Pouch design and long-term functional outcome after ileal pouch-anal anastomosis.
BACKGROUND
Functional outcome is of utmost importance after ileal pouch-anal anastomosis. Although pouch design and construction of the anastomosis are known technical determinants of function, there are few long-term results. This retrospective study evaluated functional outcome for two different pouch designs, and for handsewn versus stapled pouch-anal anastomoses.


METHODS
The analysis included 412 patients who had either a J or K pouch (double-folded J pouch), of whom 123 had a J pouch (96 handsewn and 27 stapled) and 289 had a K pouch (95 handsewn and 194 stapled). Functional outcome was evaluated by a mailed questionnaire to achieve an Oresland score (0 to 15; 15 worst).


RESULTS
Mean functional scores were 6.1 for J pouches and 4.9 for K pouches (P < 0.001). Regression analysis showed that reservoir design and age at surgery were predictors of functional outcome (P < 0.001). A higher proportion of patients with a J pouch and handsewn anastomosis than with a K pouch and stapled anastomosis had a score of 8 or more, a level previously demonstrated to impact negatively on quality of life (32 versus 16 per cent; P = 0.006).


CONCLUSIONS
The K pouch was associated with a better long-term functional outcome than the J pouch in this patient population.
Department of Surgery, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden.
M
M
Block
L
L
Börjesson
E
E
Lindholm
T
T
Oresland
D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D003108:Colonic Diseases / Q000503:physiopathology / Q000601:surgery*; D039021:Colonic Pouches / Q000502:physiology*; D003672:Defecation / Q000502:physiology; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011474:Prosthesis Design; D017792:Surgical Stapling; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult