title: Evaluation of long-term function, complications, quality of life and health status after restorative proctocolectomy with ileo neo rectal and with ileal pouch anal anastomosis for ulcerative colitis.
abstract: OBJECTIVE
  Restorative surgery after (procto)colectomy with ileo-neorectal anastomosis (INRA) or restorative proctocolectomy with ileal pouch anal anastomosis (RPC) combines cure of ulcerative colitis (UC) with restoration of intestinal continuity. This study aimed to evaluate these two operations.
  
  
  METHODS
  Patients having INRA and RPC were matched according to sex, age at onset of UC, age at restorative surgery and duration of follow-up. Patients were included if they were over 18 years of age, had UC confirmed histopathologically and had undergone either operation. Long-term function, anal and neorectal physiology, complications, quality of life (QoL) and health status (HS) were determined.
  
  
  RESULTS
  Seventy-one consecutive patients underwent surgery with the intention of having an INRA procedure. This was successfully carried out in 50, and 21 underwent intra-operative conversion to RPC. Median defaecation frequency was 6/24 h. In 11/71 patients reservoir failure occurred and 13/71 developed pouchitis. QoL and HS were comparable to the healthy population. Median follow-up was 6.2 years. These patients were matched with 71 patients who underwent RPC. RPC was successful in all patients. Median defaecation frequency was 8/24 h. Failure occurred in 7/71 patients and 13/71 developed pouchitis. QoL and HS were comparable with the healthy population. Median follow-up was 6.9 years.
  
  
  CONCLUSIONS
  Comparison of INRA and RPC on an intention to treat basis was not considered to be realistic due to the high intra-operative conversion rate and the failures in the INRA group. RPC remains the procedure of choice for restoring intestinal continuity after proctocolectomy for UC.
authors: Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. j.heikens@chir.umcn.nl
authors: J T
authors: JT
authors: Heikens
authors: J
authors: J
authors: de Vries
authors: D J
authors: DJ
authors: de Jong
authors: B L
authors: BL
authors: den Oudsten
authors: W
authors: W
authors: Hopman
authors: J M M
authors: JM
authors: Groenewoud
authors: M B
authors: MB
authors: van der Kolk
authors: H G
authors: HG
authors: Gooszen
authors: C J H M
authors: CJ
authors: van Laarhoven
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011183:Postoperative Complications; D019449:Pouchitis; D016737:Proctocolectomy, Restorative; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome