Effect of small bowel obstruction on functional outcome and quality of life in patients with ileal pouch-anal anastomosis: 10-year follow-up study.

BACKGROUND AND AIM: Postoperative abdominal adhesion formation is a troublesome clinical problem and a common cause of intestinal obstruction, chronic pain and infertility. The aim of this study was to evaluate the effect of small bowel obstruction (SBO) on functional outcome and quality of life (QOL) in patients who experienced ileal pouch-anal anastomosis (IPAA). METHODS: A total of 2418 patients who had undergone IPAA were categorized into three groups: group 1 comprised patients who had no SBO episodes until the last follow-up; group 2 comprised patients who had one or more SBO episodes treated medically; and group 3 comprised patients who had one or more SBO episodes, at least one of which was treated surgically. Functional outcomes and QOL scores for patients in each group were evaluated at 1, 3, 5 and 10 years of follow-up using multivariate analysis. RESULTS: We found that patients who had SBO episodes which were treated medically were more likely to have a higher number of total bowel movements in a day in the first year of follow-up compared to patients without postoperative SBO (P = 0.03), and more seepage during the day at 10 years follow-up compared to patients with no SBO episodes or surgically treated SBO episodes (P = 0.01). The Cleveland Global Quality of Life (CGQL) scores were comparable between the three groups at 1, 3, 5 and 10 years of follow-up. CONCLUSION: Medical management of SBO is associated with an increase in two symptoms, but QOL is comparable with surgical management.

Trocar site hernia after laparoscopic cholecystectomy.

AIM: The aim of this study was to elucidate the influence of pre and perioperative factors on the development of trocar site hernia after a laparoscopic cholecystectomy procedure. PATIENTS AND METHODS: A total of 776 patients who underwent a laparoscopic cholecystectomy procedure in our Department of General Surgery between 1999 and 2004 were assigned as the study group. The control group included patients without trocar site hernias after a cholecystectomy. The effect of five variables, including gender, age, body mass index (BMI), operation duration, and the type of cholecystitis on the development of a trocar site hernia after a laparoscopic cholecystectomy was assessed by univariable and multivariable models. RESULTS: In the univariate analysis, female gender (P = 0.021), older age (P < 0.001), higher BMI at the time of surgery (P < 0.001), and an increased duration of surgery (P < 0.001) have been found to increase the likelihood of a trocar site hernia formation. However, in the multivariable model, the gender was not a significant variable to influence the development of this complication. CONCLUSIONS: The development of a postoperative trocar site hernia may be prevented by the closure of 10-mm trocar sites in patients who are older than 60 years, obese, and who have a longer duration of operation.

Age-related analysis of functional outcome and quality of life after restorative proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis.

BACKGROUND: The aim of the present study was to evaluate the influence of a younger age at the time of ileal pouch-anal anastomosis (IPAA) on functional outcome and quality of life in patients with familial adenomatous polyposis (FAP). METHOD: A total of 105 patients with FAP who had undergone IPAA were retrieved from a dedicated Institutional Review Board (IRB)-approved IPAA database. Fifty-three patients who had complete follow-up data at 1, 3 and 5 years were included in the study. Patients were categorized into three groups according to their ages at the time of surgery. Group 1, patients < or =20 years of age (n = 9); group 2, patients >20 and < or = 40 years of age (n = 23); and group 3, patients >40 years of age (n = 21). Perioperative characteristics, postoperative complications, quality of life scores and functional outcome at 1, 3 and 5 years of postoperative follow-up were assessed. RESULTS: At any time point, there were no significant differences among the groups in terms of perioperative characteristics, quality of life scores or level of satisfaction with the procedure. However, younger patients had significantly lower nocturnal bowel movements at the first and third years of follow-up and tended to have less bowel movements per day at all stages of follow-up. CONCLUSION: These findings indicate that younger patients with FAP are inclined to have better functional outcome after IPAA in the early postoperative period. This finding may be encouraging for colorectal surgeons who will operate on young patients with FAP.