title: Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients.
abstract: BACKGROUND
  Ileal pouch anal anastomosis (IPAA) is the treatment of choice for chronic, medically refractory mucosal ulcerative colitis, indeterminate colitis, familial adenomatous polyposis (FAP), and a select group of patients with Crohn's disease.
  
  
  OBJECTIVE
  : We report outcomes, complications, and quality of life (QOL) in a cohort of 3707 patients treated at our institution from January 1984 to March 2010.
  
  
  METHODS
  Data were collected from a prospectively maintained database and chart review of 3707 consecutive primary IPAA cases. Patient demographics, postoperative complications, functional outcomes, and QOL data were available. Follow-up consisted of clinical examination with assessment of pouch function and QOL.
  
  
  RESULTS
  A total of 3707 patients underwent primary pouch and 328 underwent redo pouch surgery. Postoperative histopathological diagnoses were mucosal ulcerative colitis (n = 2953, 79.7%), indeterminate colitis (n = 63, 1.7%), FAP (n = 223, 6%), Crohn's disease (n = 150, 4%), cancer/dysplasia (n = 97, 2.6%), and others (n = 221, 6.0%). Early perioperative complications were encountered in 33.5% of patients with a mortality rate of 0.1%. Excluding pouchitis, late complications were experienced by 29.1% of patients. Of those patients who had IPAA at our institution, pouch failure occurred in 197 patients (5.3%). During a median follow-up of 84 months, 119 patients (3.2%) required excision of the pouch, 32 (0.8%) had a nonfunctioning pouch, and 46 patients (1.2%) had redo IPAA. Functional outcomes and QOL were good or excellent in 95% of patients and similar in each histopathological subgroup.
  
  
  CONCLUSIONS
  IPAA is an excellent option for patients with MUC, IC, FAP, and select patients with Crohn's disease.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH 44195, USA. faziov@ccf.org
authors.forename: Victor Warren
authors.initials: VW
authors.lastname: Fazio
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: John Calvin
authors.initials: JC
authors.lastname: Coffey
authors.forename: Helen Mary
authors.initials: HM
authors.lastname: Heneghan
authors.forename: Hasan Tarik
authors.initials: HT
authors.lastname: Kirat
authors.forename: Elena
authors.initials: E
authors.lastname: Manilich
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.forename: Sean T
authors.initials: ST
authors.lastname: Martin
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery; D000328:Adult; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D003092:Colitis / Q000601:surgery; D003093:Colitis, Ulcerative / Q000601:surgery; D039021:Colonic Pouches / Q000009:adverse effects; D003424:Crohn Disease / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011788:Quality of Life; D016896:Treatment Outcome