Abstract:Despite being limited by poor study quality, both total proctocolectomy with ileostomy and IPAA appear equivalent in terms of overall health-related quality of life. Most patients are satisfied with their choice regardless of procedure. Most of the improvement in quality of life after surgery is related to the control of disease-related symptoms. These findings indicate that both IPAA and permanent ileostomy should be discussed in detail with patients preoperatively to help them make an informed decision.
“…11,17,[40][41][42] Moreover, it has been reported that patients with an IPAA have a better or equivalent QoL than those with a Koch pouch or Brooke ileostomy. 3,43,44 Although the methods used to determine the impact on QoL in this study has not been validated, the same questions have been asked in the same manner every 5 years for 30 years, so trends toward improvement or deterioration would be expected if significant changes occurred.…”
“…11,17,[40][41][42] Moreover, it has been reported that patients with an IPAA have a better or equivalent QoL than those with a Koch pouch or Brooke ileostomy. 3,43,44 Although the methods used to determine the impact on QoL in this study has not been validated, the same questions have been asked in the same manner every 5 years for 30 years, so trends toward improvement or deterioration would be expected if significant changes occurred.…”
“…Most patients were satisfied with their choice regardless of procedure. Most of the improvement in quality of life after surgery was related to the control of disease-related symptoms [53]. …”
Aim of the work was to review systematically the published literature addressing whether quality of life (QoL) and health-related QoL (HRQoL) are influenced by surgery among patients with inflammatory bowel disease (IBD). Electronic databases and published articles were searched to identify relevant studies published in the years 1990–2015. Then, a multistep selection was undertaken to identify articles that met specific selection criteria, such us specific key-words (IBD, HRQoL, ulcerative colitis (UC), Crohn’s disease (CD), and surgery), and the population was assessed (studies concerning patients < 18 years old were excluded). The review included 27 studies that were evaluated in the context of the influence of surgery on QoL and HRQoL. Concluding, with the increase in the incidence of IBD, monitoring of QoL is an important indicator of the health effects at each stage of the surgical treatment.
“…It is important when counselling the patient to make it clear that quality of life may be very good after a proctocolectomy and ileostomy. Although limited by small sample size, significant heterogeneity and limited follow‐up, a meta‐analysis has suggested equivalent overall health‐related quality of life between total proctocolectomy with ileostomy and ileoanal pouch anastomosis .…”
Section: Proctectomy and Proctocolectomymentioning
Aim
There is a requirement of an expansive and up to date review of surgical management of inflammatory bowel disease (IBD) that can dovetail with the medical guidelines produced by the British Society of Gastroenterology.
Methods
Surgeons who are members of the ACPGBI with a recognised interest in IBD were invited to contribute various sections of the guidelines. They were directed to produce a procedure based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. An editorial board was convened to ensure consistency of style, presentation and quality. Each author was asked to provide a set of recommendations which were evidence based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after 2 votes were included in the guidelines.
Results
All aspects of surgical care for IBD have been included along with 157 recommendations for management.
Conclusion
These guidelines provide an up to date and evidence based summary of the current surgical knowledge in the management of IBD and will serve as a useful practical text for clinicians performing this type of surgery.
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