eP731 - Patient Preference for Early Ileostomy Closure After Ileal Pouch-anal Anastomosis

ePoster Presenter(s)

• 

  Alex L. Huang, MD

  General Surgery Resident
  Icahn School of Medicine at Mount Sinai
  New York, NY, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• HS

  Hannah Son, BS

  Research Associate
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.
• SZ

  Serena Zheng, MD

  General Surgery Resident
  University of California - Los Angeles
  Los Angeles, California, United States

  Disclosure information not submitted.
• YW

  Yun Hwa Walter Walter Wang, MD

  General Surgery Resident
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.
• AY

  Allen T. Yu, MD, PhD

  General Surgery Resident
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.
• RC

  Rossana Cheng He, MD

  General Surgery Resident
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.
• 

  Hans M. Huber, MD

  Resident
  Mount Sinai Hospital/Memorial Sloan Kettering Cancer Center
  Mount Sinai
  New York, New York, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• 

  Katherine C. Lee, MD, MS (she/her/hers)

  Colorectal Surgery Fellow
  Mount Sinai Hospital
  Mount Sinai Hospital
  New York, NY, United States

  Disclosure information not submitted.
• SH

  Sue J. Hahn, MD

  Assistant Professor
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.
• 

  Sergey Khaitov, MD

  Associate Professor
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.
• AG

  Alexander J. Greenstein, MD

  Associate Professor
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Patricia Sylla, MD (she/her/hers)

  Chief of Colorectal Surgery
  Icahn School of Medicine at Mount Sinai
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no relevant relationships with ineligible companies.

Purpose/Background: Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is a widely accepted surgical treatment for patients with ulcerative colitis (UC). 3-stage IPAA is standard practice with loop ileostomy reversed after 2-4 months. However, ileostomies are not entirely protective against anastomotic leaks (AL) and their sequelae and are associated with substantial morbidity. Thus, there is significant interest in early (within 2 weeks) ileostomy closure (EIC). Studies have shown the safety of EIC in rectal cancer as well as patient and surgeon interest in EIC. Similar data is lacking for UC. A recent RCT investigating EIC after IPAA was terminated due to increased complications but did not demonstrate an increased AL rate. Furthermore, patient interest in EIC for UC has not yet been surveyed. Thus, we sought to investigate interest EIC in patients who had undergone 3-stage RPC and gauge their tolerance for possible increased risks associated with EIC.Methods/Interventions: Patients post-3-stage RPC with IPAA for UC from 2019 to 2023 were identified via an institutional, prospective UC database. Demographic and clinical data were extracted. Patients were contacted, received informational packets, a questionnaire regarding EIC, and underwent a structured survey. Our 2017-2021 institutional IPAA leak rate from (2.6%) was used as the baseline risk for AL. Descriptive statistics were used to summarize results.Results/Outcomes: Thirty patients were surveyed with 20 (67%) male and 10 (33%) female. Average age at completion of IPAA was 32 years old (SD 10.7). with a median time for completion of all 3 stages of 187 days (IQR 155-246). Overall, 12(40%) patients strongly agreed and 10(33%) agreed that EIC would have overall benefits, most frequently citing reduced time with ostomy, decreased care for ostomy, and fewer ostomy-related complications. With respect to ostomies, 8(27%) patients reported severe difficulty and 6(20%) patients reported difficulty, most frequently citing malfunction, skin irritation, and difficulty sleeping with the appliance. Had it been offered, 13(43%) patients would have opted for EIC, 11(37%) patients were unsure, and 6(20%) patients would have declined. Of the 24 patients potentially interested in EIC, 14 stated they would still undergo EIC even if it increased risk of AL and were willing to accept up to mean 6.5% (SD 2.48%) risk of AL. The most commonly cited factors influencing decision-making included long-term pouch function, increased risk of pouch-related complications, and shorter time living with an ostomy.Conclusion/

Discussion: The safety of EIC following RPC in UC patients remains largely unknown. In this survey of 3-stage IPAA patients, EIC would have been of considerable interest to patients, even if associated with greater than 2-fold increase in the risk of pouch leak. Additional trials evaluating the safety of EIC in select patients undergoing RPC for UC are warranted.Figure 1: Pictured results of survey questionnaireWhile increased risk of anastomotic leak discouraged some patients, many would still accept substantially higher risk of anastomotic leaks for EIC.