Long-term Pouch Function Research Articles

Curable leakage in stapled IPAA has little effect on the long-term pouch function.

This study aimed to evaluate the frequency and grade of anastomotic leakage (AL) in stapled ileal pouch-anal anastomosis (IPAA) and its long-term impact on the pouch functions. A longitudinal cohort study was conducted on UC patients who underwent stapled IPAA at Yokohama City University Medical Center between 2007 and 2018. The diagnosis and grading of AL were performed in accordance with the recommendations of the International Study Group of Rectal Cancer. We assessed the functional pouch rate, late complication, pouch survival rate, bowel function (bowel movements per day, soiling, spotting, difficulty in distinguishing feces from flatus) and pouch inflammation (pouchitis disease activity index; PDAI) in the long-term period. Two hundred seventy-six patients were analyzed. Twenty-three (8.3%; grade B/C; 13/10) patients were diagnosed with AL, but a functional pouch was achieved in all the twenty-three patients. Anastomotic stricture was significantly more common in patients with AL (AL group) than in patients without AL (non-AL group; AL/non-AL: 13.0/3.2%, p = 0.020). There were no differences in other late complications. Furthermore, the pouch survival rate did not differ between the AL and non-AL groups (100.0/97.9%/10years, p = 0.494). There were no differences between the groups in bowel movements per day, spotting, soling, difficulty in distinguishing feces from flatus, or PDAI postoperatively. Curable AL may not affect late complications (except anastomotic stricture), pouch survival, the bowel function, or pouch inflammation over the long term. Perioperative management to prevent the severity of AL is as important as preventing its occurrence.

Management of Anastomotic Leaks in Ileal Pouch Anal Anastomosis for Ulcerative Colitis.

Anastomotic leaks remain a dreaded complication after ileal pouch anal anastomosis (IPAA). Their impacts can be devastating, ranging from an acute leak leading to postoperative sepsis to chronic leaks and sinus tracts resulting in long-term pouch dysfunction and subsequent pouch failure. The management of acute leaks is intricate. Initial management is important to resolve acute sepsis, but the type of acute intervention impacts long-term pouch function. Aggressive management in the postoperative period, including the use of IV fluids, broad-spectrum antibiotics, and operative interventions may be necessary to preserve pouch structure and function. Early identification and knowledge of the most common areas of leak, such as at the IPAA anastomosis, are important for guiding management. Long-term complications, such as pouch sinuses, pouch-vaginal fistulas, and diminished IPAA function complicate the overall survival and functionality of the pouch. Knowledge and awareness of the identification and management of leaks is crucial for optimizing IPAA success.

P058 Tofacitinib and Ileal Pouch Anal Anastomosis. A Single-Center Case Series.

BACKGROUND: Tofacitinib is an emerging off label option for patients with moderate to severe ulcerative colitis (UC). However, data about the postoperative complications after ileal pouch anal anastomosis (IPAA), and the long-term pouch function after using tofacitinib are scarce. This study aims to describe postoperative complications and pouch function for patients with UC who had prior exposure to tofacitinib preoperatively. METHODS: After institutional review board approval, electronic medical records were reviewed for patients with UC treated with tofacitinib and subsequently underwent IPAA. Demographics, anthropometrics, previous treatments, smoking, preoperative risk factors and comorbidities, postoperative complications, and long-term pouch function were evaluated. RESULTS: A total of 13 patients were included. Of them, 10 (76.9%) were male, 1 (7.7%) current smoker, 1 (7.7%) had primary sclerosing cholangitis (PSC), 13 (100%) had ≥ previous 3 lines of treatment for UC. The median age at diagnosis was 23 years (IQR 21.5 – 34) and the median duration of UC was 10 years (IQR 4 – 17.5). All patients had previously failed tumor necrosis factor-alpha inhibitors and steroids while 11 (85%) patients failed aminosalicylate and 7 (54%) failed thiopurines. The most common dose used for tofacitinib prior to colectomy was 10 mg twice per day 8 (62%) and most patients had three-stage operation 11 (85%). No 90-day postoperative Clavien Dindo class III or IV complications were reported, no intra-abdominal sepsis, no other infectious complications, and no mortality. At a median follow up of 4 months (IQR 3.2 – 10.3), 3 (23.1%) patients had pouchitis, of whom 1 had a prior history of PSC and liver transplantation. Only 1 out of the 3 patients who had pouchitis needed a permanent stoma, the other 2 were managed medically. One of these patients also had had clostridium difficile infection. CONCLUSION: No major postoperative complications were reported after IPAA for patients who were treated with tofacitinib. From a surgical standpoint, tofacitinib was not associated with surgical complications in our small cohort of medically refractory UC patients. Pouch function was similar to expected in this patient population. Larger scale studies with longer follow up are needed to confirm these findings.

Laparoscopic derotation of a twisted pouch and redo ileal pouch–anal anastomosis – a video vignette

Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard restorative procedure in patients with ulcerative colitis (UC). IPAA provides good quality of life in the majority of patients. However, restorative proctocolectomy (RP) might be associated with pouch-related complications which could impair function and possibly require further surgical revision. In selected patients with pouch failure, revisional and reconstructive surgery is associated with low complication rates, highpouchsalvage, and reasonable long-termpouch function.

Utilization of Maneuvers to Increase Mesenteric Length Employed in Children Undergoing Ileal Pouch-Anal Anastomosis.

Background: Operative maneuvers to increase mesenteric length during ileal pouch-anal anastomosis (IPAA) are frequently utilized in adults, but limited data exist on the need for their use in children. Materials and Methods: A retrospective chart review of children (age <18) considered for IPAA creation at two affiliated tertiary referral centers from 2007 to 2017 was conducted, and patient factors, operative details, and 30-day postoperative complications were abstracted. Body mass index (BMI) was normalized to BMI percentile-for-age-and-sex and classified as underweight (BMI <5th percentile), healthy weight (5th ≤ BMI percentile <85th), or overweight/obese (BMI ≥85th percentile). Maneuvers were identified from operative notes. Univariate analysis and multivariable logistic regression were performed to determine independent factors associated with the use of maneuvers. Results: A total of 94 patients underwent attempt at IPAA creation, which was successful in 91 (97%). Fourteen (15%) of 91 patients were classified as overweight or obese. The 3 failures occurred secondary to inability to reach in 3 patients, with specific mention of patients' obesity in 2 and pouch ischemia in 1. Sixty (66%) patients required maneuvers to lengthen the mesentery. Overweight/obese patients required maneuvers more often than nonoverweight/obese patients (93% versus 61%, P = .03). There were no differences in 30-day maximum Clavien-Dindo scores between patients with and without maneuvers performed (P = .83). Being overweight/obese was an independent risk factor for requiring maneuvers (odds ratio: 9.3, 95% confidence interval: 1.1-82.8) after adjusting for age, sex, height, operative stage, and surgeon. Conclusion: Surgeons should be prepared to perform mesenteric lengthening maneuvers when operating on pediatric patients to ensure minimal tension on the IPAA, and more so when operating on obese children. Whether these maneuvers have an impact on long-term pouch function is undetermined.

Endo-sponge Assisted Early Surgical Closure of Ileal Pouch-anal Anastomotic Leakage Preserves Long-term Function: A Cohort Study.

Background and AimsEndo-sponge [Braun Medical] assisted early surgical closure [ESC] is an effective treatment to control pelvic sepsis after ileal pouch-anal anastomosis [IPAA] leakage, and became standard treatment in our centre from 2010 onwards. The aim of this cohort study was to assess the long-term pouch function of ulcerative colitis [UC] patients treated with ESC or conventional management [CM] for anastomotic leakage after IPAA.MethodsConsecutive patients who underwent an IPAA for UC between 2002 and 2017 were included. Patients treated with ESC [2010–2017] or CM [2002–2009] for anastomotic leakage were compared with control patients without anastomotic leakage of the corresponding time period. Main endpoints were long-term pouch function on a 3-point scale and pouch failure, as measured with the validated pouch dysfunction score questionnaire.ResultsSome 280 of 334 patients [84%] returned the pouch dysfunction questionnaire, of whom 18 were treated with ESC and 22 with CM for anastomotic leakage. Control cohorts included 133 [2010–2017] and 107 patients [2002–2009]. Between ESC-treated patients and control patients, pouch function [p = 0.647] and pouch failure rates [0/18 versus 5/133, p >0.99] were similar. CM resulted in worse pouch function [p = 0.016] and a higher pouch failure rate [5/22 versus 5/107, p = 0.013] compared with control patients.ConclusionsESC, in contrast to CM, for IPAA leakage in UC patients is associated with preservation of pouch function and preclusion of pouch failure, probably due to early and effective treatment of pelvic sepsis.

