Ileal pouch-anal anastomosis (IPAA): functional outcome after postoperative pelvic sepsis. A prospective study of 100 patients.
BACKGROUND
The ileal pouch-anal anastomosis (IPAA) has become a standard procedure for patients with ulcerative colitis requiring surgical intervention. The technique has greatly improved and, since 1990, all patients at Huddinge University Hospital have been operated on with the double stapled technique. Pelvic sepsis is one of the most serious complications postoperatively, and, according to previous reports, leads to impaired function of the pouch and, in some cases, extirpation of the pouch.


OBJECTIVE
The purpose of this study was to find out if pelvic sepsis postoperatively after IPAA leads to impaired functional outcome at long-term follow-up.


METHODS
One hundred consecutive patients with ulcerative colitis operated on between 1990 and 1997 with double stapled J-shaped pouches were followed prospectively with a standardised questionnaire, clinical follow-up and endoscopy of the pouch. The function of the pouch has been evaluated at a minimum of 2 years after surgery to compare the functional outcome between patients with and without pelvic sepsis postoperatively.


RESULTS
Twelve patients developed pelvic sepsis postoperatively. No significant differences were found in pouch evacuation frequency, incontinence, deferral time, usage of protecting pads, skin irritation, evacuation problems, diet, usage of medication or social handicap. There was one failure in the control group.


CONCLUSIONS
In this study, no evidence was found that suggested pelvic sepsis postoperatively impairs functional outcome after IPAA at long-term follow-up.
Hallberg
Helena
H
Department of Surgical and Medical Gastroenterology, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden.
Ståhlberg
Dagny
D
Akerlund
Jan-Erik
JE
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003093:Colitis, Ulcerative / Q000601:surgery; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005769:Gastrointestinal Motility / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D034161:Pelvic Infection / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation; D018805:Sepsis / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D012720:Severity of Illness Index