Comprehensive pouch clinic concept for follow-up of patients after ileal pouch anal anastomosis: report of 3 years' experience in a tertiary referral center.
BACKGROUND
We designed and evaluated a novel concept in enhancing postoperative care of patients following restorative proctocolectomy (RPC) for ulcerative colitis (UC) and determined the risk factors, incidence, and nature of RPC-associated complications in this population.


METHODS
The study cohort consisted of consecutive UC patients post-RPC attending a comprehensive pouch clinic run by a gastroenterologist and a colorectal surgeon in a tertiary care medical center (from January 2003 to December 2005). Data were collected on their medical history, physical examination, laboratory tests, pouch endoscopy and biopsies, and anonymous in-house patient satisfaction questionnaires mailed to the first 90 patients. Assessment was also done on data regarding risk factors, incidence, and nature of RPC-associated complications.


RESULTS
A total of 120 UC patients with a functioning pouch visited the clinic: mean age 37 years, range 13-75; 57 males; mean disease duration 11 years; mean follow-up 65 months. Of the 55 patients who responded to the questionnaire, 48 (87%) felt that the comprehensive clinic significantly improved the quality of their care. The major complications were pouchitis (52%), extraintestinal manifestations, pouch-related fistula, and mechanical dysfunction. The risk factors for the development of pouchitis were time since surgery, >1-stage surgery, and reason for surgery (acute exacerbation/intractable disease more than dysplasia/cancer); the latter was the only independent risk factor.


CONCLUSIONS
The pouch clinic concept significantly enhanced patient satisfaction. The most common RPC-associated complication was pouchitis. Risk factors for developing pouchitis were duration since operation, >1-stage operation, and indication for surgery.
Tulchinsky
Hagit
H
Pouch Clinic, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Dotan
Iris
I
Alper
Arik
A
Brazowski
Eli
E
Klausner
Joseph M
JM
Halpern
Zamir
Z
Rabau
Micha
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005762:Gastroenterology; D013502:General Surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D017060:Patient Satisfaction; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D019449:Pouchitis / Q000453:epidemiology* / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000534:rehabilitation; D011787:Quality of Health Care; D012307:Risk Factors