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Factors affecting anal continence after restorative proctocolectomy.

M Pescatori1, C Mattana

  • 1Institute of Clinical Surgery, Universita Cattolica, Roma, Italy.

International Journal of Colorectal Disease
|December 1, 1990
PubMed
Summary

Restorative proctocolectomy can lead to minor leakage in 26.9% of patients, with troublesome soiling in 1.9%. Older age, ulcerative colitis, high bowel frequency, and pouchitis are associated with increased soiling after ileoanal reservoir surgery.

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Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Patient Outcomes

Background:

  • Restorative proctocolectomy with ileoanal reservoir is a common surgical procedure for ulcerative colitis and familial adenomatous polyposis.
  • Disordered continence, particularly fecal soiling, can significantly impact patient quality of life after this surgery.

Purpose of the Study:

  • To determine the incidence of disordered continence after restorative proctocolectomy and ileoanal reservoir.
  • To identify factors influencing postoperative soiling rates in patients undergoing this procedure.

Main Methods:

  • A multicenter study involving 207 patients who underwent restorative proctocolectomy.
  • Functional assessment was performed on 156 patients after ileostomy closure.
  • Statistical analysis was used to evaluate the impact of various factors on soiling rates.

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Main Results:

  • Minor leakage occurred in 26.9% of patients, with troublesome soiling in 1.9%. No gross fecal incontinence was reported.
  • Factors significantly associated with increased soiling included older age (>45 years), ulcerative colitis diagnosis, high bowel frequency (>5/24h), and pouchitis.
  • Soiling rates decreased significantly from 34% to 21% after the first postoperative year.

Conclusions:

  • While restorative proctocolectomy generally yields good continence, a subset of patients experience soiling.
  • Older patients, especially those with ulcerative colitis, diarrhea, or pouchitis, require careful preoperative assessment and may benefit from targeted interventions to manage soiling.