Pouch size: The important functional determinant after restorative proctocolectomy

Abstract

Abstract Sixty-seven patients with a J-shaped ileoanal pouch were studied over a 2-year period with regular recording of sphincter and pouch characteristics and analysis of their role in functional outcome. Although there was a 27 per cent permanent reduction in resting anal pressure (RAP) (P<0–001), two-thirds of the patients still had a RAP within the normal range. The mean(s.d.) pouch volume increased during the first year from 132(46) ml to 282(85) ml. RAP was not related to functional outcome and preoperative RAP was not predictive of subsequent function. Large pouch volume and compliance correlated with low defaecation frequency (range of r = 0·27–0·36; P <0·05) and good overall function (r = 0·37·0·56; P<0·01). The initial pouch volume was predictive of subsequent overall function. The Heal length used for pouch construction predicted subsequent pouch volume (r = 0·48; P < 0·001) and to some extent functional outcome (r = 0·28·0·37; P<0·05). However, the studied variables accounted for only 21 per cent of the total variance of functional outcome.