Ileoanal anastomosis with reservoirs: Complications and long-term results

OBJECTIVE: TO determine the rate of complications of ileoanal pouch anastom osis, their treatment and their influence on a successful outcome. DESIGN: A computerized database and chart review. SETTING: Three academic tertiary care health centres. PATIENTS: All 239 patients admitted for surgery between 1981 and 1994 with a diagnosis of ulcerative colitis and familial adenomatosis coli. INTERVENTIONS: Sphincter-saving total proctocolectomy and construction of e ither S-type or J-type ileoanal reservoir. OUTCOME MEASURES: Indications, early and late complications, incidence of p ouch excision. RESULTS: Of the 239 patients, 228 (95.4%) were operated on for ulcerative c olitis and 11. (4.6%) for familial polyposis coli. One patient in each grou p was found to have a carcinoma not previously diagnosed. Twenty-eight pati ents had poor results: in 17 (7.1%) the ileostomy was never closed or was r e-established because of pelvic sepsis or complex fistulas, sclerosing chol angitis or severe diarrhea; 11 (4.6%) patients required excision of the pou ch because of anal stenosis, perirectal abscess-fistula or rectovaginal fis tula. Three patients died - of suicide, and complications of liver transpla ntation and HIV infection. Thus, 208 patients maintained a functioning pouc h. The early complication rate (within 30 days of operation) was 57.7% (138 patients) and the late complication rate was 52.3% (125 patients). Pouchit is alone did not lead to failure or pouch excision. Emptying difficulties i n 25 patients with anal stenosis were helped in 2 by resorting to intermitt ent catheterization. Patients with indeterminate colitis had a higher rate of anorectal septic complications, and all patients having Crohn's disease after pouch construction had complicated courses. CONCLUSIONS: The complication rate associated with ileoanal pouch anastomos is continues to tie relatively high despite increasing experience with this technique. Overall, however, a satisfactory outcome was obtained in 87% of patients.