title: Long-term functional outcome and quality of life after stapled restorative proctocolectomy.
abstract: OBJECTIVE
  To evaluate prospectively long-term quality of life and functional outcome after restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis, and to evaluate and validate a novel quality-of-life indicator in this group of patients.
  
  
  BACKGROUND
  Restorative proctocolectomy with ileal pouch-anal anastomosis is now the preferred option when total proctocolectomy is required for ulcerative colitis or familial adenomatous polyposis, but long-term data on functional outcome and quality of life after the procedure are lacking.
  
  
  METHODS
  Patients (n = 977) who underwent RPC with stapled anastomosis for colitis or polyposis coli and who were followed for > or =12 months were included. Quality of life, fecal incontinence, and satisfaction with surgery were prospectively evaluated by structured interview or questionnaire for 1 to 12 years after surgery (median 5.0). Quality of life was scored using the Cleveland Global Quality of Life (CGQL) instrument (Fazio Score). This is a novel score developed over the past 15 years by the senior author. Quality of life was also evaluated in a subgroup of patients with the Short Form 36 (SF-36). The CGQL was validated by determining its reliability, responsiveness, and validity as well as its correlation with the SF-36 score.
  
  
  RESULTS
  Postoperative quality of life as measured by SF-36 was excellent and compared well with published norms for the general U.S. population. The CGQL was found to be reliable, responsive, and valid, and there was a high correlation with the SF-36 scores. Using the CGQL, quality of life was shown to increase after the first 2 years after surgery, and there was no deterioration thereafter. The prevalence of perfect continence increased from 75.5% before surgery to 82.4% after surgery, and although this deteriorated somewhat >2 years after surgery, it was no worse than preoperative values. Ninety-eight percent of patients would recommend the surgery to others.
  
  
  CONCLUSIONS
  Long-term quality of life after ileal pouch surgery is excellent and the level of continence is satisfactory. This surgery is an excellent long-term option in patients requiring total proctocolectomy. The CGQL is a simple, valid, and reliable measure of quality of life after pelvic pouch surgery and may well be applicable in many other clinical conditions.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: V W
authors.initials: VW
authors.lastname: Fazio
authors.forename: M G
authors.initials: MG
authors.lastname: O'Riordain
authors.forename: I C
authors.initials: IC
authors.lastname: Lavery
authors.forename: J M
authors.initials: JM
authors.lastname: Church
authors.forename: P
authors.initials: P
authors.lastname: Lau
authors.forename: S A
authors.initials: SA
authors.lastname: Strong
authors.forename: T
authors.initials: T
authors.lastname: Hull
mesh_terms: D000368:Aged; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome