Functional Outcome and Quality of Life after Ileal Pouch-Anal Anastomosis within a Defined Population in Sweden

Abstract

Objective: The purpose of this population-based study was to present prospectively recorded functional data and health-related quality of life (HRQOL) questionnaire data to assess the long-term results of the first 100 consecutive ileal pouch-anal anastomosis (IPAA) performed chronologically by 3 surgeons in a single referral centre. Methods: During 1993–2008, 100 patients underwent IPAA. The 90 patients still alive with an intact pouch were included (response rate = 92%). Function was evaluated using St Mark’s incontinence score, and HRQOL with SF-36. Results: At 18 months after loop ileostomy closure, 63 patients (76%) had 4–6 day-time and 47 patients (57%) had no night-time bowel movements. A stapled IPAA resulted in better St Mark’s (p = 0.0064) and Wexner scores (p = 0.0019) than did a hand-sewn anastomosis. The younger the patients were at the onset of ulcerative colitis (UC) the better St Mark’s (p = 0.0037) and Wexner scores (p = 0.011) were. The patients scored significantly higher than did the general Swedish population adjusted by age-group and sex in 6 out of 7 SF-36 subscales. Conclusions: In the hands of experienced high-volume surgeons, IPAA is a safe procedure associated with good functional results that are stable over time. Stapled IPAA and younger age at onset of UC were correlated with better functional results. The HRQOL scores were high.