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Long-term outcome 10 years or more after restorative proctocolectomy and ileal pouch–anal anastomosis in patients with ulcerative colitis

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Abstract

Purpose

The aim of this study was to assess quality of life (QOL) in a long-term follow-up of patients with ulcerative colitis (UC) 10 years and more after ileal pouch–anal anastomosis (IPAA) to correlate these results with pouch function and to assess the long-term pouch failure rate.

Methods

In a unicentric study, 294 consecutive patients after IPAA between 1988 and 1996 were identified from a prospective database. QOL was evaluated according to the validated Gastrointestinal Quality of Life Index (GIQLI).

Results

Overall median follow-up was 11.5 years. Thirty-seven patients experienced pouch failure (12.6%). The rates of ileal pouch success after 5, 10 and 15 years were 92.3%, 88.7% and 84.5%. According to the GIQLI, patients with a functioning pouch achieved a mean score of 107.8, reflecting a decrease of QOL of 10.8% compared to a healthy population. There were significant negative correlations between QOL and an age of >50 years (p < 0.05), pouchitis, perianal inflammation and increased stool frequency (p < 0.0001).

Conclusions

QOL and functional results of patients with UC 10 years or more after IPAA were acceptable; however, those were reduced when compared to a healthy population. Pouch failure rate still increases up to 15.5% 15 years after IPAA. This result represents an important issue in providing patients with comprehensive preoperative information.

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References

  1. Hahnloser D, Pemberton JH, Wolff BG et al (2007) Results up to 20 years after ileal pouch–anal anastomosis for chronic ulcerative colitis. Br J Surg 94:333–340. doi:10.1002/bjs.5464

    Article  CAS  PubMed  Google Scholar 

  2. Delaney CP, Fazio VW, Remzi FH et al (2003) Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch–anal anastomosis. Ann Surg 238:221–228

    PubMed  Google Scholar 

  3. Lichtenstein GR, Cohen R, Yamashita B et al (2006) Quality of life after proctocolectomy with ileoanal anastomosis for patients with ulcerative colitis. J Clin Gastroenterol 40:669–677. doi:10.1097/00004836-200609000-00002

    Article  PubMed  Google Scholar 

  4. Hueting WE, Buskens E, Van der Tweel I et al (2005) Results and complications after ileal pouch anal anastomosis: a meta-analysis of 43 observational studies comprising 9317 patiens. Dig Surg 22:69–79. doi:10.1159/000085356

    Article  PubMed  Google Scholar 

  5. Bach SP, Mortensen NJM (2006) Revolution and evolution: 30 years of ileoanal pouch surgery. Clinical review. Inflamm Bowel Dis 12:131–145. doi:10.1097/01.MIB.0000197547.80558.59

    Article  PubMed  Google Scholar 

  6. Eypasch E, Wood-Dauphinee S, Williams JI et al (1993) Der Gastrointestinale Lebensqualitaetsindex (GLQI). Chirurg 64:264–274

    CAS  PubMed  Google Scholar 

  7. Eypasch E, Williams JL, Wood-Dauphinee S et al (1995) Gastrointestinal quality of life index: development, validation and application of a new instrument. Br J Surg 82:216–222. doi:10.1002/bjs.1800820229

    Article  CAS  PubMed  Google Scholar 

  8. Borgaonkar MR, Irvine EJ (2000) Quality of life measurement in gastrointestinal and liver disorders. Gut 47:444–454. doi:10.1136/gut.47.3.444 Review

    Article  CAS  PubMed  Google Scholar 

  9. Heuschen UA, Heuschen G, Lucas M et al (1998) Prä- und postoperative lebensqualität von patienten mit colitis ulcerosa und familiärer polyposis bei ileoanaler pouchoperation. Chirurg 69:1329–1333. doi:10.1007/s001040050579

    Article  CAS  PubMed  Google Scholar 

  10. Tariverdian M, Leowardi C, Hinz U et al (2007) Quality of life after restorative proctocolectomy for ulcerative colitis: preoperative status and long-term results. Inflamm Bowel Dis 392:83–93

    Google Scholar 

  11. Buhr HJ, Heuschen UA, Stern J et al (1994) Technique and results of the ileoanal pouch after proctocolectomy. Zentralbl Chir 119:867–877

    CAS  PubMed  Google Scholar 

  12. Bullard KM, Madoff RD, Gemlo BT et al (2002) Is ileoanal pouch function stable with time? Dis Colon Rectum 45:229–304. doi:10.1007/s10350-004-6171-7

    Article  Google Scholar 

  13. Michelassi F, Lee J, Rubin M et al (2003) Long-term functional results after ileal pouch anal restorative proctocolectomy for ulcerative colitis. A prospective observational study. Ann Surg 238:433–445

    PubMed  Google Scholar 

  14. McIntyre PB, Pemberton JH, Wolff BG et al (1994) Comparing functional results one year and ten years after ileal pouch–anal anastomosis for chronic ulcerative colitis. Dis Colon Rectum 37:303–307. doi:10.1007/BF02053588

    Article  CAS  PubMed  Google Scholar 

  15. Carmon E, Keidar A, Ravid A et al (2003) The corelation between quality of life and functional outcome in ulcerative colitis patients after proctocolectomy ileal pouch anal anastomosis. Colorectal Dis 5:228–232. doi:10.1046/j.1463-1318.2003.00445.x

