COMPARING FUNCTIONAL RESULTS ONE-YEAR AND 10 YEARS AFTER ILEAL POUCH-ANAL ANASTOMOSIS FOR CHRONIC ULCERATIVE-COLITIS

Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatm ent of choice for most patients with chronic ulcerative colitis. Long- term results, however remain undefined; the major concern is that func tion may deteriorate. PURPOSE: The aim of this study was to assess fun ctional outcome in a subgroup of patients who have an IPAA for chronic ulcerative colitis for >10 years. METHODS: Among 1400 IPAA patients, 75 consecutive subjects (31 females and 44 males; median age 31 at ope ration) were identified who had the procedure prior to 1982. All patie nts had functional results recorded I year and 10 years following ileo stomy closure. RESULTS: There were four deaths during the follow-up pe riod; none were pouch related. Two patients refused ileostomy closure. Of the remaining 69 patients, there were 8 (11 percent) failures, lea ving 61 subjects available for study. Stool frequency (7 +/- 3, mean /- SD) remained unchanged. Of the 50 subjects with initially excellent daytime continence, 39 (78 percent) remained the same, 10 (20 percent ) developed minor incontinence, and 1 developed poor control after 10 years. Four of 10 subjects (40 percent) with initial minor daytime inc ontinence remained unchanged, 4 (40 percent) improved, and 2 (20 perce nt) worsened. The one subject with poor control at one year was unchan ged. Nocturnal fecal spotting increased over the 10-year period but no t significantly (38 percent vs. 52 percent; P= 0.08). CONCLUSIONS: Aft er IPAA, functional results in terms of stool frequency and rate of fe cal incontinence did not deteriorate with time.