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Publications

Journal Article Ahead of print

PubMed: 42895555 DOI: 10.1007/s00464-026-13515-9

Association between pregnancy and delivery mode and long-term pouch function in women with prior ileal pouch-anal anastomosis: a systematic review and meta-analysis.

Surg Endosc

Authors: Christopher Lopez, Samantha Sipe, Abel Abraham, James Burns, Cameron Perrone, Anjelli Wignakumar, Steven D Wexner, Sameh Hany Emile

Affiliations

  • Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
  • Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.
  • Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
  • Department of Colorectal Surgery, Medstar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC, 20007, USA.
  • Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.

Abstract

INTRODUCTION

This systematic review and meta-analysis aimed to evaluate the association between pregnancy and delivery mode and long-term pouch function after ileal pouch-anal anastomosis (IPAA).

METHODS

A systematic review (CRD420251076660) was conducted in accordance with PRISMA 2020 guidelines. PubMed, Embase, Scopus, Cochrane Library, and Google Scholar were searched through June 2025 for studies reporting pouch-related outcomes among women with prior IPAA who became pregnant. Outcomes included continence, stool frequency, urgency, pouchitis, and pouch failure. Random-effects meta-analysis was performed to generate pooled estimates, with narrative synthesis where appropriate.

RESULTS

Eight studies, including 1350 women who had previously undergone IPAA, were evaluated. The median age was 32 years, and the mean follow-up after delivery was 79.2 months. Proportional meta-analysis of pouch function during pregnancy demonstrated a pooled incontinence and pad usage rates of 39.4% (95% CI 25-53%) and 21.8% (95 %CI 16.5-27%), respectively. Pouchitis during pregnancy was reported in 8% (95% CI 2-30%) of patients, while pouch outlet obstruction occurred in 10.9% (95% CI 2-20%). Pairwise meta-analysis demonstrated increased risk of incontinence after pregnancy (OR = 1.61, 95% CI 1.09; 2.38, p = 0.017), with non-significant changes in either daytime stool frequency (WMD = 0.56, 95% CI 0.19; 1.12, p= 0.358, I 2 = 73%) or nocturnal (WMD = 0.17, 95% CI - 0.43; 0.78, p = 0.575, I 2 = 77%), respectively. Cesarean section was associated with a significant reduction in nighttime bowel movements (WMD: -0.22, 95% CI: -0.41, -0.02, p=0.028), with no significant differences in other outcomes.

CONCLUSIONS

Pouch function remains largely stable during and after pregnancy, although fecal incontinence is common and may worsen postpartum. Mode of delivery does not meaningfully impact long-term pouch outcomes, supporting individualized, preference-sensitive decision-making. Heterogeneity in outcome reporting and the predominance of older studies highlight the need for contemporary research.

MeSH

Pregnancy, Proctocolectomy, Restorative, Endoscopy