Results at up to 20 years after ileal pouch-anal anastomosis for chronic ulcerative colitis.
BACKGROUND
Ileal pouch-anal anastomosis (IPAA) is performed routinely for chronic ulcerative colitis.


METHODS
Using data from a prospective database and annual standardized questionnaires, functional outcome, complications and quality of life (QoL) after IPAA were assessed.


RESULTS
Some 1885 IPAA operations were performed for chronic ulcerative colitis over a 20-year period (mean follow-up 11 years). The mean age at the time of IPAA was 34.1 years, increasing from 31.2 years (1981-1985) to 36.3 years (1996-2000). The overall rate of pouch success at 5, 10, 15 and 20 years was 96.3, 93.3, 92.4 and 92.1 per cent respectively. Mean daytime stool frequency increased from 5.7 at 1 year to 6.4 at 20 years (P < 0.001), and also increased at night (from 1.5 to 2.0; P < 0.001). The incidence of frequent daytime faecal incontinence increased from 5 to 11 per cent during the day (P < 0.001) and from 12 to 21 per cent at night (P < 0.001). QoL remained unchanged and 92 per cent remained in the same employment. Seventy-six patients were eventually diagnosed with indeterminate colitis and 47 with Crohn's disease.


CONCLUSIONS
IPAA is a reliable surgical procedure for patients requiring proctocolectomy for chronic ulcerative colitis and indeterminate colitis. The clinical and functional outcomes are excellent and stable for 20 years after operation.
Hahnloser
D
D
Department of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland.
Pemberton
J H
JH
Wolff
B G
BG
Larson
D R
DR
Crownhart
B S
BS
Dozois
R R
RR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology* / Q000601:surgery; D000704:Analysis of Variance; D000714:Anastomosis, Surgical; D002648:Child; D003093:Colitis, Ulcerative / Q000503:physiopathology / Q000601:surgery*; D039021:Colonic Pouches / Q000502:physiology* / Q000592:standards; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D016737:Proctocolectomy, Restorative / Q000592:standards*; D011446:Prospective Studies; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome