Prospective assessment of functional results after ileal J pouch-anal restorative proctocolectomy.
OBJECTIVE
To document the functional results of 50 consecutive patients who underwent hand-sewn ileal J pouch-anal restorative proctocolectomy for ulcerative colitis between 1988 and 1991 (mean follow-up, 18.1 months; range, 6 to 48 months).


METHODS
Patients recorded their observations daily over 1 week. The patients completed these weekly diaries every 3 months for the first year and then at 18, 24, 36, and 48 months after ileostomy closure.


METHODS
Fifty patients (mean age, 31 years; 24 males).


METHODS
The University of Chicago (Ill).


RESULTS
Stool frequency at 3, 6, 12, and 24 months was 6.3 +/- 2.1, 5.5 +/- 2.4, and 5.1 +/- 1.9, and 5.9 +/- 1.6 per day, respectively, without urgency. Fifty-four percent were perfectly continent; 18% had occasional spotting (one or two leaks per week); 12% had minor leakage (three to seven per week); and 16% had major leakage (more than seven per week). In these three groups, loss of solid feces never occurred in 84%, 88%, and 65% of patients, respectively. Females had more severe incontinence than males, but continence improved over time for both sexes. Twenty-two percent of female patients developed dyspareunia; no males developed impotence, but 19% had retrograde ejaculation. The probability of experiencing pouchitis increased with time from 15% at 6 months to 40% at 12 months, and 50% after 24 months.


CONCLUSIONS
These results represent an accurate assessment of patient function after ileal J pouch-anal anastomosis. We encourage the use of a prospective, patient-completed protocol to obtain a realistic assessment of functional results.
Michelassi
F
F
Department of Surgery, University of Chicago, Ill.
Stella
M
M
Block
G E
GE
D000293:Adolescent; D000328:Adult; D002985:Clinical Protocols; D003093:Colitis, Ulcerative / Q000601:surgery*; D003672:Defecation; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000379:methods; D011446:Prospective Studies; D016896:Treatment Outcome