Long-term Functional Outcomes after Restorative Proctocolectomy with J-pouch, Ileoanal Anastomosis: 10-year Experience in Thai Patients
Abstract
Background: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the procedure of choice for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). Early functional outcomes after IPAA are good in Western studies, but there are minimal data on the long-term function of the pouch. The outcomes of IPAA in Thai patients are not well known. The aim of this study was to evaluate the risk of postoperative morbidity and the long-term functional results in Thai patients with UC and FAP who underwent IPAA.
Methods: A retrospectively review was carried out in 16 patients (10 with polyposis, 6 with colitis) who underwent IPAA by a single surgeon (C.E.) between May 1996 and September 2005. All patients underwent a total proctocolectomy, mucosal proctectomy, hand-sewn J-pouch ileoanal anastomosis and a protective ileostomy.
Results: The median age at surgery was 37.5 years (ranged 26-59 years). The colitis patients were older than the polyposis patients (median of 52 VS 34 years). Four patients in colitis group (66.7%) and three patients in polyposis group (30%) had coexisting colorectal carcinoma. All patients were followed for at least 12 months with a median length of follow-up at 43 months (ranged 12-124 months). There was no hospital mortality. The overall complications rate was 31.2% (30% in polyposis group and 33.3% in colitis group). The most common complication was small bowel obstruction (18.8%), followed by wound infection (12.5%), pelvic abscess and pouch fistula (6.3%). Pouchitis occurred in 6.3%. Pouch failure developed in 6.:3%. The average number of stool per day/night before IPAA in polyposis and colitis patients were 2.8/0.5 and 7.7/2.3, respectively. The average stool frequency per day / night after IPAA in polyposis and colitis group were 4.9/1 and 4.2/1, respectively. About 53% of all patients had perfect continence at night. All patients had no difficulty in evacuation or urgency.
Conclusion: IPAA in Thai patients in this study developed an acceptable morbidity and no mortality. Long-term functional outcomes after IPAA in Thai patients are as good as in Western patients.
References
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