title: Quality of life after restorative proctocolectomy for ulcerative colitis: preoperative status and long-term results.
abstract: BACKGROUND
  Restorative proctocolectomy has become the surgical procedure of choice in patients with ulcerative colitis. Only smaller studies have compared postoperative to preoperative quality of life (QoL).
  
  
  METHODS
  Patients with ulcerative colitis who had undergone restorative proctocolectomy at least 5 years before and who had filled out a disease-specific validated questionnaire (Gastrointestinal Quality of Life Index, GIQLI) prior to surgery (n = 128) were included into this follow-up study. Factors potentially influencing QoL at the time of operation were investigated with regard to pre- and postoperative QoL in univariate and multivariate analysis.
  
  
  RESULTS
  A total of 105 patients responded (82%). QoL at least 5 years after colectomy was significantly improved compared to the preoperative situation (109 versus 75). This improvement was evident in all 5 dimensions (P < 0.0001). The Colitis Activity Index (CAI) (P < 0.00001), a shorter duration of the disease (P < 0.05), and a 3-staged procedure (<0.001) were negatively correlated with preoperative QoL, whereas neoplasia (P < 0.001) was positively correlated. Colectomy was the reason for most of the increase in QoL. Ileostomy closure resulted in a further improvement in 3 of 5 dimensions but not in overall QoL. Uni- and multivariate analysis of the difference in QoL before and 5 years after colectomy revealed CAI, the type of operation (both P < 0.001), and neoplasia as significant factors (P < 0.05).
  
  
  CONCLUSIONS
  The patients in the worst clinical situation profit the most from restorative proctocolectomy.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Tariverdian
authors.forename: Christine
authors.initials: C
authors.lastname: Leowardi
authors.forename: Ulf
authors.initials: U
authors.lastname: Hinz
authors.forename: Thilo
authors.initials: T
authors.lastname: Welsch
authors.forename: Jan
authors.initials: J
authors.lastname: Schmidt
authors.forename: Peter
authors.initials: P
authors.lastname: Kienle
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000523:psychology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011184:Postoperative Period; D016737:Proctocolectomy, Restorative / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome