Ileoanal pouch procedures: clinical outcomes and quality-of-life assessment

Ileoanal pouch (IAP) anastomosis following total colectomy for ulcerative colitis or familial adenomatous polyposis is performed with the goal of avoiding a permanent ileostomy and its effects on life satisfaction. During a retrospective 10-year study period, 55 patients underwent IAP construction for ulcerative colitis (36) and familial adenomatous polyposis (19). We assessed complications by chart review and surveyed patients regarding quality of life via a standardized questionnaire. There was no operative mortality, and there were three late deaths (6%). Twenty-nine patients (54%) sustained 68 early and late complications. Pouchitis was the most common complication (24%), and two patients required pouch excision (4%), one for pouchitis and one for rectovaginal fistula. Thirty-one patients (65%) have completed questionnaires. Forty-seven patients (87%) responded that their overall quality of life is "always" better since creation of the IAP, and only one patient in the IAP group has greater than ten bowel movements a day. Twenty-one patients (68%) never have interference with intimate relationships and 20 (65%) never have interference with physical activities. However, 20 patients (65%) sometimes have sleep interference, and 19 patients (61%) sometimes have fecal soilage. None of the patients continue to take steroids. We conclude that the complication rate following IAP construction is high, but pouch loss is infrequent. Despite a high complication rate, the majority of patients experience an improvement in quality of life.