J ILEAL POUCH-ANAL ANASTOMOSIS FOR CHRONIC ULCERATIVE-COLITIS - COMPLICATIONS AND LONG-TERM OUTCOME IN 1310 PATIENTS

Aim The purpose of the study was to determine the risk of postoperativ e complications and the functional outcome after a hand-sewn heal pouc h-anal anastomosis (lPAA) for ulcerative colitis using a single J-shap ed pouch design. Methods Preoperative function, operative morbidity an d long-term functional outcome were assessed prospectively in 1310 pat ients who underwent IPAA between 1981 and 1994 for ulcerative colitis. Results Three patients died after operation. Postoperative pelvic sep sis rates decreased from 7 per cent in 1981-1985 to 3 per cent in 1991 -1994 (P = 0.02). After mean follow-up of 6.5 (range 2-15) years, the mean number of stools was 5 per day and 1 per night. Frequent daytime and nighttime incontinence occurred in 7 and 12 per cent of patients r espectively, and did not change over a I0-year period. The cumulative probability of suffering at least one episode of 'clinical' pouchitis was 18 and 48 per cent at 1 and 10 years and the cumulative probabilit y of pouch failure at 1 and 10 years was 2 and 9 per cent respectively . Conclusion These results indicate that increased experience decrease s the risk of pouch-related complications and that with time the funct ional results remain stable, but the failure rate increases.