P0192 Appropriate pouch volume associated with improved clinical outcomes and long-term quality of life in patients with ulcerative colitis after ileal pouch-anal anastomosis: Results from China UC Pouch Center Union

Abstract Background The total proctocolectomy with ileal pouch-anal anastomosis (IPAA) has been widely accepted as a radical surgery for ulcerative colitis (UC). A well functional and constructed J pouch is decisive for the long-term quality of life (QOL) in UC patients after IPAA. Appropriate pouch volume is crucial for well functional J pouch as it is associated with bowel function after operation. Although the volume is mainly determined by the length of ileum used for pouch creation, the radius of the transverse section of the terminal ileum and the compliance of ileum itself also affected the volume. Thus, the measurement of pouch volume only by pouch length is inadequate. However, the current evidence mainly focused on pouch length, few studies explored what pouch volume is appropriate for patients to achieve better long-term prognosis. In this study, we mainly aimed to explore whether pouch volume was associated with postoperative complications and long-term QOL and further determine what is the appropriate pouch volume to make patients to achieve better long-term prognosis, so as to provide clinicians with decision-making suggestions for pouch construction. Methods UC patients who underwent IPAA from January 2008 to January 2024 in our pouch surgery centers affiliated to from China UC Pouch Center Union were enrolled. The primary outcomes were the occurrence of postoperative complications and impaired long-term OQL. Results This study makes three conceptual advances in pouch construction with appropriate volume in IPAA. First, the present study with a long follow-up period first reported the results regarding the relationship between pouch volume and clinical outcomes in UC patients after IPAA from China UC Pouch Center Union. We indicated the greater pouch volume (more than 120 ml) is appropriate for UC patients and found that patients with pouch volume ≥ 120 ml were more likely to achieve more significantly improved long-term QOL, better bowel function as well as have decreased risk of late postoperative complications, mainly presented as pouchitis. Second, we explored the risk factors associated with late postoperative complications and determined that pouch with volume less than 120 ml is an independent risk factor for the development of late postoperative complications. Third, our study further highlights the greater pouch volume (more than 120 ml) as the positive factor to more significantly improve long-term QOL by multivariate logistic regression analysis. Conclusion J pouch volume of more than 120 ml could be a considerable option for colorectal surgeons in pouch configurations to make patients achieve better long-term prognosis. Conflict of interest: Dr. Xu, Weimin: No conflict of interest Dai, Zhujiang: No conflict of interest Ding, Zhao: No conflict of interest Wu, Xiaojian: No conflict of interest Zhou, Wei: No conflict of interest Ding, Wenjun: No conflict of interest Du, Peng: No conflict of interest