No abstract

These results indicate that increased experience decreases the risk of pouch-related complications and that with time the functional results remain stable, but the failure rate increases.

Primary sclerosing cholangitis (PSC), present in 5% of patients with ulcerative colitis, may be associated with pouchitis after ileal pouch-anal anastomosis. The cumulative frequency of pouchitis in patients with and without PSC who underwent ileal pouch-anal anastomosis for ulcerative colitis was determined. A total of 1097 patients who had an ileal pouch-anal anastomosis for ulcerative colitis, 54 with associated PSC, were studied. Pouchitis was defined by clinical criteria in all patients and by clinical, endoscopic, and histological criteria in 83% of PSC patients and 85% of their matched controls. PSC was defined by clinical, radiological, and pathological findings. One or more episodes of pouchitis occurred in 32% of patients without PSC and 63% of patients with PSC. The cumulative risk of pouchitis at one, two, five, and 10 years after ileal pouch-anal anastomosis was 15.5%0 22/5%, 36%/ and 45.5% for the patients without PSC and 22%/ 43%, 61%, and 79% for the patients with PSC. In the PSC group, the risk of pouchitis was not related to the severity of liver disease. In conclusion, the strong correlation between PSC and pouchitis suggest a common link in their pathogenesis.

IPAA is a reliable surgical procedure for patients requiring proctocolectomy for chronic ulcerative colitis and indeterminate colitis. The clinical and functional outcomes are excellent and stable for 20 years after operation.

ObjectiveTo assess long-term outcomes after ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis (CUC) with specific emphasis on patient sex, childbirth, and age. Summary Background DataChildbirth and the process of aging affect pelvic floor and anal sphincter function independently. Early function after IPAA is good for most patients. Nonetheless, there are concerns about the impact of the aging process as well as pregnancy on long-term functional outcomes after IPAA. MethodsFunctional outcomes using a standardized questionnaire were prospectively assessed for each patient on an annual basis. ResultsOf the 1,454 patients who underwent IPAA for CUC between 1981 and 1994, 1,386 were part of this study. Median age was 32 years. Median length of follow-up was 8 years. Pelvic sepsis was the primary cause of pouch failure irrespective of sex or age. Functional outcomes were comparable between men and women. Eighty-five women who became pregnant after IPAA had pouch function, which was comparable with women who did not have a child. Daytime and nocturnal incontinence affected older patients more frequently than younger ones. Incontinence became more common the longer the follow-up in older patients, but this was not found in younger patients. Poor anal function led to pouch excision in only 3 of 204 older patients. ConclusionsIncontinence rates were significantly higher in older patients after IPAA for CUC compared with younger patients. However, this did not contribute to a greater risk of pouch failure in these older patients. Patient sex and uncomplicated childbirth did not affect long-term functional outcomes.Early reports of function after ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis (CUC) have indicated favorable outcomes, with an excellent quality of life for more than 90% of patients.1-3 Areas of concern remain, however, regarding long-term functional outcome after vaginal delivery and the natural aging process, which may affect pelvic floor function regardless of sex. 4,5 Chronic ulcerative colitis has a bimodal distribution of incidence based on age, with a peak at 25 years and a second peak at 60 years.6 A selected group of older patients choose, in the absence of contraindications, to undergo IPAA. Short-term follow-up has shown that such patients may have comparable or only marginally worse functional outcomes compared with younger patients. 7-9Our aim was to assess long-term outcomes after IPAA for CUC with specific reference to the impact of age, aging, and childbirth to determine how these factors affect the incidence of pouch failure. METHODSBetween January 1981 and December 1994, 762 men and 692 women were identified from the Mayo Ileal Pouch Registry as having undergone proctocolectomy, endoanal mucosal resection, and hand-sewn ileal J pouch-anal anastomosis for CUC. Ethical permission to review patient records was obtained from the Institutional Review Board.