Quality of life after ileoanal pouch: a comparison of J and W pouches.
BACKGROUND
Standard treatment for ulcerative colitis and prevention of malignancy is total proctocolectomy with a neoileal pouch. The ideal configuration of the pouch has been debated. We hypothesized that there was no difference in quality of life between the J pouch and the W pouch.


METHODS
We retrospectively reviewed the medical records of all patients undergoing ileoanal anastomosis with pouch construction at a single community-based teaching hospital over an 11+-year period. We collected demographic, operative, and postoperative data and then developed and distributed a survey designed to assess patient quality of life following pouch construction. The data of patients who had J pouches were then compared with those of patients who had W pouches. Forty-nine patients were identified; 30 had J pouches and 19 had W pouches.


RESULTS
The groups did not differ significantly in age, sex, or indication for surgery. Significant differences were detected in readmission rates (J = 63%, W = 21%; p = 0.004) and length of follow-up (J = 61 months, W = 117 months; p = 0.001). Complication rates, length of stay, and conversion to end ileostomy rates were similar between groups. Self-reported health status, activity restrictions, urgency, seepage, protective pad use, and number of bowel movements at night were also similar. A significant difference existed in number of bowel movements per day (J = 6, W = 4.5, p = 0.041). No difference in quality of life was found between groups. Subgroup analysis of ulcerative-colitis-only patients had no effect on results.


CONCLUSIONS
Because the J pouch is less technically demanding, it should be the preferred configuration.
Wade
Alexander D
AD
Department of Medical Education, Gundersen Lutheran Medical Foundation, 1900 South Avenue, C03-006B, La Crosse, WI 54601, USA.
Mathiason
Michelle A
MA
Brekke
Eric F
EF
Kothari
Shanu N
SN
D000222:Adaptation, Physiological; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D003093:Colitis, Ulcerative / Q000473:pathology / Q000601:surgery; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery; D039021:Colonic Pouches; D003672:Defecation / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D011336:Probability; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult