Ileal pouch-anal anastomosis 20 years later: is it still a good surgical option for patients with ulcerative colitis?
OBJECTIVE
Short-term results after ileo-pouch anal anastomosis (IPAA) are well established; data are conflicting in long-standing patients. We retrospectively evaluated long-term complications and functional results after follow-up longer than 20 years.


METHODS
Two hundred five patients with follow-up longer than 20 years have been identified out of 1112 IPAA performed in our institution; of these, 20 cases were lost at follow-up or decline to take part at the study. We evaluated long-term complications and failure rate also according to changes in histological diagnosis. Changes in functional results and quality of life (QoL) were analyzed at 5 and 20 years after IPAA.


RESULTS
Pouch failure rate was 10.8 % (35 % due to misdiagnosed Crohn). Incidences of fistulas, anastomotic stenosis, chronic pouchitis, and pre-pouch ileitis were 17.3, 12.9, 28.6, and 7.6 %, respectively. Most of the patients reported good functional outcomes. Day-time evacuations at 5 and after 20 years were 4.3 and 4.8 (p = n.s.) while during night-time were 0.8 and 1.2 (p < 0.05). Urgency was 6 and 9.4 % (p = n.s.), respectively; need of antimotility drugs was 16 and 35 % (p < 0.001). Dietary limitations and work restrictions were similar over time. Only sexuality got worse during follow-up. Satisfaction for surgery was always high and it did not change over time.


CONCLUSIONS
IPAA is still an excellent surgical option for UC with a low rate of pouch failure even after more than 20 years. Despite a slight worsening of functional results over time, the QoL remained high and most patients expressed satisfaction with the procedure and were willing to recommend it to others.
Department of General Surgery, St. Orsola-Malpighi University Hospital, University of Bologna, Via Pietro Albertoni, 40138, Bologna, Italy. lorenzo.gentilini@aosp.bo.it.
Gentilini
G
Lorenzo
Department of General Surgery, St. Orsola-Malpighi University Hospital, University of Bologna, Via Pietro Albertoni, 40138, Bologna, Italy.
Coscia
C
Maurizio
Department of General Surgery, St. Orsola-Malpighi University Hospital, University of Bologna, Via Pietro Albertoni, 40138, Bologna, Italy.
Lombardi Pietro
LP
Maria
Department of General Surgery, St. Orsola-Malpighi University Hospital, University of Bologna, Via Pietro Albertoni, 40138, Bologna, Italy.
Marta
M
Tanzanu
Department of General Surgery, St. Orsola-Malpighi University Hospital, University of Bologna, Via Pietro Albertoni, 40138, Bologna, Italy.
Laureti
L
Silvio
Department of General Surgery, St. Orsola-Malpighi University Hospital, University of Bologna, Via Pietro Albertoni, 40138, Bologna, Italy.
Podda
P
Mariangela
Department of General Surgery, St. Orsola-Malpighi University Hospital, University of Bologna, Via Pietro Albertoni, 40138, Bologna, Italy.
Poggioli
P
Gilberto
D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D002648:Child; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016737:Proctocolectomy, Restorative; D011788:Quality of Life; D013997:Time Factors; D055815:Young Adult
Crohn; Fistulas; Pouch; Pouchitis; Restorative proctocolectomy; Ulcerative colitis
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