Pitfalls and outcome in ileo-anal pouch surgery for ulcerative colitis

We have examined the long-term results of pouch surgery in 154 patients initially thought to have ulcerative colitis. Pouch survival was 81% at 5 years and 72% at 10 years. Chronic sepsis was the commonest factor for pouch failure (P < 0.001). Re-operations were required in 60 patients (39%). Pouch salvage was used in 30 patients and was successful in 16. Function using a 12-point score was good (0-3) in 40%, moderate (4-6) in 31% or poor (> 6) in 29%. Quality-of-life assessment indicated that 81% were satisfied, but anxiety was associated with a poor outcome. Age over 60 years was not associated with impaired function. So far, 21 patients are thought to have Crohn's disease, of whom 5 have small bowel involvement above the pouch, 11 have had their pouch excised or are permanently defunctioned.