The effect of pelvic septic complications on function and quality of life after ileal pouch-anal anastomosis: a single center experience.
Ileal pouch-anal anastomosis (IPAA) has become the procedure of choice for surgical treatment of intractable ulcerative colitis (UC). Surgical complications occurring in the short-term, like pelvic sepsis, are responsible for pouch dysfunction. We prospectively evaluated 118 patients with IPAA for UC operated on between 1987 and 2002. Follow-up intervals were at 3, 6, and 12 months in the first year, then every year for at least 5 years. Patients answered a questionnaire 1 and 5 years after ileostomy closure. One hundred and seventeen patients completed the early follow-up. Nine patients developed early pelvic sepsis (7.69%); six required pouch salvage procedure. In about 33.3 per cent of cases more than one procedure was necessary. Eighty-eight patients were available for 5-year functional evaluation. Patients developing early sepsis (n = 9) showed worse long-term functional results compared with the remaining study population (n = 79): stool frequency; night evacuation; perfect day/night continence; discrimination; antidiarrhoeals need; pad usage; and sexual restriction were significantly different (P < 0.05). Quality of life and satisfaction after surgery were good in all patients. This observation did not correlate with function. Eighty-eight and 97 per cent would undergo IPAA again and would recommend it to others respectively, in septic group and controls. Functional outcome after IPAA may be influenced by early septic complications. Overall quality of life and satisfaction with surgery are comparable with those of controls.
Selvaggi
Francesco
F
I Division of General Surgery, Second University of Naples, Italy. fselvaggi@hotmail.com
Sciaudone
Guido
G
Limongelli
Paolo
P
Di Stazio
Crescenzo
C
Guadagni
Ilaria
I
Pellino
Gianluca
G
De Rosa
Michele
M
Riegler
Gabriele
G
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D002648:Child; D003093:Colitis, Ulcerative / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D016879:Salvage Therapy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome