Related Experiment Video
Updated: May 19, 2026
A Rat Model of Pouchitis Following Proctocolectomy and Ileal Pouch-Anal Anastomosis Using Dextran Sulfate Sodium
Published on: May 31, 2024
Long-term results after restorative proctocolectomy with ileal pouch-anal anastomosis at a young age
Karlijn A van Balkom1, Monique P Beld, Ruben G J Visschers
1Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Insights
Restorative proctocolectomy with an ileal pouch-anal anastomosis (IPAA) in young patients shows acceptable function but high complication rates and negative impacts on body image and sexual health, particularly for women.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pediatric Surgery
Background:
- Restorative proctocolectomy with IPAA is a key surgical option for familial adenomatous polyposis and refractory ulcerative colitis.
- Long-term outcomes in young patients undergoing this procedure are not well-documented.
Purpose of the Study:
- To evaluate long-term functional outcomes, quality of life, body image, and sexual function in young patients after restorative proctocolectomy with IPAA.
- To identify potential long-term challenges associated with this surgery in adolescents and young adults.
Main Methods:
- Retrospective review of medical records for 26 patients (aged 10-24 at surgery) who underwent restorative proctocolectomy with IPAA.
- Follow-up questionnaires assessed bowel function, quality of life, body image, and sexual function, with a median follow-up of 12.5 years.
Main Results:
- High rates of long-term colorectal complications (88%) were observed, directly related to surgery in 77% of cases.
- Patients reported lower scores for bowel function, quality of life, and body image compared to general populations.
- While men reported no sexual dysfunction, 50% of women experienced sexual dysfunction.
Conclusions:
- Restorative proctocolectomy with IPAA in young patients yields acceptable functional results but is associated with significant long-term complications.
- Negative impacts on body image, cosmesis, and sexual function in women necessitate comprehensive patient counseling and long-term monitoring.
- Surgeons must be aware of and discuss potential long-term consequences with young patients considering this procedure.
Background:
Restorative proctocolectomy with IPAA is an optimal surgical treatment for patients with familial adenomatous polyposis and therapy resistant ulcerative colitis, few data are available on long-term results in patients who have undergone this operation at a young age.
Objective:
The aim of this study was to investigate long-term functional outcome, quality of life, body image, and sexual function after restorative proctocolectomy with IPAA in young patients with familial adenomatous polyposis or ulcerative colitis.
Design, Settings, And Patients:
The study consisted of a retrospective review of medical records and questionnaire follow-up of 26 consecutive patients with familial adenomatous polyposis or ulcerative colitis who had undergone surgery between January 1992 and October 2008 at the Maastricht University Medical Center, were aged 10 to 24 years at the time of surgery, and had at least 1 year of follow-up after surgery.
Main Outcome Measures:
We reviewed medical records from an institutional database regarding surgical procedures and short- and long-term complications. At the end of 2009, validated questionnaires covering bowel function (Colorectal Functional Outcome Questionnaire), quality of life (Short Form-36 and Gastrointestinal Quality of Life Index), body image and cosmesis (Body Image Questionnaire), and sexual function (International Index of Erectile Function for men and Female Sexual Function Index for women) were mailed to patients.
Results:
Median age at surgery was 18 years, and median follow-up was 12.5 (range, 2-18) years. Long-term colorectal complications occurred in 23 patients (88%), and were directly related to the surgery in 20 patients (77%). Five patients needed pouch excision. The questionnaire response rate was 88%. Bowel function, quality-of-life, and body image and cosmesis scores were all lower in patients than in historical normal control populations. Men did not report impotence or retrograde ejaculation, but 50% of women reported sexual dysfunction.
Limitations:
This was a retrospective study in a small number of patients from a single institution with no comparison groups.
Conclusions:
Restorative proctocolectomy with IPAA can be performed in young patients with an acceptable functional outcome, but at the cost of relatively high complication rates, poor body image and cosmesis, and a high rate of sexual dysfunction in women. Because young patients undergoing this surgical procedure may experience negative long-term effects, surgeons should be aware of all potential consequences, inform patients as to what to expect, and ensure long-term follow-up to deal with long-term complications.
Related Concept Videos
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:25Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...