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Septic Complications after Restorative Proctocolectomy do not Impair Functional Outcome: Long-Term Follow-Up from a Specialty Center

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

Abstract

Purpose

After restorative proctocolectomy, 7 to 8 percent of patients may have a pouch leak. Concern exists that pouch leak may be associated with impaired functional outcome. We evaluated patients who underwent restorative proctocolectomy to determine whether pouch leak adversely affected long-term functional outcome and quality of life.

Methods

We queried our prospectively maintained database of patients who underwent restorative proctocolectomy for demographic and clinical data. We sent a long-term outcome questionnaire to patients, including the validated Fecal Incontinence Severity Index and Cleveland Global Quality of Life scores. Pouch leak was identified by clinical or radiographic evidence of leak. Patients with leak were compared with those without to determine the impact on long-term functional outcome or quality of life.

Results

A total of 817 patients were available for follow-up and 374 patients (46 percent) completed questionnaires. The group with (n = 60; 16 percent) and without (n = 314; 84 percent) leak had similar demographics. The median Fecal Incontinence Severity Index score (15.3 vs. 14.7, P = 0.77), Cleveland Global Quality of Life score (0.79 vs. 0.81, P = 0.48), and bowel movements per 24 hours (7.92 vs. 7.88, P = 0.92) were similar. The pouch loss/permanent ileostomy rate was higher in those who leaked (13.3 vs. 0.9 percent, P < 0.001).

Conclusions

Anastomotic leak after restorative proctocolectomy does not adversely affect long-term quality of life or functional outcome. However, pouch loss/permanent ileostomy is significantly more likely in patients who have had an anastomotic leak.

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Author information

Authors and Affiliations

  1. Department of Surgery, Division of Colorectal Surgery, Mount Sinai Medical Center, New York, New York, USA

    David B. Chessin M.D., Stephen R. Gorfine M.D., David S. Bub M.D., Aaron Royston B.A., Deborah Wong M.D. & Joel J. Bauer M.D.

  2. Manhattan Surgical Associates, 25 East 69th Street, New York, New York, 10021, USA

    David B. Chessin M.D.

Authors
  1. David B. Chessin M.D.
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  2. Stephen R. Gorfine M.D.
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  3. David S. Bub M.D.
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  4. Aaron Royston B.A.
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  5. Deborah Wong M.D.
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  6. Joel J. Bauer M.D.
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Corresponding author

Correspondence to David B. Chessin M.D..

Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, Boston, Massachusetts, June 7 to 11, 2008.

Reprints are not available.

Appendix

Appendix

Manhattan Surgical Associates “J-Pouch” Follow-up Questionnaire

  1. 1)

    Last Name __________________________________

  2. 2)

    First Name__________________________________

  3. 3)

    Email address (optional)_______________________

If your J-pouch needed to be removed surgically, or you currently have a diverting ileostomy that has not been reversed, please go to question number 17.

  1. 4)

    How many times a day do you move your bowels in a 24-hour period?________

  2. 5)

    Do you take any antidiarrheal medications?

    • Lomotil (Y/N) _______ If yes, how many tablets a day? _______

    • Imodium (Y/N) ______ If yes, how many tablets a day? _______

  3. 6)

    Do you ever have to wear a pad because of anal leakage?

    • During the day?_____

    • At night? ______

  4. 7)

    The questions below are in regard to fecal incontinence. Please check if you suffer from leakage of gas, mucus, or stool. If you do not suffer from incontinence please check “never.”

  5. 8)

    During sleep, do you suffer from leakage of:

    • Mucus (Y/N)___________

      • If yes, how many times per week________

    • Liquid stool (Y/N)_______

      • If yes, how many times per week________

    • Solid stool (Y/N)________

      • If yes, how many times per week________

  6. 9)

    Since your J-pouch surgery have you ever had a small-bowel obstruction?

    • Were you hospitalized, and if so in what year(s)?

    • Did you ever require surgery for a small-bowel obstruction and if so what year(s)?

  7. 10)

    Since your J-pouch surgery were you ever diagnosed with pouchitis?

    • If so, how many times? (Once) (2–5) (5–10) (more than 10)

    • If so, what medications were you treated with?

    • Cipro Flagyl Levaquin Prednisone 6-MP Other ______

  8. 11)

    Since your surgery have you ever been diagnosed with a hernia in the surgical site?

    • Did you need surgery to repair it, and if so what year(s)?

  9. 12)

    Does the pouch limit your ability to do activities that you would like to do?

  10. 13)

    Do you have to plan your activities around your pouch function?

  11. 14)

    Do you feel that you have complete control of your bowels?

  12. 15)

    Please rate the following on a scale of 0–10 (0 is worst, 10 is best)

    • Current quality of life____________________

    • Current quality of health__________________

    • Current energy level_____________________

    • Satisfaction with ileal J-pouch procedure_____

  13. 16)

    Would you have the pouch procedure again?

If you currently have an ileostomy or your J-pouch was removed surgically please answer the following questions.

  1. 17)

    Why was the pouch diverted or removed?

    1. a)

      I was discovered to have Crohn’s disease._____

    2. b)

      I had recurrent bouts of pouchitis. ______

    3. c)

      I had a perianal abscess or pouch anal fistula that did not heal. _______

    4. d)

      Other (please specify)________________

  2. 18)

    Would you have the J-pouch procedure again?

  3. 19)

    Please rate the following on a scale of 0–10 (0 is worst, 10 is best)

    • Current quality of life____________________

    • Current quality of health__________________

    • Current energy level_____________________

    • Satisfaction with ileal J-pouch procedure_____

  4. 20)

    The following questions are for men

    • Did you have difficulty obtaining or maintaining an erection before surgery?_______________

    • Did you have difficulty obtaining or maintaining an erection within 30 days after surgery?____________

    • Do you currently have difficulty obtaining or maintaining an erection?_________

    • Did you have difficulty ejaculating before surgery?_________________

    • Did you have difficulty ejaculating within 30 days after surgery?________________

    • Do you currently have difficulty ejaculating?______

  5. 21)

    The following questions are for women

    • Did you try to get pregnant after your surgery?____

    • Were you successful in getting pregnant after your surgery?__________________

    • Did you require any special procedures or medical assistance to get pregnant?_______________

      • If yes, what treatment did you require to get pregnant?________________

    • If you delivered a baby after your surgery, did you have a vaginal delivery or Cesarean section?_______

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Chessin, D.B., Gorfine, S.R., Bub, D.S. et al. Septic Complications after Restorative Proctocolectomy do not Impair Functional Outcome: Long-Term Follow-Up from a Specialty Center. Dis Colon Rectum 51, 1312–1317 (2008). https://doi.org/10.1007/s10350-008-9413-2

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  • DOI: https://doi.org/10.1007/s10350-008-9413-2

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