Long-term outcomes of the ileal pouch anal anastomosis: The association ofbowel function and quality of life 5 years after surgery

Introduction. Previous studies have reported that mean health related quali ty of life (HRQL) levels generally attain normalcy following construction o f an ileal pouch anal anastomosis (IPAA). It appears inconsistent, however, that these normal HRQL levels are achieved while bowel function (BF) score s generally remain statistically worse than "normal" (e.g., 4-8 stools/day, possible anal leakage, diaper usage). To investigate this inconsistency, t he current study attempts to determine if any statistical associations are present between HRQL and BF, specifically in the long term. Multivariate re gression analyses are performed using each of 8 individual HRQL domains aga inst the full model of BF characteristics. Methods. All patients more than 5 years status post an ileal pouch anal ana stomosis (IPAA) procedure for familial adenomatous polyposis (FAP) at a sin gle institution were studied. FAP was chosen because patients are routinely asymptomatic preoperatively. BF (e.g., stool frequency, anal leakage) and HRQL (using the 8 health domains of the SF-36) were assessed by patient int erview. Student's t tests and full model multivariate regression analyses w ere used to analyze associations between BF and HRQL. Results. The sample included 25 patients (14 male). Mean age was 39 years, mean follow-up time was 11 years. Although mean scores for the 8 individual HRQL domains were not statistically different from the general United Stat es population, regression analyses of the different domains did demonstrate significant associations with varying levels of BF. While controlling for age and gender, the analyses show that the physical function domain is impr oved with the ability to pass flatus independent of stool, and physical rol e and mental health domains are improved with decreased stool frequency. Th e social function domain is improved with increased stool retention time, w hile the perception of general health is improved with less diaper usage an d less sexual dysfunction. Conclusions. This study shows that a statistically significant association between HRQL levels and BF is present. Of the numerous BF characteristics t ested, five appear to be of greater importance with regard to certain HRQL domains. This finding may have clinical implications concerning pouch const ruction and surgical technique. Methodologically, this study demonstrates t hat merely using mean levels to describe HRQL may not elucidate meaningful relationships between important clinical outcomes, such as function and HRQ L. (C) 2001 Academic Press.