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Cumulative Failure Rate of Ileal Pouch-Anal Anastomosis and Quality of Life After Failure

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Diseases of the Colon & Rectum

Abstract

PURPOSE: The aim of the study was to calculate the cumulative occurrence of pouch failure among 486 patients who had undergone proctocolectomy and ileoanal anastomosis for ulcerative colitis or familial adenomatous polyposis. The other goal was to compare the quality of life in the failure group of 21 patients, the successful group, and the healthy population. METHODS: Data were collected from patient histories, with the probability of pouch failure being calculated by the Kaplan-Meier method. Patients with pouch failure and controls were sent a Short-Form 36-item quality-of-life questionnaire, and data were analyzed with paired t-test. RESULTS: The overall failure rate was 5.3 percent (26), including 24 pouch excisions and 2 early deaths (0.4 percent). Cumulative probabilities of pouch failure were 1, 5, and 7 percent at 1, 5, and 10 years, respectively. Neither pouchitis, gender, nor diagnosis correlated with pouch failure, but fistula formation (P < 0.001) did. Patients with failure had lower quality-of-life scores for physical function (P < 0.02), social function (P < 0.04), energy (P < 0.02), and physical role function (P < 0.03) than the healthy population. Scores for physical function (P < 0.01), energy (P < 0.01), and physical role function (P < 0.05) were also lower than those of control patients. CONCLUSIONS: The most common cause of pouch failure is fistula, whereas pouch excision is rarely caused by pouchitis. The impaired quality of life of patients in the failure group was caused by impairment of physical function and restrictions in social life.

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References

  1. C Soravia BI O’Connor T Berk RS McLeod Z Cohen (1999) ArticleTitleFunctional outcome of conversion of ileorectal anastomosis in patients with familial adenomatous polyposis and ulcerative colitis Dis Colon Rectum 42 903–908 Occurrence Handle1:STN:280:DyaK1Mzjslantg%3D%3D Occurrence Handle10411437

    CAS  PubMed  Google Scholar 

  2. EJ Simchuk RC Thirlby (2000) ArticleTitleRisk factors and true incidence of pouchitis in patients after ileal pouch-anal anastomosis World J Surg 24 851–856 Occurrence Handle1:STN:280:DC%2BD3c3ptlCqtQ%3D%3D Occurrence Handle10833254

    CAS  PubMed  Google Scholar 

  3. TJ O’Kelly M Merrett NJ Mortensen TC Denh M Kettlewell (1994) ArticleTitlePouch-vaginal fistula after restorative proctocolectomy Br J Surg 81 1374–1375 Occurrence Handle1:STN:280:ByqD2c7itFM%3D Occurrence Handle7953422

    CAS  PubMed  Google Scholar 

  4. IE Gesim BG Wolff JH Pemberton RM Devine RR Dozois (2000) ArticleTitleDoes technique of anastomosis play any role in developing late perianal abscess or fistula? Dis Colon Rectum 43 1241–1245 Occurrence Handle11005490

    PubMed  Google Scholar 

  5. R Farouk JH Pemberton BG Wolff RR Dozois S Browning D Larson (2000) ArticleTitleFunctional outcomes after ileal pouch-anal anastomosis for chronic ulcerative colitis Ann Surg 231 919–926 Occurrence Handle10.1097/00000658-200006000-00017 Occurrence Handle1:STN:280:DC%2BD3c3nslymtQ%3D%3D Occurrence Handle10816636

    Article  CAS  PubMed  Google Scholar 

  6. AP Meagher R Farouk RR Dozois KA Kelly JH Pemberton (1998) ArticleTitleJ ileal pouch-anal anastomosis for chronic ulcerative colitis Ann Surg 85 800–803 Occurrence Handle1:STN:280:DyaK1czjtVartA%3D%3D

    CAS  Google Scholar 

  7. P Belliveau J Trudel CA Vasilevsky B Stein PH Gordon (1999) ArticleTitleIleoanal anastomosis with reservoirs Can J Surg 42 345–352 Occurrence Handle1:STN:280:DyaK1MvlsFCgug%3D%3D Occurrence Handle10526518

    CAS  PubMed  Google Scholar 

  8. S Körsgen MR Keighley (1997) ArticleTitleCauses of failure and life expectancy of the ileoanal pouch Int J Colorectal Dis 12 4–8 Occurrence Handle9112142

