IS AGE RELEVANT TO FUNCTIONAL OUTCOME AFTER RESTORATIVE PROCTOCOLECTOMY FOR ULCERATIVE-COLITIS - PROSPECTIVE ASSESSMENT OF 122 CASES

Objective Restorative proctocolectomy for mucosal ulcerative colitis i s well established. However, the effect of age on physiologic sphincte r parameters is poorly understood. Our objective was to determine whet her age at the time of restorative proctocolectomy correlates with phy siologic changes. Summary Background Data In the approximately 20 year s during which restorative proctocolectomy has been performed for ulce rative colitis, the indications have changed. initially, the procedure was recommended only in patients under approximately 50 years. Howeve r, the procedure has been considered in older patients because of the increasing age of our population, the increasing frequency of recognit ion of patients during the ''second peak'' of mucosal ulcerative colit is, and the decreasing morbidity rates, due to the learning curve and to newer techniques, such as double-stapling. Few authors have present ed data analyzing the effects of this operation in older patients. Met hods One hundred twenty-two patients who had undergone a two-stage res torative proctocolectomy for mucosal ulcerative colitis were divided i nto three groups according to age: group I (>80 years), 11 men, 6 wome n; group II (40-80 years), 29 men, 18 women; and group III (<40 years) 29 men, 29 women. The patients were prospectively evaluated using ana l manometry and subjective functional results. Comparisons were made b efore surgery, after colectomy and before closure of ileostomy, and at 1 or more years after surgery. Results There were no significant diff erences among the groups relative to manometric results, frequency of bowel movements, incontinence scores, or overall patient satisfaction. The postoperative mean and maximum resting pressures were significant ly reduced (p < 0.001), and conversely the sensory threshold (p < 0.00 5) and capacity (p < 0.001) were increased in all groups up to 1 year after surgery. There were no statistically significant changes in the squeeze pressure or length of the high-pressure zone in any group at a ny point in lime. After surgery, the mean and maximum resting pressure s had returned to 80% of their original values. Conclusion Although an orectal function is transiently somewhat impaired after restorative pr octocolectomy, the impairment is not an age-related phenomenon.