Functional Outcome after Ileal J-pouch Anal Anastomosis in Patients with Ulcerative Colitis

PURPOSE: This study was performed to assess the complications and functional outcomes after a total proctocolectomy and ileal J-pouch anal anastomosis for patients with ulcerative colitis. METHODS: We reviewed the medical records of 30 patients who had undergone a total proctocolectomy and ileal J-pouch anal anastomosis for ulcerative colitis from 1992 to 1999 in our hospital. We used questionnaires or telephone interviews to assess the functional outcomes of the patients. The median duration of follow-up was 23 months after the ileostomy take down. RESULTS: The mean age of the patients at the definitive operation was 35.9 (+/-11.8). The indications for operation were medical intractability (76.7%), suspicious malignancy (13.3%), perforation (6.7%), and hemorrhage (3.3%). The double stapling method was used in 26 patients and the handsewn method in 4 patients. Of the 30 patients, 23 patients completed the functional analysis. Bowel frequency was 6.6 (+/- 2.6) per 24 hours, with 5.1 (+/- 2.1) in the daytime and 1.4 (+/-1.3) in the night. Fourteen patients (60.9%) had relatively mild incontinence, and four patients (17.4%) had to wear pads, especially at night. Eighteen patients (78.3%) were able to discriminate flatus from feces, and only one patient (4.3%) suffered from perianal irritation. Twelve patients (52.2%) had to restrict their diets, and five patients (21.7%) took antidiarrheal medications. Pouchitis occurred in three patients (13.0%). Sexual dysfunction was noted in four patients (17.4%), and urinary urgency in one patient (4.3%). There was no functional difference between the double stapling method and the handsewn method. CONCLUSIONS: The functional outcomes after ileal J-pouch anal anastomosis for patients with ulcerative colitis were satisfactory, irrespective of the method of anastomosis.

Restorative Proctocolectomy: Operative Safety and Functional Outcomes

PURPOSE: The restorative proctocolectomy has been accepted as the operation of choice for chronic ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess the operative safety and the functional outcome after a total proctocolectomy and ileal-pouch anal anastomosis. METHODS: The medical records of 16 patients who had undergone a total proctocolectomy and ileal-pouch anal anastomosis for ulcerative colitis (n=9) and familial adenomatous polyposis (n=7) from January 1996 to December 1999 were reviewed. The mean length of follow-up was 19.9 months, and we evaluated functional outcome using a prepared questionnaire. RESULTS: A hand-sewn anastomosis with diverting ileostomy was performed in 9 patients, and a double stapled anastomosis was done in 7 patients. Postoperative complications occurred in 8 cases (50%): intestinal obstructions in 4 patients and anastomosis related complications in 4 patients, i.e. stenosis (n=2), leak (n=1) and perianal abscess (n=1). The defecation frequency and the, day and night continence were improved in the first period (one year after surgery) compared to the second period (3 months after surgery). The need for anti-diarrheal medication, and for the use of a pad was also decreased in the second period compared to the first period. Postoperative urinary function was satisfactory in 13 of 14 patients. Postoperative sexual function was assessed in 8 patients (5 males, 3 females) and showed in good erection (5/5), ejaculation (5/5), and satisfactory sexual life (8/8). CONCLUSION: Satisfactory functional outcomes regarding the frequency of bowel movement and fecal incontinence and operative safety can be achieved after a restorative proctocolectomy for chronic ulcerative colitis and familial adenomatous polyposis.

Restorative proctocolectomy: operative safety and functional outcomes

Restorative proctocolectomy (total proctocolectomy and ileal J pouch anal anastomosis) has been accepted as the operation of choice in the setting of chronic ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess operative safety and functional outcome after restorative proctocolectomy. A total of sixteen patients underwent surgery between January 1996 and December 1999. Hand sewn anastomosis with diverting ileostomy was performed in 9 patients and double stapled anastomosis in 7 patients. The underlying disease was ulcerative colitis in 9 cases and familial adenomatous polyposis in 7. Postoperative complications developed in 8 cases (50%), and intestinal obstruction was found in 4 cases (2 cases were operated upon). Anastomosis related complications were stenosis (n=2), leak (n=1) and perianal abscess (n=1). All patients were followed up at the outpatient clinic using questionnaires, with a mean follow up period of 19.9 months. The frequency of bowel movement was 8.2 per day in hand sewn anastomosis (HS), and 12 per day in double stapled anastomosis (DS) 3 months after surgery (period 1). This frequency decreased to 5.5 per day in HS, and 4.6 per day in DS after one year (period 2). Day and night continence was shown in 12/15, and 5/15, respectively in period 1, but improved to 10/11, and 10/11, respectively in period 2. Night time incontinence was noted in 10 of 15 patients in period 1 (seepage 3/15, soiling 7/15). The need to take anti-diarrheal medication, and to use a pad was noted in 2/15, and 10/15, respectively in period 1, but no patient took antidiarrheal medication or wore a protective pad in period 2. Postoperative urinary function was satisfactory in 13/14 patients. Postoperative sexual function was analyzed in a total of 8 patients, who showed good erection (5/5), ejaculation (5/5) and satisfactory sexual life (5/5). In females, 3 patients showed a satisfactory sexual life. In conclusion, restorative proctocolectomy for chronic ulcerative colitis and familial adenomatous polyposis can be performed safely with excellent functional outcomes, including bowel movement, urinary and sexual functions one year after surgery.