Results at up to 20 years after ileal pouch-anal anastomosis for chronic ulcerative colitis

• Published in: British journal of surgery 2007-03, Vol.94 (3), p.333-340
• Main Authors: Hahnloser, D., Pemberton, J. H., Wolff, B. G., Larson, D. R., Crownhart, B. S., Dozois, R. R.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anal Canal - physiopathology; Anal Canal - surgery; Analysis of Variance; Anastomosis, Surgical; Biological and medical sciences; Child; Colitis, Ulcerative - physiopathology; Colitis, Ulcerative - surgery; Colonic Pouches - physiology; Colonic Pouches - standards; Fecal Incontinence - etiology; Fecal Incontinence - physiopathology; Female; Follow-Up Studies; General aspects; Humans; Ileum - surgery; Male; Medical sciences; Middle Aged; Postoperative Complications - etiology; Postoperative Complications - physiopathology; Proctocolectomy, Restorative - standards; Prospective Studies; Quality of Life; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Time Factors; Treatment Outcome
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.5464

Background: Ileal pouch–anal anastomosis (IPAA) is performed routinely for chronic ulcerative colitis. Methods: Using data from a prospective database and annual standardized questionnaires, functional outcome, complications and quality of life (QoL) after IPAA were assessed. Results: Some 1885 IPAA operations were performed for chronic ulcerative colitis over a 20‐year period (mean follow‐up 11 years). The mean age at the time of IPAA was 34·1 years, increasing from 31·2 years (1981–1985) to 36·3 years (1996–2000). The overall rate of pouch success at 5, 10, 15 and 20 years was 96·3, 93·3, 92·4 and 92·1 per cent respectively. Mean daytime stool frequency increased from 5·7 at 1 year to 6·4 at 20 years (P < 0·001), and also increased at night (from 1·5 to 2·0; P < 0·001). The incidence of frequent daytime faecal incontinence increased from 5 to 11 per cent during the day (P < 0·001) and from 12 to 21 per cent at night (P < 0·001). QoL remained unchanged and 92 per cent remained in the same employment. Seventy‐six patients were eventually diagnosed with indeterminate colitis and 47 with Crohn's disease. Conclusion: 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. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Long‐term follow‐up in 1885 patients