Long-Term Functional Outcome and Quality of Life After Restorative Proctocolectomy With Mucosectomy and Hand Suture IPAA: 20 Years' Experience in 326 Patients

Abstract

This paper was designed to evaluate the functional outcome and assess the long-term quality of life (QoL) of patients who underwent restorative proctocolectomy with mucosectomy and hand suture ileal pouch-anal anastomosis (IPAA) over 20 years. Restorative proctocolectomy with IPAA is the surgical treatment of choice to all familial adenomatous polyposis (FAP) patients and those with ulcerative colitis (UC) not responding to conservative management. The procedure has been modified from a transanal hand-suture IPAA after mucosectomy to a stapled IPAA without mucosectomy, but the benefits are still debatable. We studied retrospectively all UC and FAP patients subjected to the procedure between 1987 and 2006, using the SF-36 Health Survey, the Wexner score for incontinence, and an additional questionnaire evaluating various aspects of functional outcome and late complications. A total of 326 patients (53% male) were included in the study. Pouchitis was recorded in 31% of UC and 5% of FAP patients. Anastomotic stricture was observed in 24% of UC and 8% of FAP patients. IPAA-related pouch failures occurred in 9% of UC and 3% of FAP. The median number of bowel movements per 24 hours was 6 (range: 2–20) with 1 (range: 0–8) bowel motion occurring at night. Wexner score was 3.27 (±0.32) for UC and 1.22 (±0.36) for FAP. The overall norm-based SF-36 score for physical/mental health status was 52.85/50.31 and 57.29/50.05 respectively. Restorative proctocolectomy with mucosectomy and hand suture IPAA is a safe procedure with good functional results and quality of life in well-satisfied patients. Pouchitis, anastomotic strictures, and pouch failures were mainly observed in the UC group.