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Aim <p>Obesity has been reported to increase the risk of technical inability in performing ileal pouch–anal anastomosis (IPAA) in patients with ulcerative colitis (UC). This study aimed to prospectively investigate the association between visceral fat and the feasibility of pouch reach in hand-sewn IPAA.</p> Methods <p>We prospectively enrolled patients with UC scheduled for two-stage restorative proctocolectomy with a preoperative plan for hand-sewn IPAA. Patients were categorized into a conversion group that required conversion to stapled IPAA intraoperatively and a non-conversion group. Preoperative visceral fat area and anatomical indicators were measured using computed tomography (CT). Logistic regression analysis was performed to identify predictors of conversion surgery.</p> Results <p>A total of 106 patients were included, with 12 (11.3%) in the conversion group. Compared with those in the non-conversion group, patients in the conversion group had significantly higher body mass index (BMI), greater visceral fat, and a longer distance between the ileal end and the anal verge (<i>p</i> &lt; 0.01). Logistic regression identified visceral fat (per 10 cm<sup>2</sup> increase: odds ratio [OR] 1.19, 95% confidence interval [CI] 1.02–1.39, <i>p</i> = 0.01) as a significant predictor of conversion surgery, whereas BMI was not (OR 1.03, 95% CI 0.77–1.21, <i>p</i> = 0.72).</p> Conclusions <p>Visceral fat is an independent risk factor for conversion surgery in patients undergoing hand-sewn IPAA. Preoperative CT-based measurement of visceral fat may provide a more accurate prediction of pouch reachability than BMI alone. These findings may help surgeons decide preoperatively whether a hand-sewn IPAA is feasible.</p>

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Visceral obesity as a predictor of ileal pouch reachability in ulcerative colitis: A prospective single-center study

  • 期刊论文

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  • 发表日期：

    2025年9月12日

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  • Yuki Horio,
  • Motoi Uchino,
  • Masato Kiriki,
  • Yusuke Tomoo,
  • Kazunori Nomura,
  • Kentaro Nagano,
  • Kurando Kusunoki,
  • Ryuichi Kuwahara,
  • Kei Kimura,
  • Kozo Kataoka,
  • Masataka Ikeda,
  • Hiroki Ikeuchi

摘要

Aim

Obesity has been reported to increase the risk of technical inability in performing ileal pouch–anal anastomosis (IPAA) in patients with ulcerative colitis (UC). This study aimed to prospectively investigate the association between visceral fat and the feasibility of pouch reach in hand-sewn IPAA.

Methods

We prospectively enrolled patients with UC scheduled for two-stage restorative proctocolectomy with a preoperative plan for hand-sewn IPAA. Patients were categorized into a conversion group that required conversion to stapled IPAA intraoperatively and a non-conversion group. Preoperative visceral fat area and anatomical indicators were measured using computed tomography (CT). Logistic regression analysis was performed to identify predictors of conversion surgery.

Results

A total of 106 patients were included, with 12 (11.3%) in the conversion group. Compared with those in the non-conversion group, patients in the conversion group had significantly higher body mass index (BMI), greater visceral fat, and a longer distance between the ileal end and the anal verge (p < 0.01). Logistic regression identified visceral fat (per 10 cm2 increase: odds ratio [OR] 1.19, 95% confidence interval [CI] 1.02–1.39, p = 0.01) as a significant predictor of conversion surgery, whereas BMI was not (OR 1.03, 95% CI 0.77–1.21, p = 0.72).

Conclusions

Visceral fat is an independent risk factor for conversion surgery in patients undergoing hand-sewn IPAA. Preoperative CT-based measurement of visceral fat may provide a more accurate prediction of pouch reachability than BMI alone. These findings may help surgeons decide preoperatively whether a hand-sewn IPAA is feasible.