Does external beam radiation therapy to the pelvis portend worse ileal pouch outcomes? An international multi-institution collaborative study.

Short-term morbidity and long-term functional outcome of patients with an ileal pouch-anal anastomosis (IPAA) exposed to pelvic external beam radiation therapy (EBRT) remains unknown. We report the largest series to date regarding the effects of pelvic EBRT on: (i) 30-day postoperative outcomes; and (ii) long-term functional outcome following IPAA. A retrospective chart review was conducted of patients who received EBRT before or after IPAA between 1980 and 2017 across three international inflammatory bowel disease referral centres. Nineteen patients were included. Indications for EBRT were rectal adenocarcinoma (n=13), prostate adenocarcinoma (n=4) or anal squamous cell carcinoma (ASCC) (n=2). EBRT was given prior to IPAA in 12 (63%) patients and after IPAA in seven (37%). In EBRT before IPAA, patients had a median of 5 (range: 4-8) daytime bowel movements, 1 (range: 0-5) night-time bowel movement, no daytime incontinence, and only one patient used pads at a median follow up of 25(range: 11-163) months; one patient underwent pouch excision 15months after IPAA. In EBRT after IPAA, patients reported a median of 8 (range: 5-10) daytime and 2 (range: 0-5) night-time bowel movements, 80% had either daytime or night-time incontinence and 80% used pads at a median follow up of 90(range: 25-315) months. Pelvic EBRT administered prior to IPAA is associated with acceptable long-term function outcome. However, when pelvic EBRT is given to an IPAA insitu, most patients experience poor long-term pouch function without pouch failure.

Revisional and Reconstructive Surgery for Failing IPAA is Associated with Good Function and Pouch Salvage in Highly Selected Patients.

Revisional and reconstructive surgery for IPAA is rare given the high success of pouch surgery for chronic ulcerative colitis. Limited data exist on both surgical and functional outcomes in patients with chronic ulcerative colitis who undergo IPAA revision or reconstruction. This study aimed to determine the surgical and functional outcome in patients with chronic ulcerative colitis who undergo IPAA revision or reconstruction. A prospectively collected surgical database was accessed for this study. This study was conducted at an IBD referral center. Patients with chronic ulcerative colitis who underwent IPAA revision or reconstruction were selected. The primary outcomes measured were 30-day postoperative outcomes and long-term pouch function. Eighty-one patients were identified. Original IPAA was performed for chronic ulcerative colitis (n = 71; 88%) and indeterminate colitis (n = 11; 12.%), and the most common configuration was a J-pouch (n = 69; 86%) with handsewn anastomosis (n = 41;68%). No independent predictors of 30-day postoperative complications following reconstructive/revisional surgery were identified. Pelvic abscesses and Crohn's disease of the pouch were independently associated with ultimate pouch excision. Median follow-up following revision/reconstruction was 40 months (range, 1-292 months) during which 15 patients (23%) had pouch failure. The 5- and 10-year pouch survival rates following revision were 85 ± 5% and 65 ± 9% by Kaplan-Meier estimation; age <30 years was significantly associated with pouch survival. Long-term function (n = 30; 35%) compared with a matched control cohort of primary IPAA was characterized by significantly increased daytime bowel incontinence (p = 0.0119), liquid stool (p = 0.0062), and medication to thicken stools (p = 0.0452). This was a single-center series, and response rate for functional data was 35%. In properly selected patients with a failing pouch, originally made for chronic ulcerative colitis or indeterminate colitis, revisional and reconstructive surgery is associated with low complication rates, high pouch salvage, and acceptable long-term pouch function. See Video Abstract at http://links.lww.com/DCR/A640.

P278 Short and long-term surgical outcomes and pouch function following proctocolectomy and pouch formation in paediatric ulcerative colitis: a multicentre-retrospective cohort study from the Porto IBD working group of ESPGHAN

P278 Short and long-term surgical outcomes and pouch function following proctocolectomy and pouch formation in paediatric ulcerative colitis: a multicentre-retrospective cohort study from the Porto IBD working group of ESPGHAN

Long-Term Outcomes in Indeterminate Colitis Patients Undergoing Ileal Pouch-Anal Anastomosis: Function, Quality of Life, and Complications

