Should older patients undergo ileal pouch-anal anastomosis?
BACKGROUND
Ileal pouch-anal anastomosis (IPAA) is a technically demanding, lengthy procedure with substantial associated morbidity. Some have suggested that this procedure should not be performed in older patients. This study was conducted to evaluate whether older patients have a poorer functional outcome and higher complication rate than younger patients who undergo IPAA.


METHODS
The 455 patients who have undergone IPAA at this institution were stratified according to age (< 55 versus > 55) to compare functional outcome and complication rates. The data were prospectively collected. The groups included 32 patients > 55 (7%) and 423 patients < 55. Comparisons were made with regard to stool frequency, incontinence rates, post-IPAA complications, postileostomy closure complications, and results 12 months postileostomy closure.


RESULTS
Preoperative anal sphincter resting and squeeze pressures were significantly lower in the > 55 group. Most complication rates were similar after IPAA except dehydration rates, which were higher in the older patients than the younger ones (27% versus 11%, respectively). Pre-ileostomy closure anal sphincter resting and squeeze pressures were not significantly lower in patients older than 55. Twenty-four hour daytime and nighttime stool frequencies were significantly higher in the > 55 group, as were daytime and nighttime stool incontinence.


CONCLUSIONS
Although functional outcome is poorer and some complications are higher in the > 55 group, the procedure can be safely performed with acceptable results and is greatly preferred by this population over permanent ileostomy.
Dayton
M T
MT
Department of Surgery, University of Utah School of Medicine, Salt Lake City 84132-0001, USA.
Larsen
K R
KR
D000328:Adult; D000367:Age Factors; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D011446:Prospective Studies