Long-term results of the ileoanal pouch procedure
P. W. Marcello, P. L. Roberts, D. J. Schoetz Jr, J. A. Coller, J. J. Murray and M. C. Veidenheimer
Department of Colon-Rectal Surgery, Lahey Clinic, Burlington, Mass.
Many surgeons consider the ileoanal pouch procedure to be the procedure of
choice for patients who require surgery for ulcerative colitis and familial
adenomatous polyposis. To determine long-term results, 460 patients (mean
+/- SD age, 31 +/- 9 years) who underwent the ileoanal pouch procedure from
1980 through 1991 were prospectively observed by computerized registry. The
leading indication for operation was ulcerative colitis (n = 382; 83%). A
J-shaped reservoir was created in 434 patients (94%). More than 5 years
after ileostomy closure, the mean number of bowel movements was 5.8 +/-
2.2, and 13% of patients had leakage. Most patients (94%) were satisfied
with their results. Sixteen patients (3.5%) required recreation of a
permanent stoma for pouch failure. Complications (major and minor) occurred
in 266 patients (58%) and included obstruction (n = 94; 20%), pouch fistula
(n = 26; 6%), anastomotic stricture (n = 40; 9%), anastomosis separation (n
= 14; 3%), and pouchitis (n = 83; 18%). Modifications in technique and
increased operative experience have significantly decreased the incidence
of obstruction (P = .05) and pouch-related complications (P = .004).
Despite complications, long-term results are acceptable, and patient
satisfaction remains high.
