title: Comparison of Functional Outcomes of Patients Who Underwent Hand-Sewn or Stapled Ileal Pouch-Anal Anastomosis for Ulcerative Colitis.
abstract: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for patients with ulcerative colitis (UC). The purpose of this study was to investigate the long-term functional outcomes and quality of life (QOL) associated with hand-sewn and stapled IPAA. Ninety-one patients with UC had undergone IPAA using hand-sewn anastomosis with mucosectomy (32 patients) or stapled anastomosis (59 patients) from January 1988 to May 2010. Patients were evaluated according to patient characteristics, postoperative complications, functional outcomes and QOL. The QOL of patients were evaluated using the Medical Outcomes Study Short Form 36 (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ). Numbers of patients with colorectal cancer or dysplasia were significantly greater in the hand-sewn IPAA group (P < 0.01). These patients had longer disease durations and were older (both P < 0.01). There was no difference in the incidence of complications between the groups, except for a greater incidence of postoperative anal fistula in the stapled group (P = 0.03). In the early postsurgery period, both the frequency of bowel movements and the rate of soiling were significantly higher in the hand-sewn group, but in a later period, there was no difference in these events >3 years after surgery. The SF-36 and IBDQ results were similar in the two groups, indicating that hand-sewn and stapled IPAA result in similar QOL in the late postoperative period. Postoperative complications, functional outcomes, and long-term QOL were similar in patients who had received hand-sewn or stapled IPAA.
authors.affiliation: 1 Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ishii
authors.affiliation: 1 Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kawai
authors.affiliation: 1 Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hata
authors.affiliation: 2 Department of Surgery, Chigasaki Municipal Hospital, Tokyo, Japan.
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Shuno
authors.affiliation: 1 Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishikawa
authors.affiliation: 1 Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: 1 Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Tanaka
authors.affiliation: 1 Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Tomomichi
authors.initials: T
authors.lastname: Kiyomatsu
authors.affiliation: 1 Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nozawa
authors.affiliation: 1 Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Kazama
authors.affiliation: 1 Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamaguchi
authors.affiliation: 1 Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Ishihara
authors.affiliation: 1 Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Sunami
authors.affiliation: 1 Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Kitayama
authors.affiliation: 1 Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Watanabe
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000503:physiopathology / Q000601:surgery*; D003672:Defecation / Q000502:physiology*; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011788:Quality of Life; D017792:Surgical Stapling; D011795:Surveys and Questionnaires; D013536:Suture Techniques
keywords: Functional outcome; Hand-sewn anastomosis; Ileal pouch anal anastomosis (IPAA); Quality of life; Stapled anastomosis; Ulcerative colitis