Long-term failure and function after restorative proctocolectomy - a multi-centre study of patients from the UK National Ileal Pouch Registry.
OBJECTIVE
There is little information on the long-term failure and function after restorative proctocolectomy (RPC). The results of data submitted to a national registry were analysed.


METHODS
The UK National Pouch Registry was established in 2004. By 2006, it comprised data collected from ten centres between 1976 and 2006. The long-term failure and functional outcome were determined. Trends over time were assessed using the gamma statistic or the Kruskal-Wallis statistic wherever appropriate.


RESULTS
In all, 2491 patients underwent primary RPC over a median of 54 months (range 1 month to 28.9 years). Of these, 127 (5.1%) underwent abdominal salvage surgery. The incidence of failure (excision or indefinite diversion) was 7.7% following primary and 27.5% following salvage RPC (P < 0.001). The median frequency of defaecation/24 h was five including one at night. Nocturnal seepage occurred in 8% at 1 year, rising to 15.4% at 20 years (P = 0.037). Urgency was experienced by 5.1% of patients at 1 year rising to 9.1% at 15 years (P = 0.022). Stool frequency and the need for antidiarrhoeal medication were greater following salvage RPC.


CONCLUSIONS
In patients retaining anal function after RPC, frequency of defaecation was stable over 20 years. Faecal urgency and minor incontinence worsened with time. Function after salvage RPC was significantly worse.
Tekkis
P P
PP
Department of Biosurgery and Surgical Technology, St. Mary's Hospital, Imperial College, London, UK.
Lovegrove
R E
RE
Tilney
H S
HS
Smith
J J
JJ
Sagar
P M
PM
Shorthouse
A J
AJ
Mortensen
N J
NJ
Nicholls
R J
RJ
D000328:Adult; D039021:Colonic Pouches; D015179:Colorectal Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects; D020127:Recovery of Function; D012042:Registries; D012086:Reoperation; D017211:Treatment Failure; D006113:United Kingdom; D055815:Young Adult