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Bowel Function After J-Pouch May Be More Complex Than Previously Appreciated: A Comprehensive Analysis to Highlight
Grace C Lee1, Paul M Cavallaro, Lieba R Savitt
1Section of Colon and Rectal Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Diseases of the Colon and Rectum
|January 9, 2020
Summary
Patients undergoing J-pouch surgery for ulcerative colitis experience complex bowel dysfunction, including urgency and incomplete emptying, which is more severe than previously reported. This highlights a need for patient-centered symptom assessment beyond basic frequency and incontinence.
Area of Science:
- Gastroenterology and Surgical Outcomes
- Colorectal Surgery
- Patient-Reported Outcomes
Background:
- Standardized reporting of functional outcomes after J-pouch surgery for ulcerative colitis is lacking.
- Previous studies have not adequately focused on patient-centered symptom selection.
- J-pouch functional outcomes may be more complex than commonly assessed.
Purpose of the Study:
- To use a validated bowel function survey to identify symptoms experienced by patients after J-pouch creation.
- To compare the functional profile of J-pouch patients with those experiencing low anterior resection syndrome.
Main Methods:
- Retrospective analysis of a prospectively maintained single-center database.
- Inclusion of 159 patients with J-pouch, at least 6 months post-ileostomy reversal.
- Utilized the Memorial Sloan Kettering Cancer Center Bowel Function Instrument for primary outcome assessment, comparing with a historical validation cohort (n=127).
Main Results:
- J-pouch patients reported worse overall bowel function (mean score 59.9 ± 9.7) compared to low anterior resection patients (63.7 ± 11.6, p < 0.001).
- Significant differences were observed in frequency (18.2 ± 3.8 vs 21.7 ± 4.5, p < 0.001), diet (12.2 ± 3.8 vs 14.1 ± 3.7, p < 0.001), and urgency (15.9 ± 3.7 vs 15.0 ± 3.9, p = 0.04) subscales.
- High prevalence of urgency (90.4% unable to wait 15 min), double defecation (56.4%), and incomplete emptying (50.6%) reported by J-pouch patients.
Conclusions:
- J-pouch surgery results in a complex array of bowel symptoms beyond simple incontinence and frequency.
- Patient-reported outcomes reveal significant functional deficits, suggesting a need for more comprehensive assessment and management strategies.
- Study limitations include single-center design and validation of the instrument primarily for rectal resection patients.
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