IntroductionIt is uncertain whether the outcomes of patients with indeterminate colitis (IC) undergoing ileal pouch-anal anastomosis (IPAA) deteriorate over time. The aim of this study was to determine the long-term pouch function, quality of life, complications, and incidence of Crohn’s disease after IPAA for patients with IC compared to ulcerative colitis (UC). MethodsA case matched analysis was performed on patients undergoing IPAA for pathologically confirmed IC or UC, between 1985 and 2014. Patients were case matched for age ± 5 years, gender, date of surgery ± 3 years, type of anastomosis and presence of a diverting loop ileostomy. All patients were followed up for greater than six months. Results448 patients were case matched, the average age was 36.8 year old and 52.7 % of patients were male. Mean follow-up was 122.06 months (+/− 80.77 months). There were statistically and clinically comparable number of daytime bowel movements (5.7 v 5.5, p = 0.45), rates of incontinence (26.1 % v 18.3 %, p = 0.09) and nighttime seepage in patients (23.1 % v 28.4 %, p = 0.28) with IC and UC. Quality of life markers and patient restrictions were comparable between the two groups. Rates of pelvic sepsis (IC 8.5 %, UC 8.5 %, p = 0.99) and anastomotic leak (IC 3.1 %, UC 4.0 %, p = 0.61) were similar but fistula formation (IC 15.6 %, UC 8.0 %, p = 0.01) and IPAA Crohn’s disease rates (IC 6.7 %, UC 2.7 %, p = 0.04) were significantly increased in IC patients. There was no statistically significant difference in pouch failure rates for IC and UC (5.8 % vs.4.9 %, p = 0.58). ConclusionPatients undergoing IPAA for IC have a higher risk of post-operative fistulae and development of Crohn’s disease, but comparable morbidity, functional outcomes, quality of life scores and pouch failure rates when compared to UC patients. Long-term data confirms that IPAA is a good surgical option in patients with IC.

Differences in Short-term Outcomes Among Patients Undergoing IPAA With or Without Preoperative Radiation

Single-institution studies demonstrate a correlation between preoperative pelvic radiation and poor long-term pouch function after IPAA. The rarity of the radiated pelvis before these procedures limits the ability to draw conclusions on the effects of preoperative radiation on short-term outcomes, which may contribute to long-term pouch dysfunction. The purpose of this work was to better understand the impact of pelvic radiation on short-term outcomes in patients undergoing IPAA. We conducted a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database (2005-2011). The study was conducted at all participating NSQIP institutions. The cohort was composed of patients undergoing nonemergent IPAA procedures. Proportions of patients experiencing postoperative complications within 30 days were compared by Fisher exact and Wilcoxon rank-sum tests based on whether they received preoperative radiation. Multivariate logistic regression models controlled for the effects of multiple risk factors. Included were 3172 patients receiving IPAA; 162 received pelvic radiation. The postoperative complication rate was not significantly different in patients receiving pelvic radiation versus not receiving pelvic radiation (p = 0.06). In a subset of patients with cancer diagnoses (n = 598), 157 received pelvic radiation; complication rates were not significantly different (p = 0.16). Patients receiving pelvic radiation had significantly lower rates of sepsis in both the overall and cancer diagnosis groups (p = 0.005 and p = 0.047), a finding which persisted after controlling for the effects of multiple risk factors (multivariate p values = 0.030 and 0.047). This was a retrospective database design with short-term follow-up. Patients who received radiation before IPAA had no difference in overall 30-day complication rates but had significantly lower rates of sepsis when compared with patients not receiving pelvic radiation. The perceived inferior long-term pouch function in patients undergoing preoperative pelvic radiation does not appear to be attributable to increases in 30-day complications.

Pelvic Sepsis After IPAA Adversely Affects Function of the Pouch and Quality of Life

