J ileal pouch–anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients

TLDR

The study aimed to determine the risk of postoperative complications and functional outcomes after a hand‑sewn J‑shaped ileal pouch–anal anastomosis for ulcerative colitis. Preoperative function, operative morbidity, and long‑term functional outcomes were prospectively assessed in 1,310 patients who underwent IPAA between 1981 and 1994. Three deaths occurred, pelvic sepsis fell from 7 % to 3 %, and over a mean 6.5‑year follow‑up patients had 5 stools/day and 1 at night, with 7 % daytime and 12 % nighttime incontinence unchanged over 10 years, pouchitis occurring in 18 % at 1 year and 48 % at 10 years, and pouch failure in 2 % at 1 year and 9 % at 10 years, indicating that experience lowers complications while functional outcomes remain stable but failure rates rise.

Abstract

Abstract Aim The purpose of the study was to determine the risk of postoperative complications and the functional outcome after a hand-sewn ileal pouch–anal anastomosis (IPAA) for ulcerative colitis using a single J-shaped pouch design. Methods Preoperative function, operative morbidity and long-term functional outcome were assessed prospectively in 1310 patients who underwent IPAA between 1981 and 1994 for ulcerative colitis. Results Three patients died after operation. Postoperative pelvic sepsis rates decreased from 7 per cent in 1981–1985 to 3 per cent in 1991–1994 (P=0·02). After mean follow-up of 6·5 (range 2–15) years, the mean number of stools was 5 per day and 1 per night. Frequent daytime and night-time incontinence occurred in 7 and 12 per cent of patients respectively, and did not change over a 10-year period. The cumulative probability of suffering at least one episode of ‘clinical’ pouchitis was 18 and 48 per cent at 1 and 10 years and the cumulative probability of pouch failure at 1 and 10 years was 2 and 9 per cent respectively. Conclusion These results indicate that increased experience decreases the risk of pouch-related complications and that with time the functional results remain stable, but the failure rate increases.