Comparing functional results one year and ten years after ileal pouch-anal anastomosis for chronic ulcerative colitis.
Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice for most patients with chronic ulcerative colitis. Long-term results, however remain undefined; the major concern is that function may deteriorate.


OBJECTIVE
The aim of this study was to assess functional outcome in a subgroup of patients who have an IPAA for chronic ulcerative colitis for > 10 years.


METHODS
Among 1400 IPAA patients, 75 consecutive subjects (31 females and 44 males; median age 31 at operation) were identified who had the procedure prior to 1982. All patients had functional results recorded 1 year and 10 years following ileostomy closure.


RESULTS
There were four deaths during the follow-up period; none were pouch related. Two patients refused ileostomy closure. Of the remaining 69 patients, there were 8 (11 percent) failures, leaving 61 subjects available for study. Stool frequency (7 +/- 3, mean +/- SD) remained unchanged. Of the 50 subjects with initially excellent daytime continence, 39 (78 percent) remained the same, 10 (20 percent) developed minor incontinence, and 1 developed poor control after 10 years. Four of 10 subjects (40 percent) with initial minor daytime incontinence remained unchanged, 4 (40 percent) improved, and 2 (20 percent) worsened. The one subject with poor control at one year was unchanged. Nocturnal fecal spotting increased over the 10-year period but not significantly (38 percent vs. 52 percent; P = 0.08).


CONCLUSIONS
After IPAA, functional results in terms of stool frequency and rate of fecal incontinence did not deteriorate with time.
McIntyre
P B
PB
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 55905.
Pemberton
J H
JH
Wolff
B G
BG
Beart
R W
RW
Dozois
R R
RR
D000293:Adolescent; D000328:Adult; D003093:Colitis, Ulcerative / Q000503:physiopathology* / Q000601:surgery*; D003106:Colon / Q000503:physiopathology*; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005769:Gastrointestinal Motility; D006801:Humans; D007249:Inflammation / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome