Determinants of long‐term function and general well‐being in patients with an ileoanal pouch

Abstract

Background and aim: Fecal incontinence and/or evacuation difficulty are common after ileoanal pouch surgery. This study aimed to determine whether the development of these symptoms can be predicted so that preventive measures might be instituted. Methods: A consecutive series of 46 patients with ulcerative colitis (median age at surgery, 41 years; 50% female) and a functioning pouch for a duration ≥12 months was included. Assessment utilized medical record review and questionnaires on preand postoperative bowel function, quality of life, and psychological well-being. Pouch function was assessed by the Colorectal Functional Outcome score (0 = no impairment, 100 = worst impairment). Good pouch function was defined as a score ≤24. Results: Fecal incontinence occurred in 67% preoperatively and 54% postoperatively; evacuation difficulty occurred in 65% and preoperatively and 85% postoperatively. The postoperative median Colorectal Functional Outcome score was 20 (range 2-74), with 44% of patients >24 (poor pouch function). Preoperative nocturnal fecal incontinence (odds ratio [OR] 4.92, 95% confidence interval [CI] 1.2-19.4, P = 0.02) and pouchitis (OR 5.41, 95% CI 1.2-23.7, P = 0.02) were associated with poor pouch function after multivariable regression analysis. Postoperative satisfaction, psychological well-being, and quality of life were significantly better in those with good pouch function, while poor sleep, impaired work, and sexual dysfunction were independently associated with poor pouch function. Conclusions: Functional bowel symptoms are common before and after pouch surgery and are associated with the impairment of patient-reported outcomes. Preoperative nocturnal fecal incontinence predicts poor pouch function. Therapeutic focus on continence, bowel evacuation, psychological well-being, and quality of life should begin before surgery.

Review of long‐term complications and functional outcomes of ileoanal pouch procedures in patients with inflammatory bowel disease

“…Defaecatory urgency, an inability to defer defaecation for more than 15 min, affected a majority (>50%) of patients in four included studies, 6,22,32,44 whilst another two studies reported that approximately a third of patients experienced defaecatory urgency 4,21 . Difficult stool evacuation was rare (<10%) in three studies, 6,21,43 yet was reported as high as 85% by Khera et al 44 . although this was in a select population.…”

“…Many patients post‐IAPP remained on motility agents (loperamide, cholestyramine and domperidone), with rates reported as 47%, 43 50%, 44 66.2% 32 and 68.8% 45 . Nyabanga et al 41 .…”

“…4,21 Difficult stool evacuation was rare (<10%) in three studies, 6,21,43 yet was reported as high as 85% by Khera et al 44 although this was in a select population. An inability to differentiate between stool and flatus was reported by approximately 50% of patients post-IAPP according to five studies, 6,32,[43][44][45] yet Fazio et al suggested this incidence was lower (20%). 4 Despite the variability of bowel function in many included studies, overall patient satisfaction post-IAPP was very high.…”

“…4 Despite the variability of bowel function in many included studies, overall patient satisfaction post-IAPP was very high. Four separate studies reported satisfaction rates greater than 90%, 4,6,31,43 44 Ninety-two percent 43 and 93% 31 of patients from two studies stated they would undergo IAPP again. Almost all patients from three studies were happy with the timing of surgery, with approximately 50% stating they would have had the surgery earlier if given the opportunity.…”

Ileoanal pouch revision and excision surgery in a newly established pouch center. Requirements and costs for service provision

“…As previously mentioned, the cost analysis we conducted is likely underestimating the costs of pouch disorders, as cannot include the pre-referral pathway, or the cost for primary care providers. More importantly, the implications on patients' health and quality of life are obviously much more signi cant, but we considered them outside of the scope of this manuscript due to the small sample size and short follow-up, having these already been reported extensively [10][11].…”