Prospective assessment of functional results after ileal J pouch-anal restorative proctocolectomy
F. Michelassi, M. Stella and G. E. Block
Department of Surgery, University of Chicago, Ill.
OBJECTIVE: To document the functional results of 50 consecutive patients
who underwent hand-sewn ileal J pouch-anal restorative proctocolectomy for
ulcerative colitis between 1988 and 1991 (mean follow-up, 18.1 months;
range, 6 to 48 months). DESIGN: Patients recorded their observations daily
over 1 week. The patients completed these weekly diaries every 3 months for
the first year and then at 18, 24, 36, and 48 months after ileostomy
closure. STUDY PARTICIPANTS: Fifty patients (mean age, 31 years; 24 males).
SETTING: The University of Chicago (Ill). RESULTS: Stool frequency at 3, 6,
12, and 24 months was 6.3 +/- 2.1, 5.5 +/- 2.4, and 5.1 +/- 1.9, and 5.9
+/- 1.6 per day, respectively, without urgency. Fifty-four percent were
perfectly continent; 18% had occasional spotting (one or two leaks per
week); 12% had minor leakage (three to seven per week); and 16% had major
leakage (more than seven per week). In these three groups, loss of solid
feces never occurred in 84%, 88%, and 65% of patients, respectively.
Females had more severe incontinence than males, but continence improved
over time for both sexes. Twenty-two percent of female patients developed
dyspareunia; no males developed impotence, but 19% had retrograde
ejaculation. The probability of experiencing pouchitis increased with time
from 15% at 6 months to 40% at 12 months, and 50% after 24 months.
CONCLUSIONS: These results represent an accurate assessment of patient
function after ileal J pouch-anal anastomosis. We encourage the use of a
prospective, patient-completed protocol to obtain a realistic assessment of
functional results.