    Article  CAS  PubMed  Google Scholar 

  16. Cima RR, Pemberton JH (2005) Medical and surgical management of chronic ulcerative colitis. Arch Surg 140:300–307. doi:10.1001/archsurg.140.3.300

    Article  PubMed  Google Scholar 

  17. Fazio VW, O'Riordan MG, Lavery IC et al (1999) Long term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230:575–584. doi:10.1097/00000658-199910000-00013

    Article  CAS  PubMed  Google Scholar 

  18. Bernklev T, Jahnsen J, Henriksen M et al (2006) Relationship between sick leave, unemployment, disability, and health-related quality of life in patients with inflammatory bowel disease. Inflamm Bowel Dis 12:402–412. doi:10.1097/01.MIB.0000218762.61217.4a

    Article  PubMed  Google Scholar 

  19. Heuschen UA, Allemeyer EH, Hinz U et al (2002) Outcome after septic complications in J pouch procedures. Br J Surg 89(2):194–200

    CAS  PubMed  Google Scholar 

  20. Meagher AP, Farouk R, Dozois RR et al (1998) J ileal pouch–anal anstomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients. Br J Surg 85:80–803. doi:10.1046/j.1365-2168.1998.00689.x

    Article  Google Scholar 

  21. Dayton MT, Larsen KP (1997) Outcomes of pouch-related complications after ileal pouch–anal anastomosis. Am J Surg 174:728–732. doi:10.1016/S0002-9610(97) 00188-8

    Article  CAS  PubMed  Google Scholar 

  22. Korsgen S, Keighley MR (1997) Causes of failure and life-expectancy of the ileoanal pouch. Int J Colorectal Dis 12:4–8. doi:10.1007/s003840050069

    Article  CAS  PubMed  Google Scholar 

  23. Lepisto A, Luukkonen P, Jarvinen HJ (2002) Cumulative failure rate of ileal pouch–anal anastomosis and quality of life after failure. Dis Colon Rectum 45:1289–1294. doi:10.1007/s10350-004-6412-9

    Article  PubMed  Google Scholar 

  24. MacRae HM, McLeod RS, Cohen Z et al (1997) Risk factors for pelvic pouch failure. Dis Colon Rectum 40:257–262. doi:10.1007/BF02050412

    Article  CAS  PubMed  Google Scholar 

  25. Farouk R, Pemberon JH, Wolff BG et al (2000) Functional outcomes after ileal pouch–anal anastomosis for chronic ulcerative colitis. Ann Surg 231(231):919–926. doi:10.1097/00000658-200006000-00017

    Article  CAS  PubMed  Google Scholar 

  26. Tulchinsky H, Hawley PR, Nicholls J (2003) Long-term failure after restorative proctocolectomy for ulcerative colitis. Ann Surg 238:229–234

    PubMed  Google Scholar 

  27. Krausz MM, Duek SD (2005) Restaurative proctocolectomy with ileal pouch–anal anastomosis for ulcerative colitis and familial adenomatous polyposis: twenty years follow-up in 174 patients. Isr Med Assoc J 7:23–27

    PubMed  Google Scholar 

  28. Wheeler JMD, Banerjee A, Ahuja N et al (2005) Long-term function after restorative proctocolectomy. Dis Colon Rectum 48:46–951. doi:10.1007/s10350-004-0885-4

    Article  Google Scholar 

  29. Delaney CP, Remzi FH, Gramlich T et al (2002) Equivalent function, quality of life and pouch survival rates after ileal pouch-anal anastomosis for indeterminate and ulcerative colitis. Ann Surg 236:43–48. doi:10.1097/00000658-200207000-00008

    Article  PubMed  Google Scholar 

  30. Fonkalsrud EW, Bustorff-Silva J (1999) Reconstruction for chronic dysfunction of ileoanal pouches. Ann Surg 229:197–204. doi:10.1097/00000658-199902000-00006

    Article  CAS  PubMed  Google Scholar 

  31. Galandiuk S, Scott NA, Dozois RR et al (1990) Ileal pouch–anal anastomosis: reoperation for pouch-related complications. Ann Surg 212:446–454. doi:10.1097/00000658-199010000-00007

    Article  CAS  PubMed  Google Scholar 

  32. Fazio VW, Wu JS, Lavery IC et al (1998) Repeat ileal pouch–anal anastomosis to salvage septic complications of pelvic pouches: clinical outcomes and quality of life assessment. Ann Surg 228:588–597. doi:10.1097/00000658-199810000-00015

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Christine Leowardi, Ulf Hinz, Mirjam Tariverdian, Christian Herfarth, Alexis Ulrich & Martina Kadmon

  2. Department of General, Visceral and Thoracic Surgery, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany

    Peter Kienle

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  1. Christine Leowardi
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  2. Ulf Hinz
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  3. Mirjam Tariverdian
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  7. Martina Kadmon
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Correspondence to Christine Leowardi.

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Leowardi, C., Hinz, U., Tariverdian, M. et al. Long-term outcome 10 years or more after restorative proctocolectomy and ileal pouch–anal anastomosis in patients with ulcerative colitis. Langenbecks Arch Surg 395, 49–56 (2010). https://doi.org/10.1007/s00423-009-0479-7

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  • DOI: https://doi.org/10.1007/s00423-009-0479-7

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