In patients with UC undergoing restorative proctocolectomy with IPAA, does preoperative anti-TNF therapy reduce the risk of postoperative pouch failure compared with surgery alone

What is known

- One cohort found preoperative biologics before IPAA associated with septic complications, supporting a staged surgical strategy in patients on biologics at the time of surgery. ¹ - Studies are conflicting on whether preoperative anti-TNF adds risk of inflammatory pouch conditions postoperatively. ² - Individual studies within meta-analyses report both increased postoperative complications and no increased risk after preoperative infliximab. ³ - Preoperative anti-TNF has been associated with de novo Crohn's disease of the pouch and, in one report, with treatment failure when recycled for pouch inflammation. ^4,5

What is unknown / caveats

- Some studies link preoperative anti-TNF to increased septic/postoperative complications, while others find no increase in postoperative complications - No excerpt directly compares pouch-failure rates between preoperative anti-TNF and surgery alone - Evidence is observational (cohorts, registries, meta-analyses of complications), not designed to isolate a pouch-failure endpoint - The excerpts address postoperative complications and pouch inflammation rather than a head-to-head pouch-failure comparison, so no reduction in pouch failure can be established.

## References

1. Gu J, Remzi FH, Shen B, Vogel JD, Kiran RP. Operative strategy modifies risk of pouch-related outcomes in patients with ulcerative colitis on preoperative anti-tumor necrosis factor-α therapy. Dis Colon Rectum. 2013;56(11):1243-52. PMID: 24104999.

2. Powers JC, Cohen BL, Rieder F, Click BH, Lyu R, Westbrook K, Hull T, Holubar S, Regueiro MD, Qazi T. Preoperative Use of Multiple Advanced Therapies Is Not Associated With Endoscopic Inflammatory Pouch Diseases. Inflamm Bowel Dis. 2024;30(2):203-212. PMID: 37061838.

3. [No authors listed]. Preoperative use of anti-TNF therapy and postoperative complications in inflammatory bowel diseases: a meta-analysis. J Crohns Colitis. 2013;7(11):853-67. PMID: 23523418.

4. Ricardo AP, Kayal M, Plietz MC, Khaitov S, Sylla P, Dubinsky MC, Greenstein A. Predictors of pouch failure: A tertiary care inflammatory bowel disease centre experience. Colorectal Dis. 2023;25(7):1469-1478. PMID: 37128185.

5. Kayal M, Posner H, Milwidsky HM, Plietz M, Khaitov S, Sylla P, Greenstein A, Dubinsky MC, Mehandru S, Colombel JF. Acute Severe Ulcerative Colitis Is Associated With an Increased Risk of Acute Pouchitis. Inflamm Bowel Dis. 2023;29(12):1907-1911. PMID: 36939632.

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_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._