomes and pouch failure. Methods: This single-center retrospective study examined IBD patients with IPAA who underwent post-operative ARM at Cleveland Clinic between 2009 and 2024 with at least one pouchoscopy >6 months after ileostomy takedown. Patients <18 years old at time of colectomy and patients with ostomies at the time of ARM were excluded. Patients were divided into 2 groups, one for patients with normal relaxation of the anal sphincter with strain (normal function) and the other for those with failure to relax with strain (abnormal function). The primary outcome was post-operative inflammation of the pouch and/or rectal cuff. Results: A total of 123 patients were included: 51 patients in the abnormal function group and 72 patients in the normal function group. The groups were similar in demographic and pre-operative variables except for age and gender, with the abnormal function group favoring female gender (P < 0.001) and younger age (P = 0.037). There was no significant difference in follow-up time, time to post-operative ARM, or post-operative symptoms prior to ARM (including incontinence and incomplete evacuation). In univariate analysis, the abnormal function group had a higher prevalence of rectal cuff inflammation (P = 0.037) and pouch excision (P = 0.016). Multivariable logistic regression showed a significant association between pouch ulceration and abnormal ARM while adjusting for gender and endoscopic evidence of strictures (P = 0.049); age did not significantly contribute to the model and thus was substituted with strictures, a significant covariate. Multivariate logistic regression did not show a significant association between cuffitis and abnormal ARM (P = 0.071). Conclusion: Post-operative ARM abnormalities are significantly associated with pouch ulceration and may predict long-term inflammatory outcomes in IPAA patients. These findings support the utility of post-operative ARM in the comprehensive assessment of patients with IPAA.