Long-term followup with evaluation of the surgical and functional results of the ileal pouch reservoir in restorative proctocolectomy for ulcerative colitis

Abstract

Aims. Evaluate the early and long term surgical and functional results of the ileal pouch-reservoir (IPAA) in patients with intractable ulcerative colitis. Material and Methods. Followup of 134 consecutive patients with W-or J-ileal pouch by diseases-specific and general health (SF-36) questionnaire. In the first 44 patients, early and late followup was performed. Results. Followup was performed 7.4 years (0.5-17 years) after construction of W (n = 9) and J (n = 125) ileal pouch, which had similar results. There were 14.9% early and 43.6% late complications with 12.7% early and 19.5% late reoperations. Protecting loop-ileostomy used in 54 patients (43.9%), did not protect against complications. Thirteen reservoirs (9.8%) were resected (n = 8) or deactivated (n = 5) due to functional failure. Operation time, postoperative complications and pouchitis were determinators for reservoir failure and reduced quality of life. The functional results at followup of 44 patients at 2.5 years (0.8-6.7 years) and 11.5 years (8.2-19.2 years) were remarkably similar. Conclusions. IPAA is a good option for most patients when medication fails. 10% experience failure with inferior quality of life. Protective stoma will not reduce failure rates. After an initial time period, reservoir function will not change over time.

Figure 1

SF-36 scores for patients operated with W reservoir compared to patients with J reservoir; and scores for the normal population. Subscale scores in the Short Form Health Survey questionnaire (SF-36). Higher scores indicate better function. PF equal physical function sum score, RP equal role limitations/physical sum score, BP equal bodily pain sum score, GH equal general health sum score, VT equal vitality sum score, SF equal social function sum score, RE equal role limitation/emotional problems, MH equal mental health sum score, PCS equal physical health summary score, MCS equal mental health summary score. Significances are calculated between J and W reservoirs: **P < .01, ***P < .001.

Figure 2

Number of average day-time defecations in 44 patients in 1993 compared to 2002.

Figure 3

Number of average night-time defecations in 44 patients in 1993 compared to 2002.

Figure 4

Number of reservoir constructions and the use of diverting stoma during the study period.

Figure 5

Number of functional J- reservoirs during the observation period.

Figure 6

SF-36 scores in patients with functional J reservoirs compared to patients with failed J reservoirs, and scores for the normal population. Subscale scores in the short form health survey questionnaire (SF-36). Higher scores indicate better function. PF equal physical function sum score, RP equal role limitations/physical sum score, BP equal bodily pain sum score, GH equal general health sum score, VT equal vitality sum score, SF equal social function sum score, RE equal role limitation/emotional problems, MH equal mental health sum score, PCS equal physical health summary score, MCS equal mental health summary score. significances are calculated between functional and failed reservoirs: **P < .01, ***P < .001.