Restorative proctocolectomy with ileal pouch-anal anastomosis in 203 patients: The Auckland experience

Background: Restorative proctocolectomy with ileal pouch-anal anastomosis ( IPAA) has become an established operation for patients with ulcerative coli tis and familial adenomatous polyposis (FAP). The results of a 15-year expe rience with IPAA are reported. Methods: Between September 1982 and June 1997, 203 patients had IPAA surger y, from a review of the charts, data were collected on the surgical procedu re, the diagnosis and early and late complications. Pouch function was asse ssed by means of a postal questionnaire. Results: Of the 201 patients (median age of 32 years; 89 women) with comple te records, 122 had J pouches, 65 had W pouches and 14 S pouches were const ructed. The pre-operative diagnosis in 88% was ulcerative colitis and in 10 % it was FAP. During a median follow-up time of 6.1 years the diagnoses wer e changed for 8% of the patients; in 4% the diagnosis was changed to Crohn' s disease. The overall mortality was 1.5% (early = 2, late = 1)The overall morbidity was 62% (early = 17%, late = 52%). The pouch was removed or was n on-functional in 9%. All patients With a final diagnosis of Crohn's disease have had their pouch excised. The median stool frequency was 4.0 (range 1. 3-8.7) during the day, and 0.7 (range 0-2.1) during the night. The fewer ni ght-time stools (J = 1.0 +/- 0.6; W = 0.4 +/- 0.5 P < 0.0001) and the reduc ed requirement of the W-pouch patients for anti-diarrhoeals (P = 0.004) wer e offset by the need for two W-pouch patients to pass a catheter to empty t heir pouches. Conclusions: The type of patients who present for IPAA surgery and the outc omes observed in this series of Auckland patients are similar to those repo rted from major centres elsewhere.