Ileoanal pouch procedures: Clinical outcomes and quality-of-life assessment

Ileoanal pouch (IAP) anastomosis following total colectomy for ulcerative c olitis or familial adenomatous polyposis is performed with the goal of avoi ding a permanent ileostomy and its effects on life satisfaction. During a r etrospective 10-year study period, 55 patients underwent IAP construction f or ulcerative colitis (36) and familial adenomatous polyposis (19). We asse ssed complications by chart review and surveyed patients regarding quality of life via a standardized questionnaire. There was no operative mortality, and there were three late deaths (6%). Twenty-nine patients (54%) sustaine d 68 early and late complications. Pouchitis was the most common complicati on (24%), and two patients required pouch excision (4%), one for pouchitis and one for rectovaginal fistula. Thirty-one patients (65%) have completed questionnaires. Forty-seven patients (87%) responded that their overall qua lity of life is "always" better since creation of the IAP, and only one pat ient in the IAP group has greater than ten bowel movements a day. Twenty-on e patients (68%) never have interference with intimate relationships and 20 (65%) never have interference with physical activities. However, 20 patien ts (65%) sometimes have sleep interference, and 19 patients (61%) sometimes have fecal soilage. None of the patients continue to take steroids. We con clude that the complication rate following IAP construction is high, but po uch loss is infrequent. Despite a high complication rate, the majority of p atients experience an improvement in quality of life.