Abstract
Purpose
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.
Conclusion
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.
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References
Parks AG, Nicholls RJ (1978) Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 2(6130):85–88
Andersson P, Söderholm JD (2009) Surgery in ulcerative colitis: indication and timing. Dig Dis Vol 27:335–340
Hueting WE, Buskens E, Van Der Tweel I, Gooszen HG, Van Laarhoven CJHM (2005) Results and complications after ileal pouch anal anastomosis: a meta-analysis of 43 observational studies comprising 9,317 patients. Dig Surg 22(1–2):69–79
Fazio VW, Tekkis PP, Remzi F et al (2003) Quantification of risk for pouch failure after ileal pouch anal anastomosis surgery. Ann Surg 238(4):605–614 discussion 614-617
Grucela AL, Bauer JJ, Gorfine SR, Chessin DB (2011) Outcome and long-term function of restorative proctocolectomy for Crohn’s disease: comparison to patients with ulcerative colitis. Color Dis 13(4):426–430
Shen B, Patel S, Lian L (2010) Natural history of Crohn’s disease in patients who underwent intentional restorative proctocolectomy with ileal pouch-anal anastomosis. Aliment Pharmacol Ther 31(7):745–753
Michellassi F, Lee J et al (2003) Long-term functional results after ileal pouch anal restorative proctocolectomy for ulcerative colitis. Ann Surg 238:433–435
Scarpa M et al (2004) Health-related quality of life after restorative proctocolectomy for ulcerative colitis: long-term results. World J Surg 28(2):124–129
Heikens JT et al (2012) Quality of life and health status before and after ileal pouch-anal anastomosis for ulcerative colitis. Br J Surg. 99(2):263–269
Karlbom U, Lindfors A, Pahlman L (2012) Long-term functional outcome after restorative proctocolectomy in patients with ulcerative colitis. Color Dis 14(8):977–984
Tulchinsky H, Hawley PR, Nicholls J (2003) Long-term failure after restorative proctocolectomy for ulcerative colitis. Ann Surg 238(2):229–234
Kiran RP, El-Gazzaz G, Remzi FH et al (2011) Influence of age at ileoanal pouch creation on long-term changes in functional outcomes. Color Dis 13(2):184–190
Shen B, Achkar JP, Connor JT et al (2003) Modified pouchitis disease activity index: a simplified approach to the diagnosis of pouchitis. Dis Colon rectum 46(6):748–753
McLaughlin SD, Clark SK, Bell AJ, Tekkis PP, Ciclitira PJ, Nicholls RJ (2009) Incidence and short-term implications of prepouch ileitis following restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. Dis Colon rectum 52(5):879–883
Fazio VW, O’Riordain MG, Lavery IC et al (1999) Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230(4):575–584 discussion 584-586
Fazio VW, Kiran RP, Remzi FH et al (2013) Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 257(4):679–685
Poggioli G, Laureti S, Campieri M et al (2007) Infliximab in the treatment of Crohn’s disease. Ther Clin Risk Manag 3(2):301–308
Poggioli G, Laureti S, Pierangeli F et al (2005) Local injection of infliximab for the treatment of perianal Crohn’s disease. Dis Colon rectum 48(4):768–774
Hahnloser D, Pemberton JH, Wolff BG, Larson DR, Crownhart BS, Dozois RR (2004) The effect of ageing on function and quality of life in ileal pouch patients: a single cohort experience of 409 patients with chronic ulcerative colitis. Ann Surg 240(4):615–621 discussion 621-623
Heuschen UA, Allemeyer EH, Hinz U, Lucas M, Herfarth C, Heuschen G (2002) Outcome after septic complications in J pouch procedures. Br J Surg. 89(2):194–200
Ferrante M, Declerck S, De Hertogh G et al (2008) Outcome after proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. Inflamm Bowel Dis 14(1):20–28
Burns EM, Bottle A, Aylin P et al (2011) Volume analysis of outcome following restorative proctocolectomy. Br J Surg. 98(3):408–417
Berndtsson I, Lindholm E, Oresland T, Börjesson L (2007) Long-term outcome after ileal pouch-anal anastomosis: function and health-related quality of life. Dis Colon rectum 50(10):1545–1552
Braveman JM, Schoetz DJ, Marcello PW et al (2004) The fate of the ileal pouch in patients developing Crohn’s disease. Dis Colon rectum 47(10):1613–1619
Brown CJ, MacLean AR, Cohen Z, MacRae HM, BI O’C, RS ML (2005) Crohn’s disease and indeterminate colitis and the ileal pouch-anal anastomosis: outcomes and patterns of failure. Dis Colon rectum 48(8):1542–1549
Hyman NH, Fazio VW, Tuckson WB, Lavery IC (1991) Consequences of ileal pouch-anal anastomosis for Crohn’s colitis. Dis Colon rectum 34(8):653–657
Melton GB, Fazio VW, Kiran RP et al (2008) Long-term outcomes with ileal pouch-anal anastomosis and Crohn’s disease: pouch retention and implications of delayed diagnosis. Ann Surg 248(4):608–616
Panis Y, Poupard B, Nemeth J, Lavergne A, Hautefeuille P, Valleur P (1996) Ileal pouch/anal anastomosis for Crohn’s disease. Lancet 347(9005):854–857
Rickard MJFX, Young CJ, Bissett IP, Stitz R, Solomon MJ (2007) Ileal pouch-anal anastomosis: the Australasian experience. Color Dis 9(2):139–145
Lolohea S, Lynch AC, Robertson GB, Frizelle FA (2005) Ileal pouch-anal anastomosis-vaginal fistula: a review. Dis Colon rectum 48(9):1802–1810
Mclaughlin SD, Clark SK, Bell AJ, Tekkis PP, Ciclitira PJ, Nicholls RJ (2009) An open study of antibiotics for the treatment of pre-pouch ileitis following restorative proctocolectomy with ileal pouch-anal anastomosis. Aliment Pharmacol Ther 29(1):69–74
Wolf JM, Achkar J-P, Lashner BA et al (2004) Afferent limb ulcers predict Crohn’s disease in patients with ileal pouch-anal anastomosis. Gastroenterology 126(7):1686–1691
Heikens JT, de Vries J, Goos MRE, Oostvogel HJ, Gooszen HG, van Laarhoven CJHM (2012) Quality of life and health status before and after ileal pouch-anal anastomosis for ulcerative colitis. Br J Surg. 99(2):263–269
Ryhammer AM, Laurberg S, Sørensen FH (1997) Effects of age on anal function in normal women. Int J Color Dis 12(4):225–229
Hahnloser D, Pemberton JH, Wolff BG, Larson DR, Crownhart BS, Dozois RR (2007) Results at up to 20 years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Br J Surg 94(3):333–340
Bengtsson J, Borjesson L, Lundstam U, Oresland T (2007) Long-term function and manovolumetric characteristics after ileal pouch-anal anastomosis for ulcerative colitis. Br J Surg 94(3):327–332. doi:10.1002/bjs.5484
Bengtsson J, Borjesson L, Lundstam U, Oresland T (2007) Long-term function and manovolumetric characteristics after ileal pouch-anal anastomosis for ulcerative colitis. Br J Surg 94(3):327–332
Beutel ME, Stobel-Richter Y, Brahler E (2008) Sexual desire and sexual activity of men and women across their lifespans: results from a representative German community survey. BJU Int 101(1):76–82
Holden CA, McLachlan RI, Pitts M et al (2005) Men in Australia telephone survey (MATeS): a national survey of the reproductive health and concers of middle-aged and older Australian men. Lancet 366:218–224
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Long-term outcomes and functional results after IPAA
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Lorenzo, G., Maurizio, C., Maria, L.P. et al. Ileal pouch-anal anastomosis 20 years later: is it still a good surgical option for patients with ulcerative colitis?. Int J Colorectal Dis 31, 1835–1843 (2016). https://doi.org/10.1007/s00384-016-2657-8
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DOI: https://doi.org/10.1007/s00384-016-2657-8