Long-term functional outcome and quality of life after stapled restorativeproctocolectomy

Objective To evaluate prospectively long-term quality of life and functiona l outcome after restorative proctocolectomy (RPC) with ileal pouch-anal ana stomosis, and to evaluate and validate a novel quality-of-life indicator in this group of patients. Summary Background Data Restorative proctocolectomy with ileal pouch-anal a nastomosis is now the preferred option when total proctocolectomy is requir ed for ulcerative colitis or familial adenomatous polyposis, but long-term data on functional outcome and quality of life after the procedure are lack ing. Methods Patients (n = 977) who underwent RPC with stapled anastomosis for c olitis or polyposis coli and who were followed for greater than or equal to 12 months were included. Quality of life, fecal incontinence, and satisfac tion with surgery were prospectively evaluated by structured interview or q uestionnaire for 1 to 12 years after surgery (median 5.0). Quality of life was scored using the Cleveland Global Quality of life (CGQL) instrument (Fa zio Score). This is a novel score developed over the past 15 years by the s enior author. Quality of life was also evaluated in a subgroup of patients with the Short Form 36 (SF-36). The CGQL was validated by determining its r eliability, responsiveness, and validity as well as its correlation with th e SF-36 score. Results Postoperative quality of life as measured by SF-36 was excellent an d compared well with published norms for the general U.S. population. The C GQL was found to be reliable, responsive, and valid, acid there was a high correlation with the SF-36 scores. Using the CGQL, quality of life was show n to increase after the first 2 years after surgery, and there was no deter ioration thereafter. The prevalence of perfect continence increased from 75 .5% before surgery to 82.4% after surgery, and although this deteriorated s omewhat >2 years after surgery, it was no worse than preoperative values. N inety-eight percent of patients would recommend the surgery to others. Conclusions Long-term quality of life after ileal pouch surgery is excellen t and the level of continence is satisfactory. This surgery is an excellent long-term option in patients requiring total proctocolectomy, The CGQL is a simple, valid, and reliable measure of quality of life after pelvic pouch surgery and may well be applicable in many other clinical conditions.