ILEAL POUCH-ANAL ANASTOMOSES COMPLICATIONS AND FUNCTION IN 1005 PATIENTS

Background Restorative proctocolectomy and ileal pouch-anal anastomosi s (IPAA) has become an established surgery for patients with chronic u lcerative colitis and familiar adenomatous polyposis. Purpose The auth ors report the results of an 11-year experience of restorative proctoc olectomy and IPAA at a tertiary referral center. Methods Chart review was performed for 1005 patients undergoing IPAA from 1983 through 1993 . Preoperative histopathologic diagnoses were ulcerative colitis (n = 858), familial adenomatous polyposis (n = 62), indeterminate colitis ( n = 75), acid miscellaneous (n = 10). Information was obtained regardi ng patient demographics, type and duration of diseases, previous opera tions, and indications for surgery. Data were collected on surgical pr ocedure and postoperative pathologic diagnosis. Early (within 30 days after surgery) and late complications were noted. Follow-up included a n annual function and quality-of-life questionnaire, physical examinat ion, and biopsies of the pouch and anal transitional zone. Results Of the 1005 patients (455 women), postoperative histopathologic diagnoses were as follows: ulcerative colitis (n = 812), familial adenomatous p olyposis (n = 62), indeterminate colitis (n = 54), Crohn's disease (n = 67), and miscellaneous (n = 10). During a mean follow-up time of 35 months (range 1-125 months), histopathologic diagnoses were changed fo r 25 patients. The overall mortality rate was 1% (n = 10 patients, ear ly = 4, late = 6); one death (0.1%) was related to pouch necrosis and sepsis. The overall morbidity rate was 62.7% (1218 complications in 63 0 patients; early, n = 27.5%; late, n = 50.5%). Septic complication an d reoperation rates were 6.8% and 24%, respectively. The ileal pouch w as removed in 34 patients (3.4%), and it is nonfunctional in 11 (1%). Functional results and quality of life were good to excellent in 93% o f the patients with complete data (n = 645) and are similar for patien ts with ulcerative colitis, familial adenomatous polyposis, indetermin ate colitis, and Crohn's disease. Patients who underwent operations fr om 1983 through 1988 have similar functional results and quality of li fe compared with patients who underwent operations after 1988. Conclus ion Restorative proctocolectomy with an IPAA is a safe procedure, with low mortality and major morbidity rates. Although total morbidity rat e is appreciable, functional results generally are good and patient sa tisfaction is high.