Pelvic sepsis after IPAA predisposes to pouch failure. There are limited data on long-term pouch function for patients with pelvic sepsis. The aim of this study was to investigate functional outcomes and quality of life for patients undergoing IPAA who develop pelvic sepsis and preserve their pouch long-term. This study is based on retrospective analysis of prospectively accrued data. This study was conducted at a single-center institution. All patients undergoing IPAA from 1983 to 2007 were included. The primary outcomes measured were functional outcomes (urgency, incontinence, bowel movements) and quality-of-life (restrictions, energy, happiness) parameters. Two hundred (6.2%) of 3234 patients developed pelvic septic complications within 3 months of IPAA. In the comparison of complications at the time of IPAA for the 2 groups, patients with pelvic sepsis had higher rates of postoperative hemorrhage (13.5% vs 3.7%, p < 0.001), anastomotic leak (35% vs 3.7%, p < 0.001), wound infection (14% vs 7.4%, p < 0.001), and fistula formation (37% vs 7.1%, p < 0.001). The overall median follow-up was 7 years. Pelvic sepsis was associated with greater pouch failure (19.5% vs 4%, p < 0.001). For patients with follow-up (pelvic sepsis = 144, nonpelvic sepsis = 2677) with a retained pouch, for whom we compared functional outcomes and quality of life, incontinence was worse (never/rare: 69.5% vs 77.8%, p = 0.03). Urgency scores were lower in pelvic sepsis but not statistically significant. The overall Cleveland Global Quality of Life score (and components) in the sepsis group were significantly worse than in the nonsepsis group (0.74 vs 0.79, p < 0.001). Patients who developed sepsis were also less likely to recommend IPAA to others than patients who did not develop pelvic sepsis. This study was limited by the retrospective analysis and the use of questionnaires. Pelvic sepsis after IPAA leads to worse functional outcomes and quality of life even when it does not lead to pouch failure. This finding argues for careful attention to preoperative and intraoperative planning and strategies aimed at reducing this complication after IPAA.

Short- and Long-Term Surgical Outcomes in Patients Undergoing Proctocolectomy With Ileal Pouch-Anal Anastomosis in the Setting of Primary Sclerosing Cholangitis

Primary sclerosing cholangitis occurs in approximately 10% of patients with ulcerative colitis, but studies involving IPAA in patients with cholangitis have been reported in limited numbers. This study aimed to examine surgical outcomes in patients with ulcerative colitis and sclerosing cholangitis undergoing total proctocolectomy with IPAA and to identify variables associated with surgical complications. This is a retrospective cohort study. This study was conducted at a single tertiary referral institution. Included were all patients with cholangitis and ulcerative colitis who underwent proctocolectomy with IPAA from 1994 to 2005. Perioperative morbidity, long-term pouch function, and pouch survival were the main outcome measures. One hundred patients (62 male) were studied. Forty-three percent were on steroids. There was no perioperative mortality, and 51 30-day complications occurred in 39 patients (39%). Median follow-up time was 5.9 years (range, 0.14-16.2 y). Pouch failure occurred in 3 patients (3%). The single variable that predicted 30-day morbidity was previous abdominal surgery (P = .03). Prednisone use, body mass index, age, ASA score, preoperative Model for End Stage Liver Disease score, and year of surgery were not significantly associated with short-term complications. IPAA can be performed safely in the setting of sclerosing cholangitis. The preoperative Model for End-stage Liver Disease Score and the use of preoperative immunosuppressive agents are not associated with an increased risk of complications. The likelihood of long-term pouch survival is excellent.

Do outcomes differ after 3-Stage versus 2-Stage Ileal Pouch-Anal Anastomosis for chronic Ulcerative Colitis?

