title: Does Stool Leakage Increase in Aging Pouches?
abstract: BACKGROUND
  Restorative proctocolectomy with IPAA is the standard surgical option for patients with ulcerative colitis. Although ileal pouches have been shown to have acceptable functional outcomes, some patients experience fecal incontinence.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the incidence of fecal leakage and the way it may change over time in patients with an ileoanal pouch.
  
  
  METHODS
  This study used a retrospective design.
  
  
  METHODS
  The study was conducted at a tertiary care center.
  
  
  METHODS
  Patients who received an IPAA for ulcerative colitis between 1983 and 2008 were accessed from a prospectively maintained database. We excluded patients with cancer, colonic dysplasia, and missing record of ileostomy closure and without long-term functional data.
  
  
  METHODS
  We defined fecal leakage as leakage of stool more than once per day. Univariate and multivariate analyses were performed to identify associations with and possible risk factors for fecal leakage.
  
  
  RESULTS
  A total of 1228 patients were included in this study. There were 656 men, with a mean age of 38.7 years. The median follow-up time was 158 months. The fecal leakage rates at 5, 10, and >15 years were 24.6%, 25.7%, and 27.4% (p = 0.66). Patients with fecal leakage were significantly older at the time of surgery (p < 0.001), had longer disease duration before surgery (p = 0.04), underwent more 2-stage surgery (p = 0.04), included more women (p < 0.01), and showed lower preoperative maximum anal squeeze pressure (p = 0.008). On multivariate analysis, the only significant factor predisposing to fecal leakage was older age at the time of pouch surgery (OR = 1.07 (95% CI, 1.02-1.12); p = 0.005).
  
  
  CONCLUSIONS
  The study was limited by its retrospective and non-randomized nature.
  
  
  CONCLUSIONS
  The occurrence of fecal leakage in patients with IPAA does not change with time. However, increased age at the time of surgery may increase the chances of patients with IPAA having fecal leakage.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: HyungJin
authors.initials: H
authors.lastname: Kim
authors.forename: Li
authors.initials: L
authors.lastname: Sun
authors.forename: Brooke
authors.initials: B
authors.lastname: Gurland
authors.forename: Tracy
authors.initials: T
authors.lastname: Hull
authors.forename: Massarat
authors.initials: M
authors.lastname: Zutshi
authors.forename: James
authors.initials: J
authors.lastname: Church
mesh_terms: D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome