Ileoanal pouch versus ileostomy: Is there a difference in quality of life?

Ileoanal pouch (IAP) construction is arguably the procedure of choice to fo llow proctocolectomy for ulcerative colitis (UC) or familial adenomatous po lyposis (FAP). Patients with UC or FAP at our institution choose their oper ation after counseling with the surgeon, with an enterostomal therapist, an d with patients who have undergone IAP and proctocolectomy with ileostomy ( IL). We studied these patients who chose IAP and IL, to determine differenc es in outcome and quality of life (QOL) between those two groups. We assess ed outcomes by evaluating clinic and hospital records and surveyed patients ' QOL via a standardized questionnaire. During a retrospective 10-year stud y period, 86 patients underwent evaluation for IAP construction for UC (64) and FAP (22). Fifty-five patients underwent IAP construction, and 31 under went IL. There were no operative deaths. Thirty-four patients sustained 69 early and late complications (40%). The IAP group experienced a higher comp lication rate, 53 per cent, compared with the IL group, 16 per cent. Forty- five patients (56%) have completed questionnaires. Eighty-seven per cent of IAP patients and 93 per cent of IL patients responded that their overall Q OL is "always" better since their operation (P = not significant). Both gro ups reported very favorable responses to questions regarding work, social l ife, family life, sleep, and relationships without statistically significan t differences between the two groups. Despite a high complication rate, IAP is an excellent operation for many patients with UC or FAP, but patients w ho choose IL after preoperative counseling can be expected to have similar improvement in quality of life.