ILEAL POUCH-ANAL ANASTOMOSIS FUNCTION FOLLOWING CHILDBIRTH - AN EXTENDED EVALUATION

PURPOSE: Women undergoing ileal pouch-anal anastomosis (IPAA) are freq uently within reproductive years and eager to bear children. Managemen t issues have been raised regarding the effects of pregnancy and deliv ery on the pouch, particularly with respect to obstetric care. Our exp erience is updated to search for delayed sequelae of pregnancy and del ivery and to establish whether other factors have an adverse effect on pouch function. These results are also compared with the outcome of p regnancy and delivery in patients with ileostomy or Kock pouch. METHOD S: Records of 43 women who had a successful pregnancy and delivery fol lowing IPAA were reviewed, including 8 women who had more than 1 pregn ancy. RESULTS: Pregnancy was generally well tolerated, with complicati ons being managed nonoperatively. Stool frequency (P < 0.01), incontin ence (P < 0.01), and pad usage (P < 0.05; sign rank test) were signifi cantly increased during pregnancy, but prepregnancy function was resto red following delivery. Vaginal delivery, multiple births, length of l abor, and birth weight had no adverse permanent effect on subsequent p ouch function. Longer follow-up after vaginal delivery (mean, 2.4 year s) demonstrated no compromise of pouch function. CONCLUSIONS: incidenc e of pouch-related complications in patients with IPAA compares favora bly with incidence in patients with ileostomy or Kock pouch. Operative rate for complications was 0 percent in IPAA patients compared with 9 percent in patients with ileostomy and 19 percent in patients with Ko ck pouch. The cesarean section rate was higher in patients with IPAA t han in those with ileostomy or Kock pouch, and this may be caused by u ncertainty about how to manage delivery in patients with IPAA. Pregnan cy and childbirth are well tolerated in women with IPAA, with a lower complication rate and a higher cesarean section rate than women with i leostomy or Kock pouch. Type of delivery should be influenced by obste tric considerations, with vaginal delivery avoided in patients with a noncompliant, rigid perineum.