Short- and long-term outcomes of ileal pouch-anal anastomosis for ulcerative colitis.
Ileal pouch-anal anastomosis was an important advancement in the treatment of ulcerative colitis. The aim of this study was to determine whether early complications of ileal pouch-anal anastomosis in patients with ulcerative colitis are associated with poor late functional results.


METHODS
Eighty patients were operated on from 1986 to 2000, 62 patients with ileostomy and 18 without. The early and late complications were recorded. Specific emphasis has been placed on the incidence of pouchitis with prolonged follow-up.


RESULTS
The ileostomy was closed an average of 9.2 months after the first operation. Fourteen patients were excluded from the long-term evaluation; 6 patients were lost to regular follow-up, 4 died, and 4 patients still have the ileostomy. Of the 4 patients that died, 1 died from surgical complications. Early complications after operation (41) occurred in 34 patients (42.5%). Late complications (29) occurred in 25 patients as follows: 16 had pouchitis, 3 associated with stenosis and 1 with sexual dysfunction; 5 had stenosis; and there was 1 case each of incisional hernia, ileoanal fistula, hepatic cancer, and endometriosis. Pouchitis occurred in 6 patients (9.8%) 1 year after ileal pouch-anal anastomosis, 9 (14.8%) after 3 years, 13 (21.3%) after 5 years, and 16 (26.2%) after more than 6 years. The mean daily stool frequency was 12 before and 5.8 after operation. One pouch was removed because of fistulas that appeared 2 years later.


CONCLUSIONS
Ileal pouch-anal anastomosis is associated with a considerable number of early complications. There was no correlation between pouchitis and severe disease, operation with or without ileostomy, or early postoperative complications. The incidence of pouchitis was directly proportional to duration of time of follow-up.
Teixeira
Magaly Gemio
MG
Division of Coloproctology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo/SP, Brazil.
Ponte
Adauto C Abreu da
AC
Sousa
Manuela
M
Almeida
Maristela G de
MG
Silva Filho
Edésio
E
Calache
João Elias
JE
Habr-Gama
Angelita
A
Kiss
Desidério R
DR
D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001938:Brazil / Q000453:epidemiology; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D015994:Incidence; D008297:Male; D019449:Pouchitis / Q000453:epidemiology / Q000209:etiology; D011350:Proctocolitis / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome