Quality-of-life assessment after ileoanal pull-through for ulcerative colitis and familial adenomatous polyposis
Related Experiment Videos
R C Shamberger1, B J Masek, A M Leichtner
1Department of Surgery, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Insights
The ileoanal pull-through procedure (IAP) offers excellent long-term quality of life for children with ulcerative colitis or familial adenomatous polyposis. This surgery shows minimal adverse effects, with the surgical scar being the only significant negative factor reported.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Quality of Life Research
Background:
- Ileoanal pull-through (IAP) is increasingly used for pediatric ulcerative colitis (UC) and familial adenomatous polyposis (FP).
- Previous studies focused on physiological outcomes, lacking long-term quality-of-life (QoL) data post-IAP.
Purpose of the Study:
- To assess the long-term quality of life in pediatric patients following an ileoanal pull-through procedure.
- To identify any adverse effects impacting QoL after IAP surgery.
Main Methods:
- A survey of 32 patients (at least 6 months post-IAP) using the SF-36 and supplemental questions.
- Comparison of QoL data with national normative values for adult patients.
Main Results:
- No statistically significant differences in physical or mental health SF-36 scores compared to US population norms.
- Minimal adverse effects reported, including limited medication use and activity restrictions.
- The surgical scar was noted as the sole significant negative factor.
Conclusions:
- Ileoanal pull-through is an excellent surgical option for pediatric UC and FP.
- The procedure demonstrates minimal adverse effects on long-term quality of life.
Background/Purpose:
The ileoanal pull-through procedure (IAP) is gaining increasing favor and use in the surgical treatment of children with ulcerative colitis (UC) and familial adenomatous polyposis (FP). Although physiological studies have been performed to assess the outcome of these children, no long-term quality-of-life assessment after the procedure has been performed.
Methods:
Forty-three patients were identified who had an IAP at our institution in the last 10 years and were at least 6 months postsurgery. Thirty-four were contacted, and 32 agreed to participate in the survey, which was approved by the Human Studies Committee. Participants completed the standardized Medical Outcome Study Short Form-36 (SF-36), which has well-established normative values. Several supplemental questions were prepared in a similar format dealing with issues specific to the ileoanal pull-through procedure.
Results:
Of the 32 participants, 19 (59%) were girls and 26 (81%) had ulcerative colitis. Mean age at the time of survey was 18.1 years with 12 less than 18 years and 20 > or =18 years. Data from the latter group could be compared with national normative values for this age. The study group was not statistically different from age-appropriate US population normal values on all assessable scales of physical and mental health in the SF-36 survey including physical functioning, role limitations-physical, bodily pain, general health, vitality, social functioning, role limitations-emotional, and mental health (all P>.05 or mean difference SD units <0.8). The supplemental questionaire demonstrated little adverse effect of the surgery. There was limited consumption of medications to control bowel frequency and little restriction of activity because of the frequency of bowel movements or fear of incontinence. The surgical scar was the sole negative factor of significance.
Conclusions:
The ileoanal pull-through procedure is an excellent surgical option for children with ulcerative colitis or familial adenomatous polyposis, and it produced minimal, if any, adverse effects on their long-term quality of life.
Related Concept Videos
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the colonic...
01:25Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
01:30Irritable Bowel Syndrome II: Clinical Features and Diagnostic Evaluation
Irritable Bowel Syndrome (IBS) is classified into subtypes based on the predominant bowel habits as determined by the Bristol Stool Form Scale (BSFS). The subtypes are:
01:26Inflammatory Bowel Disease I: Introduction