Ileoanal-pouch reconstruction does not impair sphincter function or quality of life

A retrospective trial with regard to continence function and quality of life was conducted in patients who had undergone proctocolectomy and ileo-anal-pouch (IAP) reconstruction for ulcerative colitis (UC) or familial polyposis (FAP), and continence function was compared to patients under conservative treatment for UC. The aim of the study was to evaluate, if proctocolectomy and IAP differed in quality of life and sphincter function from those patients with chronic UC who were not operated on.

50 patients were included in this study: 25 patients had undergone proctocolectomy and ileo-pouch-anal-anastomosis (IPAA) for UC (n=13) or FAP (n=12). The control group included 25 patients under medical treatment for UC (n=25). Anal manometry was performed and quality of life questionnaires were evaluated.

No significant differences in maximum basal and squeeze pressure were found. There was a significantly later pouch perception in the patient group (55mL in patients vs. 39mL in controls; p = 0.0054) as well as a significantly greater stool frequency (6 vs. 4 per day; p = 0.0018) and a shorter high pressure zone in the patients' group (25 mm vs. 35 mm; p < 0.0001). Patients demonstrated superior but not significantly better values for Gastrointestinal Quality of Life Score (GLQI) and Activity Index (AI). Furthermore, there was a significant negative correlation between perception values and GLQI (p = 0.014) and AI (p = 0.04) in this group, indicating that the later the perception the worse the Quality of Life and Activity Index.

Proctocolectomy combined with IPAA neither deteriorates anorectal function nor quality of life compared to conservatively treated controls. These data support that prophylactic proctocolectomy in patients who are at high risk for the development of colorectal cancer can be performed at an early stage of the disease.