EP135 - Patient Perspective: Decisional Factors for Ileo-anal Pouch Versus Permanent Ileostomy After Emergency Colectomy for Ulcerative Colitis

Saturday, May 10, 2025

3:36 PM – 3:41 PM PT

Location: Monitor 5, Sails Pavilion, Upper Level

ePoster Presenter(s)

SW

Sonia Wu, MD

Resident
University of Montreal
Montreal, Quebec, Canada

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

Author(s)

CM

Christina-Maria Maalouf, n/a

Medical Student
University of Montreal
Montreal, Quebec, Canada

Disclosure information not submitted.

Senior Author(s)

CR

Carole S. Richard, MD,FRCS(C)

Associate professor
Universite de Montreal
Montreal, Quebec, Canada

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

Author(s)

LR

Loungnarath Rasmy, n/a

Colorectal surgeon
Université de Montréal
Montreal, Quebec, Canada

Disclosure information not submitted.
RW

Ramses Wassef, MD, MSc, FRCSC

Clinical Professor
Université de Montréal
Ville Mont-Royal, Quebec, Canada

Disclosure information not submitted.
FD

François Dagbert, MD

Colorectal Surgeon
Centre Hospitalier de l'Universite de Montreal
Montreal, Quebec, Canada

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

Franck Schwenter, n/a

Professor
Montréal University Hospital
Montreal, Quebec, Canada

Disclosure information not submitted.
HS

Herawaty Sebajang, Dr

Colorectal surgeon
CHUM
Montréal, Quebec, Canada

Disclosure information not submitted.
MG

Marianne Gagnon-Konamna, MD, FRCSC, FACS, FASCRS

Attending staff
University of Montreal
Montreal, Quebec, Canada

Disclosure information not submitted.
RR

Richard Ratelle, MD FRCSC

Chief of digetive surgery unit
University of Montreal
Montreal, Quebec, Canada

Disclosure information not submitted.
ED

Eric De Broux, MD, MSc,FRCSC

Colorectal surgeon and teaching professor at the Montréal University Hospital (CHUM)
University of Montreal
Mont-Royal, Quebec, Canada

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Sonia Wu, MD: This individual has no financial relationships with ineligible companies.

Carole S. Richard, MD,FRCS(C): This individual has no financial relationships with ineligible companies.

François Dagbert, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Despite new medical treatments optimizing control of Inflammatory Bowel Diseases, approximately 10-15% of Ulcerative Colitis (UC) patients require surgery. Most patients undergo a 2-step approach: first, colectomy with ileostomy and a second elective intervention, either Ileal Pouch Anal Anastomosis (IPAA) or Abdomino-Perineal Resection (APR). After colectomy, patients are faced with a major life-altering decision for definitive rectum surgery. The quality-of-life (QoL) impacts between choosing an IPAA or an APR can be difficult to gauge and challenging for professionals to counsel.
This prospective cohort study aimed to identify decisional factors for patients who underwent either IPAA or APR. The secondary objective was to compare this study population’s QoL with the general population.

Methods/Interventions: This was a single-center qualitative cohort study, with prospectively recruited patients based on a retrospective database. Adult patients diagnosed with UC who underwent total colectomy and either IPAA or APR between 2005 and 2020 were eligible for the study. Patients were recruited and consented by telephone. A semi-structured telephone interview was completed, recorded and transcribed. Five open questions prompted the interview: whether both surgical options (IPAA, APR) were presented prior to definitive surgery, whether surgeons influenced the decision, which factors pushed towards IPAA or APR, overall satisfaction level regarding the choice (IPAA, APR) made, and discussion of sexual function or fertility struggles after definitive surgery. Participants then completed the SF12v2 questionnaire for health-related QoL. Qualitative analysis was done using QDAMinerLite with the Grounded Theory. SPSS was used for statistical descriptive analysis.

Results/Outcomes: A total of 150 eligible patients were contacted, of which 89 were included (59% response rate). Seventy-two patients (81%) underwent IPAA and 17 had an APR. Mean age was 48 and 46 years old, respectively. Fifty-three IPAA patients were male and 70% of APR group were female. Mean time between surgery and questionnaire completion was 9 years. Impact on daily functional routine such as sleep schedule, dressing issues, work and travel oriented decision for 65% of patients. Based on these themes, 48 chose the IPAA and 10 chose the APR. Forty-seven percent of patients were greatly influenced by the impact of stoma management and cost in choosing IPAA. Stomal impact on self-esteem, body image and social stigma was mentioned by 56% of patients, of which 97% chose the IPAA. Nine patients who chose APR mentioned fear of IPAA complications as a deciding factor. Eleven percent of patients reported that patient testimonials were instrumental in their decision while 17% mentioned healthcare provider as main decision factor. Most patients (85) were satisfied with their choice.
On SF12v2 analysis for health-related QoL, mean physical component score (PCS) was 50.84 and mean mental component score (MCS) was 49.38, both comparable or better than general population scores.

Conclusion/Discussion: UC patients undergoing two-stage surgery face a challenging choice between IPAA and APR. Impact on daily function, stoma management and body image were the main decisional factors in our study. Patient testimonials and healthcare provider input were helpful, but less likely to influence choice. Overall, patients were satisfied with selection of either surgery and QoL scores were comparable or better than general population, which is reassuring from a counselling perspective.