    PubMed  Google Scholar 

  9. P Mowschenson JF Critchlow MA Peppercorn (2000) ArticleTitleIleoanal pouch operation. Long-term outcome with or without diverting ileostomy Arch Surg 135 463–466 Occurrence Handle1:STN:280:DC%2BD3c3ivFajsg%3D%3D Occurrence Handle10768713

    CAS  PubMed  Google Scholar 

  10. SA Seidel SE Peach M Newman KW Sharp (1999) ArticleTitleIleoanal pouch procedures Am Surg 64 40–46

    Google Scholar 

  11. HT Tan D Morton AB Connolly W Pringle M White MR Keighley (1998) ArticleTitleQuality of life after pouch excision Br J Surg 85 249–251 Occurrence Handle10.1046/j.1365-2168.1998.00582.x Occurrence Handle1:STN:280:DyaK1c7mt1Cmsg%3D%3D Occurrence Handle9501828

    Article  CAS  PubMed  Google Scholar 

  12. A O’Bichere K Wilkinson S Rumbles S Norton C Green RK Phillips (2000) ArticleTitleFunctional outcome after restorative panproctocolectomy for ulcerative colitis decreases an otherwise enhanced quality of life Br J Surg 87 802–807 Occurrence Handle1:STN:280:DC%2BD3czgslekuw%3D%3D Occurrence Handle10848862

    CAS  PubMed  Google Scholar 

  13. RS Mcleod DN Churchill AM Lock S Vanderburgh Z Cohen (1991) ArticleTitleQuality of life of patients with ulcerative colitis preoperatively and postoperatively Gastroenterology 101 1307–1313 Occurrence Handle1:STN:280:By2D3sfnt10%3D Occurrence Handle1936801

    CAS  PubMed  Google Scholar 

  14. P Luukkonen H Järvinen M Tanskanen A Kahri (1994) ArticleTitlePouchitis—recurrence of the inflammatory bowel disease? Gut 35 243–246 Occurrence Handle1:STN:280:ByuC2c%2FisVU%3D Occurrence Handle8307476

    CAS  PubMed  Google Scholar 

  15. JE Ware SuffixJr CD Sherbourne (1992) ArticleTitleThe MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection Med Care 30 473–483 Occurrence Handle1593914

    PubMed  Google Scholar 

  16. WZ Fazio MG O’Riordain IC Lavery (1999) ArticleTitleLong-term functional outcome and quality of life after stapled restorative proctocolectomy Ann Surg 230 575–586 Occurrence Handle10.1097/00000658-199910000-00013 Occurrence Handle1:STN:280:DyaK1MvltVGlsA%3D%3D Occurrence Handle10522727

    Article  CAS  PubMed  Google Scholar 

  17. Z Cohen RS McLeod W Stephen HS Stern B O’Connor R Reznick (1992) ArticleTitleContinuing evolution of the pelvic pouch procedure Ann Surg 216 506–511 Occurrence Handle1:STN:280:ByyD3sjnsFY%3D Occurrence Handle1329683

    CAS  PubMed  Google Scholar 

  18. MR Keighley MC Winslet R Flinn W Kmiot (1989) ArticleTitleMultivariate analysis of factors influencing the result of restorative proctocolectomy Br J Surg 76 740–744 Occurrence Handle1:STN:280:BiaA2MzjsFU%3D Occurrence Handle2765817

    CAS  PubMed  Google Scholar 

  19. LW Köhler JH Pemberton AR Zinsmeister KA Kelly (1991) ArticleTitleQuality of life after proctocolectomy. A comparison of Brooke ileostomy, Kock pouch, and ileal pouch-anal anastomosis Gastroenterology 101 679–684

    Google Scholar 

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    Authors
    1. Anna Lepistö M.D., Ph.D.
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    2. Pekka Luukkonen M.D., Ph.D.
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    3. Heikki J. Järvinen M.D., Ph.D.
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    Lepistö, A., Luukkonen, P. & Järvinen, H.J. Cumulative Failure Rate of Ileal Pouch-Anal Anastomosis and Quality of Life After Failure. Dis Colon Rectum 45, 1289–1294 (2002). https://doi.org/10.1007/s10350-004-6412-9

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    • DOI: https://doi.org/10.1007/s10350-004-6412-9

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