Functional outcome of conversion of ileorectal anastomosis to ileal pouch-anal anastomosis in patients with familial adenomatous polyposis and ulcerative colitis

PURPOSE: The aim of this study was to review the functional outcome in 20 p atients with familial adenomatous polyposis and ulcerative colitis who were converted from ileorectal anastomosis to ileal pouch-anal anastomosis. MET HODS: From 1985 to 1997, 12 patients with familial adenomatous polyposis (5 males; mean age, 39.1 years) and 8 patients with ulcerative colitis (5 mal es; mean age, 36.7 years) underwent conversion from ileorectal anastomosis to ileal pouch-anal anastomosis. Clinical and operative data were analyzed retrospectively. Functional results were obtained by telephone interview in 16 patients (94 percent) after pouch construction. Four patients were not interviewed (2 were deceased, 1 was lost to follow-up, and 1 was not reacha ble). RESULTS: Indications for conversion were uncontrollable rectal polyps (10 patients) and colonic cancer found in the pathology specimen after ile orectal anastomosis in patients with familial adenomatous polyposis (2 pati ents), intractable proctitis (5 patients), colonic cancer found in the path ology specimen of patients with ulcerative colitis after ileorectal anastom osis (2 patients), and rectal dysplasia (1 patients). Mean follow-up time w as 5 (range, 1-11) years. heal pouch-anal anastomosis was handsewn in 14 pa tients, and the remaining cases were double-stapled in 4 patients with ulce rative colitis. No intraoperative difficulties were reported in 13 cases; t echnical problems were related to adhesions (3 cases), difficult rectal dis section (2 cases), and stapler-related difficulties (2 cases). Postoperativ e complications after ileal pouch-anal anastomosis included small-bowel obs truction (4 patients) and ileal pouch-anal anastomosis leak (1 patient). Pa tients with ileorectal anastomosis vs. those with ileal pouch-anal anastomo sis had a better functional outcome with regard to nighttime continence (14 (88 percent) vs. 6 (38 percent) patients) and average bowel movements (<6/ day; 12 (75 percent) vs. 4 (25 percent) patients). Complete daytime contine nce, 15 (94 percent) vs. 10 (62 percent) patients, was similar in the two g roups. Physical and emotional well-being were similarly rated as very good to excellent. CONCLUSIONS: In patients with familial adenomatous polyposis and ulcerative colitis with ileorectal anastomosis, conversion to ileal pou ch-anal anastomosis may be required. In view of the risk of rectal cancer o r intractable proctitis, patients seem to accept the conversion in spite of poorer bowel function.