Given concerns of increased post-operative complications associated with anti-TNF-alpha antibody therapy, some surgeons are increasingly offering patients with chronic ulcerative colitis (CUC) a 3-stage approach to ileal pouch-anal anastomosis (IPAA). We aimed to assess outcomes after the 1st of 2-stages compared with the 2nd of 3-stages in a cohort of patients who underwent hand-assisted laparoscopic surgery (HALS). We identified all adult patients with CUC who underwent total proctocolectomy (TPC-IPAA, stage 1 of 2) and patients who underwent completion proctectomy (CP-IPAA, stage 2 of 3) at our institution from 2004 - 2009 using a prospectively maintained database. Univariate analysis assessed differences in 30-day outcomes after stage 1 of 2 as compared with stage 2 of 3. Data are frequency (proportion) or median. Over 5-years, 243 patients underwent HALS restorative proctocolectomy: TPC-IPAA (n= 212, 88%) or CP-IPAA (n= 30, 12%). At time of IPAA, patients in these two groups were not significantly different with respect to age, gender, BMI, medical comorbidities, and ASA classification. Two cases in TPC-IPAA had concurrent cancer, while none in the CP-IPAA did (p= 0.47). TPC-IPAA patients were less likely to have had prior abdominal (21% vs. 100%, p<0.0001) or intestinal surgery (1.4% vs. 100%, p<0.0001) compared to CP-IPAA. In regards to colitis medications, TPC-IPAA were more likely to be receiving 5-ASA (59% vs. 17%, p<0.0001), corticosteroids (75% vs. 23%, P<0.0001) or Immunomodulators (37% vs. 3.3%, p<0.0001); 13% of the TPCIPAA group, and none of the CP-IPAA group were receiving biologic therapy (p= 0.0006). In terms of severity of disease, according to the Montreal classification, TPC-IPAA had more severe disease than CP-IPAA (p<0.0001), while 23% and 13% were recently hospitalized (p= 0.2), 8% and 10% were recently transfused (p= 0.7), 12.8% and 30% were malnourished (p= 0.02), and 78.8% and 6.7% were had recently received either corticosteroids or biologic therapy (p<0.0001). In terms of surgical outcomes, 16 (7.5%) of TPC-IPAA were converted to laparotomy (most commonly for obesity, n= 4). Intra-operative complications occurred in TPC-IPAA was 8 (3.8%, most commonly for bleeding, n= 7), and after CP-IPAA none (0%, p= 0.14). TPC-IPAA had longer operative times (291 vs. 187, p<0.0001), and similar lengths of stay (5 vs. 5 days, p= 0.83) and readmissions (15.5% vs. 16.7%, p= 0.87). A total of 8% had re-operation after TPC-IPAA, and none after CP-IPAA (p= 0.03). Overall complications of any grade occurred in similar proportions (38% and 43%, p= 0.58). There were a total of 6 (2.8%) anastomotic leaks after TPC-IPAA, and none after CP-IPAA (p= 0.2). There were no mortalities in either group. Ileal pouch-anal anastomosis at the time of completion proctectomy, as compared with total proctocolectomy, is associated with shorter operative times, fewer intra-operative complications and reoperations, with similar rates of readmissions and overall complications. Further study in a larger cohort is needed to determine if a 3-stage approach to IPAA is associated with a lower anastomotic leak rate - the most important determinant of long-term pouch function and patient quality of life.

Restorative proctocolectomy. Does ethnicity affect outcome?

Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is well-established in the management of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). We review outcome of pouch surgery from a single centre, comparing non-South Asian and South Asian Caucasian populations. Patients undergoing RPC for UC and FAP during a 10-year period between January 1997 and January 2007 were identified from hospital records. Data were collected retrospectively from case notes on early and long-term results. A total of 107 patients underwent pouch formation for UC (94%) or FAP (6%) and 22 (21%) were from the Asian subcontinent. Eighty-seven (81%) underwent a three-stage procedure and 20 (19%) a two-stage procedure. Postoperative complications occurred in 40 (37%) patients, being major in 11 (10%) patients with relaparotomy required in 9 (8%) with no difference between South Asian and non-South Asian Caucasian patients. Long-term pouch function, with a median of five times over 24 h (range 2-15), was similar between the two groups. The incidence of pouchitis was 57 (53%) and this was significantly greater in the South Asian population [17/21 (77%); 39/86 (46%); P = 0.006]. Surgical results were similar in South Asian and non-South Asian Caucasian patients, but the incidence of pouchitis was greater in the former group.

Portal Vein Thrombi After Restorative Proctocolectomy: Serious Complication Without Long-Term Sequelae

Portal vein thrombi have been observed after restorative proctocolectomy and ileal pouch-anal anastomosis, and present as a clinical spectrum of abdominal pain, fever, and leukocytosis. Anticoagulation treatment is usually associated with resolution of symptoms. However, the long-term consequences and effect on pouch function are not known. The purpose of this study was to analyze the long-term functional outcome of patients with confirmed portal vein thrombi after restorative proctocolectomy. A retrospective study of all patients undergoing restorative proctocolectomy from January 1997 to 2000 was performed. A case-control study was designed that matched 37 patients with confirmed portal vein thrombi in this period with 133 patients without portal vein thrombi; the groups were compared with respect to pouch function and quality of life by using the Global Cleveland Clinic Quality of Life Questionnaire for pelvic pouch patients. The mean follow-up was 4.73 (range, 4.21-7.28) years. The percentage of male patients was 58.8. The most common diagnosis was ulcerative colitis (62.4 percent). There were no significant differences between portal vein thrombi patients and controls with respect to pouch function (number of bowel movements, urgency, incontinence), episodes of pouchitis, or quality of life. Portal vein thrombi can be a serious complication after restorative proctocolectomy that usually resolves with anticoagulation therapy. Long-term pouch function and quality of life are not affected.

