Abstract
Background
The functional outcome and quality of life after sphincter-saving operations for ulcerative colitis have not been previously assessed in Indian patients whose dietary habits and socio-cultural practices differ considerably from those in western countries.
Patients and methods
Between 1996 and 2002, we performed 46 J-pouch ileoanal anastomoses (IPAA), for patients with ulcerative colitis. Thirty-eight of these patients had had their ileostomy closure more than 4 years previously of whom 31 could be assessed by interviews and a telephonic questionnaire. Their quality of life was objectively assessed using the Cleveland Global Quality of Life (CGQL) index, a validated index for IPAA, the score being 1 in normal people. There were 20 males and 11 females with a mean age of 38 years. In the same period, six of the nine patients who did not opt to have an IPAA (permanent stoma) were assessed. These included four males and two females, mean age 45 years (36–52).
Results
One patient died in the postoperative period and another died 3 months after surgery from multiple small bowel perforations. Other complications included intestinal obstruction in seven, pouchitis in four and incisional hernia in two. One pouch had to be converted to a permanent ileostomy following development of a fistula because of Crohn’s disease. The mean daily postoperative stool frequency was seven (range 2–20). Eighty-one percent had perfect daytime continence and 81% used dietary restrictions. Eighty-four percent rated their pouch function to be excellent or good. All patients preferred IPAA to an ileostomy citing mainly social and cultural reasons and were willing to choose it again. The mean preoperative CGQL score (0.27) increased significantly after colectomy (0.50) and after closure of ileostomy (0.77; p < 0.001). The mean CGQL in the “permanent stoma” group did not improve significantly after surgery (0.62 vs. 0.50) and four of these expressed a wish to have an IPAA.
Conclusions
Restorative proctocolectomy provides a good functional outcome and improves the quality of life in Indians with ulcerative colitis and may be the most appropriate procedure for such patients in developing countries.
Similar content being viewed by others
References
Meagher AP, Farouk R, Dozois RR, Kelly KA et al (1998) Ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long term outcome in 1,310 patients. Br J Surg 85:800–803
Romanos J, Samarasekara DN, Stebbing JF, Jewell DP et al (1997) Outcome of 200 restorative proctocolectomy operations: the John Radcliffe Hospital experience. Br J Surg 84:814–818
Fazio VW, Zi Y, Church JM et al (1995) Ileal pouch-anal anastomoses complications and functions in 1,005 patients. Ann Surg 222:120–127
Fazio VW, O’Riordan MG, Lavery IC et al (1999) Long term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230:575–586
Marcello PW, Roberts PL, Schoetz DJ, Coller JA et al (1993) Long term results of the ileoanal pouch procedure. Arch Surg 128:500–504
Karlbom U, Raab Y, Ejerbald S, Graf W et al (2000) Factors influencing the functional outcome of restorative proctocolectomy in ulcerative colitis. Br J Surg 87:1401–1408
Wexner SD, Jensen L, Rothenberger DA et al (1989) Long term functional analysis of the ileoanal reservoir. Dis Colon Rectum 32:275–281
Bapat RD, Kantharia CV, Bakshi GD. Surgery for ulcerative colitis: our experience. Bom Hosp J online.
Muir AJ, Edwards LJ, Sanders LL, Boltinger RR et al (2001) A prospective evaluation of healthy related QOL after ileal pouch-anal anastomosis for ulcerative colitis. Am J Gastroenterol 96:1480–1485
Martin A, Dinca M, Leone L, Fries W et al (1998) Quality of life after proctocolectomy and ileoanal anastomosis for severe ulcerative colitis. Am J Gastroenterol 93:166–169
Weinryb RM, Gustavsson JP, Liljeqvist L, Poppen B, Rossel RJ (1995) A prospective study of the quality of life after pelvic pouch operation. J Am Coll Surg 180:589–595
Shah S, Satyendra T, Amarapurkar D. Health related quality of life in ulcerative colitis. Bom Hosp J; online.
Penzim ME, Nicholls RJ (1985) Quality of life after restorative proctocolectomy and pelvic ileal reservoir. Br J Surg 72:31–33
Michelassi F, Lee J, Rubin M, Fichera A, Kasza K, Karrison T, Hurst RD (2003) Long-term functional results after ileal pouch anal restorative proctocolectomy for ulcerative colitis. A prospective observational study. Ann Surg 238:433–445
Krausz MM, Duek SD (2005) Restorative proctocolectomy with ileal pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis: twenty years follow-up in 174 patients. IMAJ 7:23–27
Hahnloser D, Pemberton JH, Wolff BG, Larson DR, Crownhart BS, Dozois RR (2007) Results at up to 20 years after ileal pouch—anal anastomosis for chronic ulcerative colitis. Br J Surg 94:333–340
Andersson T, Lunde OC, Johnson E, MoumT, Nesbakken A. Long-term functional outcome and quality of life after restorative proctocolectomy with ileo-anal anastomosis for colitis. Colorectal Disease . doi:10.1111/j.1463-1318.2009.02163.x.
Thirlby RC, Kelly R (1997) Pectin and methyl cellulose do not affect intestinal function in patients after ileal pouch-anal anastomosis. Am J Gastroenterol 92:99–102
Coffey JC, Winter DC, Neary P et al (2002) Quality of life after ileal pouch-anal anastomosis: an evaluation of diet and other factors using the Cleveland Global quality of life instrument. Dis Colon Rectum 45:30–38
Fujita S, Kusunoki M, Shoji Y et al (1992) Quality of life after total proctocolectomy and ileal J-pouch-anastomosis. Dis Colon Rectum 35:1030–1039
McLeod RS, Baxter NN (1998) Quality of life of patients with inflammatory bowel disease after surgery. World J Surg 22:375–381
McGuire BB, Brannigan AE, O’Connell PR (2007) Ileal pouch–anal anastomosis. Br J Surg 94:812–823
Pemberton JH, Phillips SF, Ready RR, Zinsmeister AR, Beahes OH (1989) Quality of life after Brookes ileostomy and ileal pouch-anal anastomosis: comparison of performance status. Ann Surg 209:620–628
Jimmo B, Hyman NH (1998) Is ileal pouch-anal anastomosis really the procedure of choice for patients with ulcerative colitis. Dis Colon Rectum 41:41–45
Seidel SA, Newman M, Sharp K (2000) Ileoanal pouch versus ileostomy: is there a difference in quality of life. Am Surg 66:540–547
Camilleri-Brennan J, Munro A, Steele RJ (2003) Does an ileoanal pouch offer a better quality of life than a permanent ileostomy for patients with ulcerative colitis? J Gastrointest Surg 7:814–819
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Somashekar, U., Gupta, S., Soin, A. et al. Functional outcome and quality of life following restorative proctocolectomy for ulcerative colitis in Indians. Int J Colorectal Dis 25, 967–973 (2010). https://doi.org/10.1007/s00384-010-0974-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-010-0974-x