Septic complications after restorative proctocolectomy do not impair functional outcome: long-term follow-up from a specialty center.
OBJECTIVE
After restorative proctocolectomy, 7 to 8 percent of patients may have a pouch leak. Concern exists that pouch leak may be associated with impaired functional outcome. We evaluated patients who underwent restorative proctocolectomy to determine whether pouch leak adversely affected long-term functional outcome and quality of life.


METHODS
We queried our prospectively maintained database of patients who underwent restorative proctocolectomy for demographic and clinical data. We sent a long-term outcome questionnaire to patients, including the validated Fecal Incontinence Severity Index and Cleveland Global Quality of Life scores. Pouch leak was identified by clinical or radiographic evidence of leak. Patients with leak were compared with those without to determine the impact on long-term functional outcome or quality of life.


RESULTS
A total of 817 patients were available for follow-up and 374 patients (46 percent) completed questionnaires. The group with (n = 60; 16 percent) and without (n = 314; 84 percent) leak had similar demographics. The median Fecal Incontinence Severity Index score (15.3 vs. 14.7, P = 0.77), Cleveland Global Quality of Life score (0.79 vs. 0.81, P = 0.48), and bowel movements per 24 hours (7.92 vs. 7.88, P = 0.92) were similar. The pouch loss/permanent ileostomy rate was higher in those who leaked (13.3 vs. 0.9 percent, P < 0.001).


CONCLUSIONS
Anastomotic leak after restorative proctocolectomy does not adversely affect long-term quality of life or functional outcome. However, pouch loss/permanent ileostomy is significantly more likely in patients who have had an anastomotic leak.
Chessin
David B
DB
Department of Surgery, Division of Colorectal Surgery, Mount Sinai Medical Center, New York, New York, USA. david.chessin@mssm.edu
Gorfine
Stephen R
SR
Bub
David S
DS
Royston
Aaron
A
Wong
Deborah
D
Bauer
Joel J
JJ
D000328:Adult; D000714:Anastomosis, Surgical; D003082:Colectomy; D005242:Fecal Incontinence; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D008297:Male; D017063:Outcome Assessment, Health Care; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D011446:Prospective Studies; D011788:Quality of Life; D018805:Sepsis / Q000209:etiology*; D011795:Surveys and Questionnaires