Post-operative outcome following ileal pouch-anal anastomosis (IPAA)

Abstract

Background IPAA procedure is the surgery of choice in severe ulcerative colitis (UC) and familial adenomatous polyposis (FAP). The objectives of the study were to assess symptomatic improvement, complications, effect on sexual function and quality of life (QOL) following IPAA procedure. Methods Twenty one patients who underwent IPAA procedure at a tertiary care unit with a minimum of one year follow-up from 2009, were included. QOL was assessed retrospectively prior to surgery and one year after surgery using Cleveland Global Quality of Life Score (CGQLS). Details of pre and post-op symptoms, complications and sexual function were obtained using clinical records, operative notes and interviewer administered questionnaire. Results Male: female ratio was 1.33:1. Fourteen (66.7%) were sexually active and seven (33.3%) were not. Mean age was 40.48(range, 17-69) years. 13(61.9%) had UC and 8(38.1%) had FAP. Mean pre-op CGQL scores for UC and FAP were 0.5754 and 0.7537 respectively. Post-op CGQLS for UC and FAP were 0.7532 and 0.7070. There was no statistically significant difference between CGQL scores against the indication for surgery (P=0.779). Stool frequency was significantly reduced in UC (pre-op=12.4, post-op=5.2 per day, p=0.004) but no difference in FAP (pre-op=2.6, postop= 3.5 per day, p=0.292). Post-operatively, one patient developed erectile dysfunction and another patient developed dyspareunia. Conclusion There is no significant difference of CGQL scores following IPAA procedure in relation to the surgical indication. IPAA significantly reduced stool frequency per day in UC but not in FAP. Erectile dysfunction and dyspareunia are possible sexual dysfunctions following IPAA procedure.