Long-term functional outcomes and quality of life after restorative proctocolectomy and ileal pouch-anal anastomosis
Abstract
Introduction: Restorative proctocolectomy with ileal pouch anal anastomosis has become a surgical procedure of choice in patients with ulcerative colitis. Aims and Methods: The aim of this study was to assess long-term functional results and quality of life in ulcerative colitis (n = 138) patients who underwent ileal pouch anal anastomosis between 1993 and 2013 in two Czech refferal centers.
Results: A total of 118 (85.5%) out of 138 patients answered all of the questions in the questionnaires, 62% of whom were male. Median age at proctocolectomy was 34 (18-56) years and the median follow-up time was 7.9 (2.1-20.7) years.
The overall late complication rate was 29.2%. Pouch failure occurred in 7.9% patients, and pouch excision was required in two patients (1.6%).
In 8.7% and 10.2% of patients, respectively, anastomotic strictures and complete fistula were detected. The "re-do" pelvic pouch procedure was applied to 5.5% of patients and 24% developed at least one episode of acute pouchitis, and 15% of patients suffered from chronic pouchitis.
The median score of functional outcome was 2 (0-19), according to the Wexner Continence Score. The median number of bowel movements during the daytime was 6 (1-15), 2 at night (0-7), and 8 in 24 hours (2-20).
Impairments in health-related quality of life were mainly in psychological and social areas and to a lesser degree in the physical area. The scores of Physical Component Summary and Mental Component Summary were significantly lower than those of the general population (p < 0.001).
Conclusion: The majority of patients were fully continent; however, one third had a slightly lower quality of life than the general population, and had worse functional outcomes. This should be taken into account during the selection process for the best treatment alternative.