Skip to main content

Advertisement

SpringerLink
Log in

Quality of life after proctocolectomy and ileal pouch-anal anastomosis in patients with ulcerative colitis

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

While ileal pouch-anal anastomosis is performed in many patients with ulcerative colitis, conflicting data exist about its effects on quality of life. We aimed to determine quality of life and to identify risk factors for impaired quality of life in these patients.

Methods

Forty-eight of 82 patients (59 %; median follow-up 57 months [range 21–93 months]) after ileal pouch-anal anastomosis for ulcerative colitis were compared to 48 matched healthy controls. Generic, health-, and disease-related, as well as symptom-specific quality of life was analyzed using five well-established quality of life instruments.

Results

Although generic quality of life was comparable between groups, health-related quality of life was impaired after ileal pouch-anal anastomosis. While high stool frequency was associated with impaired health-related and disease-specific quality of life, fecal incontinence and history of pouchitis also caused a deterioration of generic and symptom-related quality of life. Seventy-seven percent of patients reported their quality of life to be better compared to the situation before surgery and 88 % would undergo ileal pouch-anal anastomosis again.

Conclusions

Overall quality of life after ileal pouch-anal anastomosis is good. However, high stool frequency, fecal incontinence, and pouchitis are associated with impaired quality of life and should be prevented or treated to the best possible extent.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Kornbluth A, Sachar DB (2010) Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 105:501–523, quiz 24

    Article  PubMed  Google Scholar 

  2. Dignass A, Preiss JC, Aust DE, Autschbach F, Ballauff A, Barretton G, Bokemeyer B, Fichtner-Feigl S, Hagel S, Herrlinger KR, Jantschek G, Kroesen A, Kruis W, Kucharzik T, Langhorst J, Reinshagen M, Rogler G, Schleiermacher D, Schmidt C, Schreiber S, Schulze H, Stange E, Zeitz M, Hoffmann JC, Stallmach A (2011) Updated German guideline on diagnosis and treatment of ulcerative colitis, 2011. Z Gastroenterol 49:1276–1341

    Article  CAS  PubMed  Google Scholar 

  3. Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R, Mitton S, Orchard T, Rutter M, Younge L, Lees C, Ho GT, Satsangi J, Bloom S (2011) Guidelines for the management of inflammatory bowel disease in adults. Gut 60:571–607

    Article  PubMed  Google Scholar 

  4. de Zeeuw S, Ahmed Ali U, Donders RA, Hueting WE, Keus F, van Laarhoven CJ (2012) Update of complications and functional outcome of the ileo-pouch anal anastomosis: overview of evidence and meta-analysis of 96 observational studies. Int J Color Dis 27:843–853

    Article  Google Scholar 

  5. Heikens JT, de Vries J, Goos MR, Oostvogel HJ, Gooszen HG, van Laarhoven CJ (2012) Quality of life and health status before and after ileal pouch-anal anastomosis for ulcerative colitis. Br J Surg 99:263–269

    Article  CAS  PubMed  Google Scholar 

  6. Somashekar U, Gupta S, Soin A, Nundy S (2010) Functional outcome and quality of life following restorative proctocolectomy for ulcerative colitis in Indians. Int J Color Dis 25:967–973

    Article  Google Scholar 

  7. Ware JE, