Abstract
Purpose
Ileal pouch–anal anastomosis (IPAA) has become the surgical procedure of choice for patients with ulcerative colitis (UC). IPAA was incorporated into our institution in 1984, and thereafter, more than 200 procedures have been performed. The functional results and morbidity of this surgery have been reported previously. However, long-term functional outcomes and quality of life have not been evaluated.
Methods
As a cohort study, we identified all consecutive patients who underwent IPAA for UC between 1984 and 2017 and selected those with more than 10-year follow-up. Demographic data, morbidity, and pouch survival information were obtained. Long-term functional results and quality of life were evaluated through an e-mail survey using the Öresland score and the Cleveland Global Quality of Life scales, respectively.
Results
Of 201 patients, 116 met the inclusion criteria. Median follow-up was 20 (10–34) years. Early post-operative complications (30 days) were observed in 19 (16.4%) patients and 66 (56.9%) presented adverse events. The IPAA preservation rate at 10 and 20 years was 96.5% and 93.1%, respectively. Long-term functional scores presented a median of 6 (1–15) points. IPAA function was satisfactory in 11 (20.0%) patients, acceptable in 18 (32.7%), and deficient in 26 (47.3%). The median score for global quality of life was 0.8 (0.23–1.0) points.
Conclusion
IPAA as treatment for UC meets the expectations of cure of the disease, maintaining adequate long-term intestinal functionality associated with a good quality of life in most patients.
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References
Mark W, Onaitis CM (2003) Ileal pouch-anal anastomosis for ulcerative colitis and familial adenomatous polyposis: historical development and current status. Ann Surg 238(6S). https://doi.org/10.1097/01.sla.0000098115.90865.16
Scarpa M (2007) Quality of life after restorative proctocolectomy for ulcerative colitis. Arch Surg 142(2):158–165. https://doi.org/10.1001/archsurg.142.2.158
Parks AG, Nicholls RJBP (1980) Proctocolectomy with ileal reservoir and anal anastomosis. Br J Surg 67(8):533–538. https://doi.org/10.1002/bjs.1800670802
Parks A, Nicholls R (1978) Proctocolectomy without ileostomy. Br Med J 2(July):85–88. https://doi.org/10.1136/bmj.2.6130.85
Heikens JT, de Vries J, van Laarhoven CJHM (2012) Quality of life, health-related quality of life and health status in patients having restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis: a systematic review. Color Dis 14(5):536–544. https://doi.org/10.1111/j.1463-1318.2010.02538.x
Murphy PB, Khot Z, Vogt KN, Ott M, Dubois L (2015) Quality of life after total proctocolectomy with ileostomy or IPAA: a systematic review. Dis Colon Rectum 58(9):899–908. https://doi.org/10.1097/DCR.0000000000000418
Lightner AL, Mathis KL, Dozois EJ, Hahnsloser D, Loftus EV Jr, Raffals LE, Pemberton JH (2017) Results at up to 30 years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Inflamm Bowel Dis 23(5):781–790. https://doi.org/10.1097/MIB.0000000000001061
Delaney CP, Fazio VW, Remzi FH, Hammel J, Church JM, Hull TL, Senagore AJ, Strong SA, Lavery IC (2003) Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch-anal anastomosis. Ann Surg 238(2):221–228. https://doi.org/10.1097/00000658-200308000-00010
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. https://doi.org/10.1002/bjs.5464
Farouk R, Pemberton JH, Wolff BG, Dozois RR, Browning S, Larson D (2000) Functional outcomes after ileal pouch-anal anastomosis for chronic ulcerative colitis. Ann Surg 231(6):919–926. https://doi.org/10.1097/00000658-200006000-00017
Michelassi F, Lee J, Rubin M et al (2003) Long-term functional results after Ileal pouch anal restorative proctocolectomy for ulcerative colitis. Trans Meet Am Surg Assoc 121(3):127–139. https://doi.org/10.1097/01.sla.0000086658.60555.ea
Zárate CA, Zúñiga Díaz Á, Pinedo MG, López KF, Molina PME, Viviani GP (2008) Reservorio ileal con anastomosis reservorio anal por colitis ulcerosa: omplicaciones y resultados funcionales a largo plazo. Rev Med Chil 136(4):467–474. https://doi.org/10.4067/S0034-98872008000400007
Fazio VW, Kiran RP, Remzi FH et al (2013) Ileal pouch anal anastomosis. Ann Surg 257(4). https://doi.org/10.1097/SLA.0b013e31827d99a2
Öresland T, Fasth S, Nordgren S, Åkervall S, Hultén L (1990) Pouch size: the important functional determinant after restorative proctocolectomy. Br J Surg 77(3):265–269. https://doi.org/10.1002/bjs.1800770310
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. https://doi.org/10.1097/00000658-199910000-00013
McCombie A, Lee Y, Vanamala R, Gearry R, Frizelle F, McKay E, Williman J, Eglinton T (2016) Early postoperative complications have long-term impact on quality of life after restorative proctocolectomy. Medicine 95(27):e3966. https://doi.org/10.1097/MD.0000000000003966
Leowardi C, Hinz U, Tariverdian M, Kienle P, Herfarth C, Ulrich A, Kadmon M (2010) Long-term outcome 10 years or more after restorative proctocolectomy and ileal pouch-anal anastomosis in patients with ulcerative colitis. Langenbeck's Arch Surg 395(1):49–56. https://doi.org/10.1007/s00423-009-0479-7
Berndtsson I, Lindholm E, Öresland 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. https://doi.org/10.1007/s10350-007-0278-6
Hallberg H, Stahlberg D, Akerlund J-E (2005) Ileal pouch-anal anastomosis (IPAA): functional outcome after postoperative pelvic sepsis. A prospective study of 100 patients. Int J Color Dis 20(6):529–533. https://doi.org/10.1007/s00384-004-0717-y
Chessin DB, Gorfine SR, Bub DS, Royston A, Wong D, Bauer JJ (2008) Septic complications after restorative proctocolectomy do not impair functional outcome: long-term follow-up from a specialty center. Dis Colon Rectum 51(9):1312–1317. https://doi.org/10.1007/s10350-008-9413-2
De Zeeuw S, Ali UA, Donders RART, Hueting WE, Keus F, Van Laarhoven CJHM (2012) Update of complications and functional outcome of the ileo-pouch anal anastomosis: overview of evidence and meta-analysis of 96 observational studies. Int J Color Dis 27(7):843–853. https://doi.org/10.1007/s00384-011-1402-6
Kiely JM, Fazio VW, Remzi FH, Shen B, Kiran RP (2012) Pelvic sepsis after IPAA adversely affects function of the pouch and quality of life. Dis Colon Rectum 55(4). https://doi.org/10.1097/DCR.0b013e318246418e
Guyatt G, Mitchell A, Irvine EJ, Singer J, Williams N, Goodacre R, Tompkins C (1989) A new measure of health status for clinical trials in inflammatory bowel disease. Gastroenterology. 96(3):804–810. https://doi.org/10.1016/S0016-5085(89)80080-0
Carmon E, Keidar A, Ravid A, Goldman G, Rabau M (2003) The correlation between quality of life and functional outcome in ulcerative colitis patients after proctocolectomy ileal pouch anal anastomosis. Color Dis 5(3):228–232. https://doi.org/10.1046/j.1463-1318.2003.00445.x
Richards DM, Hughes SA, Irving MH, Scott NA (2001) Patient quality of life after successful restorative proctocolectomy is normal. Color Dis 3(4):223–226. https://doi.org/10.1046/j.1463-1318.2001.00228.x
Scarpa M, Angriman I, Ruffolo C, Ferronato A, Polese L, Barollo M, Martin A, Sturniolo GC, D'Amico DF (2004) Health-related quality of life after restorative proctocolectomy for ulcerative colitis: long-term results. World J Surg 28(2):124–129. https://doi.org/10.1007/s00268-003-7047-z
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This work is supported by Pontificia Universidad Católica.
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Carcamo, L., Miranda, P., Zúñiga, A. et al. Ileal pouch–anal anastomosis in ulcerative colitis: outcomes, functional results, and quality of life in patients with more than 10-year follow-up. Int J Colorectal Dis 35, 747–753 (2020). https://doi.org/10.1007/s00384-020-03529-7
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DOI: https://doi.org/10.1007/s00384-020-03529-7