Endometriosis and its role in pouch patients: A matched-pair analysis

Jessica Stockheim, Mikhael Belkovsky, Lukas Schabl, Stefan D. Holubar, Scott Steele, Steele SR, Scott R. Steele, Tracy L. Hull, Hull T, Tracy Hull, Hermann Kessler, Kessler H
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2025 · vol. 27(8) , pp. e70183 · doi:10.1111/codi.70183 · PMID:40722210 · W4412725064
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This study found that ileoanal pouch patients with endometriosis experienced significantly more pouch dysfunction, but comparable quality of life, to those without the condition.

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Abstract

INTRODUCTION: Patients requiring ileoanal pouch (IPAA) are often women of reproductive age. Outcomes in pouch patients with endometriosis have not been described. This study aimed to assess the association of endometriosis on pelvic pouch function, quality of life and pouch survival. MATERIALS AND METHODS: Patients who underwent IPAA between 1985 and 2022 with endometriosis were retrospectively reviewed and matched in a 1:3 ratio based on gender, diagnosis, pouch type, age at pouch creation, BMI and ASA score. RESULTS: Twenty-two patients with endometriosis and IPAA were matched with 66 patients without endometriosis, with ulcerative colitis being the most common diagnosis in both groups (86%). Histopathological verification of endometriosis was available in 45.5% of cases. Intraoperative variables and surgery-related postoperative complications were similar between groups, except for a higher incidence of thromboembolism in the endometriosis group (18% vs. 3%, p = 0.04). There was no significant difference in pouchitis (73% vs. 46%, p = 0.06), while pouch dysfunction occurred significantly more frequently in endometriosis patients (18% vs. 3%, p = 0.03; OR 7.11, 1.53-33.10, p = 0.01). Hysterectomy, with or without salpingo-oophorectomy, was performed in 45% of endometriosis patients, primarily due to endometriosis and pain and most commonly (90%) following IPAA. The timing of endometriosis diagnosis (before or after IPAA) did not significantly influence perioperative outcomes. Overall quality of life was favourable in both groups (0.7 vs. 0.8, p = 0.35). CONCLUSION: Pouch function was inferior in endometriosis patients, yet with a comparable overall quality of life. The timing of endometriosis did not appear to be a significant factor. Endometriosis should not be considered a contraindication for IPAA. A multidisciplinary approach addressing pain management, infertility treatment and potential hysterectomy should be considered early in patient care.
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Abstract

Introduction Patients requiring ileoanal pouch (IPAA) are often women of reproductive age. Outcomes in pouch patients with endometriosis have not been described. This study aimed to assess the association of endometriosis on pelvic pouch function, quality of life and pouch survival.

Materials and methods

Patients who underwent IPAA between 1985 and 2022 with endometriosis were retrospectively reviewed and matched in a 1:3 ratio based on gender, diagnosis, pouch type, age at pouch creation, BMI and ASA score.

Results

Twenty-two patients with endometriosis and IPAA were matched with 66 patients without endometriosis, with ulcerative colitis being the most common diagnosis in both groups (86%). Histopathological verification of endometriosis was available in 45.5% of cases. Intraoperative variables and surgery-related postoperative complications were similar between groups, except for a higher incidence of thromboembolism in the endometriosis group (18% vs. 3%, p = 0.04). There was no significant difference in pouchitis (73% vs. 46%, p = 0.06), while pouch dysfunction occurred significantly more frequently in endometriosis patients (18% vs. 3%, p = 0.03; OR 7.11, 1.53–33.10, p = 0.01). Hysterectomy, with or without salpingo-oophorectomy, was performed in 45% of endometriosis patients, primarily due to endometriosis and pain and most commonly (90%) following IPAA. The timing of endometriosis diagnosis (before or after IPAA) did not significantly influence perioperative outcomes. Overall quality of life was favourable in both groups (0.7 vs. 0.8, p = 0.35).

Conclusion

Pouch function was inferior in endometriosis patients, yet with a comparable overall quality of life. The timing of endometriosis did not appear to be a significant factor. Endometriosis should not be considered a contraindication for IPAA. A multidisciplinary approach addressing pain management, infertility treatment and potential hysterectomy should be considered early in patient care. CONFLICT OF INTEREST STATEMENT S.D. Holubar, fees, Takeda; funding, American Society of Colorectal Surgeons, Crohn's and Colitis Foundation. The remaining authors have no disclosures. DATA AVAILABILITY STATEMENT The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Condition tags

endometriosisinfertility

MeSH descriptors

Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (23)

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