Effect of vaginal delivery on long-term pouch function.
BACKGROUND
The optimal method of childbirth for women with a restorative proctocolectomy (RP) has yet to be determined. Little is known about long-term ileal pouch function after vaginal delivery, especially when childbirth occurred before RP. The aim of this study was to evaluate the effect of vaginal delivery before or after RP on long-term pouch function.


METHODS
All 267 women who underwent RP between January 1985 and November 2004 were invited to participate. Functional outcome was assessed by colorectal functional outcome questionnaire, and patients were asked about their pregnancies and risk factors for obstetric injury. Linear regression analysis was performed to study potential risk factors for poor pouch function.


RESULTS
The response rate was 82.6 per cent. Median follow-up after pouch surgery was 7.2 (range 1.0-19.7) years. One hundred patients had at least one delivery. Fifty-two (60 per cent) of the 86 patients who attempted a vaginal delivery had an increased risk of obstetric injury according to predefined risk factors. In these patients ageing and longer follow-up were significant risk factors for impaired incontinence.


CONCLUSIONS
Women who had RP and vaginal delivery with a high risk of obstetric injury had impaired continence with ageing and longer follow-up. Patients with RP should be informed about the considerable risk of vaginal delivery on long-term ileal pouch function.
Polle
S W
SW
Department of Surgery, Academic Medical Centre, The Netherlands.
Vlug
M S
MS
Slors
J F M
JF
Zwinderman
A H
AH
van der Hoop
A Gerritsen
AG
Cuesta
M A
MA
Gouma
D J
DJ
Bemelman
W A
WA
D000328:Adult; D000367:Age Factors; D039021:Colonic Pouches / Q000502:physiology*; D036861:Delivery, Obstetric; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D016737:Proctocolectomy, Restorative; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires