DOI: 10.4103/wjcs.wjcs_49_25 ISSN: 1941-8213

Comparison of 30-day Outcomes for J-pouch and K-pouch Procedures at a High-volume Center

Amirbahador Abbasi, Louella Escoto-Ortaliz, Venessa S. Smith, Anna J. Varghese, James M. Church, Bo Shen, Ravi P. Kiran
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Abstract

Background:

The ileal pouch–anal anastomosis (IPAA) is the most commonly performed reconstructive procedure following proctocolectomy for ulcerative colitis and familial adenomatous polyposis. It provides a good quality of life and enables per anal defecation with normal continence in most patients. However, some patients experience IPAA failure or are unsuitable for a pouch–anal anastomosis. In select patients, the Kock pouch (K-pouch) (continent ileostomy) is a reconstructive option that may provide continence without a conventional end ileostomy; however, it is complex and technically challenging. Expertise in the K-pouch is limited, making comparison between IPAA and K-pouch procedures difficult. Here, we compare the 30-day outcomes of IPAA and K-pouch procedures.

Objectives:

To compare 30-day postoperative outcomes between J-pouch and K-pouch procedures performed at a high-volume tertiary care center.

Design:

A single-center retrospective cohort study.

Setting:

At a high-volume tertiary referral center during the period 2014–2024.

Materials (Patients) and Methods:

All patients who underwent either a primary J-pouch or K-pouch between 2014 and 2024 were included from a prospectively maintained database. The following data were collected: patient demographics; preoperative variables; and postoperative outcomes, including length of stay (LOS), readmission, reoperation, mortality, and postoperative complications. Multivariable logistic regression was performed to identify independent predictors of 30-day postoperative readmission.

Sample Size:

A total of 128 patients were included: 96 underwent J-pouch creation and 32 underwent K-pouch creation.

Main Outcome Measures:

Thirty-day postoperative outcomes included LOS, readmission, reoperation, mortality, and postoperative complications (anastomotic leak, abscess, ileus, obstruction, surgical site infection, and cardiopulmonary events).

Results:

A total of 96 patients underwent J-pouch creation and 32 underwent K-pouch creation. The median age (46 years [interquartile range (IQR) 26–60] vs. 45 years [IQR 32–52], P = .84) and median body mass index (BMI) (23.7 [IQR 20.6–27.8] vs. 21.6 [IQR 20.4–25.1] kg/m², P = .17) were similar between the J- and K-pouch groups. Operating time was longer for the K-pouch (293 minutes vs. 233 minutes, P = .004). The median postoperative LOS was shorter for J-pouch patients (6 days [IQR 4–9] vs. 8 days [IQR 7–11], P = .005), whereas there was no significant difference in readmission rates (24% vs. 25%, P = .90). At 30 days, rates of anastomotic leak (1% vs. 3.1%) and abscess (7.3% vs. 6.3%) were similar between the J- and K-pouch groups. There were also no significant differences in ileus ( P = .43), sepsis ( P = 1.00), obstruction ( P = .26), or cardiopulmonary complications ( P = .63) between the groups. The reoperation rate was 6.3% in the J-pouch group and 0% in the K-pouch group ( P = .34).

Conclusion:

Although K-pouch creation is associated with longer operative times and a longer hospital stay, it can be performed with 30-day outcomes similar to those of J-pouch creation.

Limitations:

The retrospective, single-center design and the relatively small K-pouch sample size may limit the generalizability of the findings.

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