Functional Outcome and Quality of Life after Ileal Pouch-Anal Anastomosis within a Defined Population in Sweden

Abstract

Objective: The purpose of this population-based study was to present prospectively recorded functional data and health-related quality of life (HRQOL) questionnaire data to assess the long-term results of the first 100 consecutive ileal pouch-anal anastomosis (IPAA) performed chronologically by 3 surgeons in a single referral centre. Methods: During 1993–2008, 100 patients underwent IPAA. The 90 patients still alive with an intact pouch were included (response rate = 92%). Function was evaluated using St Mark’s incontinence score, and HRQOL with SF-36. Results: At 18 months after loop ileostomy closure, 63 patients (76%) had 4–6 day-time and 47 patients (57%) had no night-time bowel movements. A stapled IPAA resulted in better St Mark’s (p = 0.0064) and Wexner scores (p = 0.0019) than did a hand-sewn anastomosis. The younger the patients were at the onset of ulcerative colitis (UC) the better St Mark’s (p = 0.0037) and Wexner scores (p = 0.011) were. The patients scored significantly higher than did the general Swedish population adjusted by age-group and sex in 6 out of 7 SF-36 subscales. Conclusions: In the hands of experienced high-volume surgeons, IPAA is a safe procedure associated with good functional results that are stable over time. Stapled IPAA and younger age at onset of UC were correlated with better functional results. The HRQOL scores were high.

Fecal continence outcomes are associated with the type, height, and stage procedure of ileal pouch-anal anastomosis

“…Soiling had the highest impact on the quality of life of patients with IPAA, with five scales diminished. The overall quality-of-life scores were comparable with previous research that also used the RAND-36 questionnaire [ 6 , 7 ].…”

“…It is known that these patients have a better quality of life after restorative proctocolectomy [5]. Nevertheless, there are only a few studies that report on the quality of life of IPAA patients in relation to functional outcomes [6][7][8].…”

Bowel Function After J-Pouch May Be More Complex Than Previously Appreciated: A Comprehensive Analysis to Highlight Existing Knowledge Gaps

“…20 Table 6 summarizes the existing literature on bowel function after J-pouch. 4,5,13,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Based on our data, patients that undergo IPAA with J-pouch exhibit a constellation of bowel function symptoms that is more complex than fecal incontinence and frequency alone, despite the focus on these specific outcomes in the literature. The identification of a large portion of pouch patients with symptoms that are not commonly studied begs the question: are patients experiencing additional dysfunction symptoms that we are simply not studying?…”

Restorative Proctocolectomy: When to Propose and When to Avoid

“…Dafni et al refer that stapled IPAA and younger age at the onset of UC correlated with better functional results, and the HRQOL scores were high [31].…”