Long-Term Outcome After Ileal Pouch-Anal Anastomosis: Function and Health-Related Quality of Life

This study was designed to investigate long-term pouch function and health-related quality of life in a single, large cohort of patients with ileal pouch-anal anastomosis for ulcerative colitis. Data from 370 patients were included in the study. Thirty-nine patients (11 percent) did not have a functioning pouch (failures) but were included in the health-related quality of life analyses. Pouch function (Oresland score) and health-related quality of life (Short Form-36) were evaluated by postal questionnaires. A total of 88 percent of the patients with a functioning ileal pouch-anal anastomosis returned the questionnaires vs. 76 percent of the failures. Median follow-up time after ileal pouch-anal anastomosis was 15 years vs. 11 years after failure. An age-matched and gender-matched reference sample (n = 286) was randomly drawn from the Swedish Short Form-36 database. Median bowel frequency was six per 24 hours: 76 percent emptied the reservoir at night, 23 percent had urgency, 12 percent had evacuation difficulties, and 17 percent experienced soiling during the day. Fifty-two percent of the males and 32 percent of the females suffered from soiling at night. More than one-half of the patients had occasional perianal soreness, 6 percent considered the pouch to be a social handicap, and 94 percent were satisfied with their pouch. Patients with a functioning ileal pouch-anal anastomosis did not differ from the reference sample on any Short Form-36 domain, except for a reduced score in General Health (P = 0.02). Pouch function was positively correlated to health-related quality of life. Patients with pouch failure had reduced health-related quality of life in most domains. Patients' satisfaction is high and functional outcome is good after ileal pouch-anal anastomosis. Poor pouch function affects health-related quality of life negatively. Patients with failure after ileal pouch-anal anastomosis are substantially limited in a variety of health-related quality of life domains.

Long-term function and manovolumetric characteristics after ileal pouch–anal anastomosis for ulcerative colitis

Long-term pouch function and physiological characteristics after ileal pouch-anal anastomosis (IPAA) are poorly described. The aim of this study was to undertake a prospective investigation of long-term pouch function and manovolumetric characteristics. Forty-two patients with a median follow-up of 16 years after IPAA were included. Function was assessed using a questionnaire and a score was calculated ranging from 0 to 15 (15 being the worst). Manovolumetry was performed and pouchitis recorded. A paired analysis was conducted, as the results were compared with previous data for each patient. The median functional score was 3.5 (range 0-10) at 2 years and 5 (range 1-11) at 16 years (P = 0.013). Resting anal canal pressures were higher (P < 0.001) and squeeze pressures lower (P = 0.008) at long-term follow-up. Ileal pouch volumes at distension pressures of 10, 20 and 40 cm H(2)O were diminished at 16 years (P < 0.001, P = 0.005 and P = 0.058 respectively). The volume and pressure for first sensation and urge to defaecate were reduced. Increased age correlated positively with a poor functional score. A history of pouchitis did not affect functional or physiological characteristics. Ileal pouch function declines in the long term. The reasons are unclear, but the ageing process may have an impact.

Effect of vaginal delivery on long-term pouch function

The optimal method of childbirth for women with a restorative proctocolectomy (RP) has yet to be determined. Little is known about long-term ileal pouch function after vaginal delivery, especially when childbirth occurred before RP. The aim of this study was to evaluate the effect of vaginal delivery before or after RP on long-term pouch function. All 267 women who underwent RP between January 1985 and November 2004 were invited to participate. Functional outcome was assessed by colorectal functional outcome questionnaire, and patients were asked about their pregnancies and risk factors for obstetric injury. Linear regression analysis was performed to study potential risk factors for poor pouch function. The response rate was 82.6 per cent. Median follow-up after pouch surgery was 7.2 (range 1.0-19.7) years. One hundred patients had at least one delivery. Fifty-two (60 per cent) of the 86 patients who attempted a vaginal delivery had an increased risk of obstetric injury according to predefined risk factors. In these patients ageing and longer follow-up were significant risk factors for impaired incontinence. Women who had RP and vaginal delivery with a high risk of obstetric injury had impaired continence with ageing and longer follow-up. Patients with RP should be informed about the considerable risk of vaginal delivery on long-term ileal pouch function.

The influence of delivery on long-term pouch-function: an underestimated risk-factor

The influence of delivery on long-term pouch-function: an underestimated risk-factor