Long-term functional outcomes and quality of life after restorative proctocolectomy and ileal pouch-anal anastomosis

Czech version

Authors: M. Kostrejová ¹; M. Bortlík ^2,3; D. Ďuricová ^2,4; M. Kolář ²; R. Sequens ^5,6; M. Lukáš ^2,7
Authors‘ workplace: Gastroenterologie a digestivní endoskopie, Nemocnice Milosrdných sester sv. Karla Boromejského v Praze ¹; Klinické a výzkumné centrum pro střevní záněty, ISCARE I. V. F. a. s., Praha ²; Interní klinika 1. LF UK a ÚVN Praha ³; Farmakologický ústav, 1. LF UK a VFN v Praze ⁴; Chirurgické oddělení, NH Hospital a. s., Nemocnice Hořovice ⁵; Chirurgické oddělení, Nemocnice Milosrdných sester sv. Karla Boromejského v Praze ⁶; Ústav lékařské biochemie a laboratorní diagnostiky, 1. LF UK a VFN v Praze ⁷
Published in: Gastroent Hepatol 2016; 70(1): 38-44
Category: Original Article
doi: https://doi.org/10.14735/amgh201638

Overview

Introduction:
Restorative proctocolectomy with ileal pouch anal anastomosis has become a surgical procedure of choice in patients with ulcerative colitis.

Aims and Methods:
The aim of this study was to assess long-term functional results and quality of life in ulcerative colitis (n = 138) patients who underwent ileal pouch anal anastomosis between 1993 and 2013 in two Czech refferal centers.

Results:
A total of 118 (85.5%) out of 138 patients answered all of the questions in the questionnaires, 62% of whom were male. Median age at proctocolectomy was 34 (18–56) years and the median follow-up time was 7.9 (2.1–20.7) years. The overall late complication rate was 29.2%. Pouch failure occurred in 7.9% patients, and pouch excision was required in two patients (1.6%). In 8.7% and 10.2% of patients, respectively, anastomotic strictures and complete fistula were detected. The “re-do” pelvic pouch procedure was applied to 5.5% of patients and 24% developed at least one episode of acute pouchitis, and 15% of patients suffered from chronic pouchitis. The median score of functional outcome was 2 (0–19), according to the Wexner Continence Score. The median number of bowel movements during the daytime was 6 (1–15), 2 at night (0–7), and 8 in 24 hours (2–20). Impairments in health-related quality of life were mainly in psychological and social areas and to a lesser degree in the physical area. The scores of Physical Component Summary and Mental Component Summary were significantly lower than those of the general population (p < 0.001).

Conclusion:
The majority of patients were fully continent; however, one third had a slightly lower quality of life than the general population, and had worse functional outcomes. This should be taken into account during the selection process for the best treatment alternative.

Key words:
ulcerative colitis – quality of life – restorative proctocolectomy – ileal pouch-anal anastomosis

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
26. 1. 2016

Accepted:
8. 2. 2016

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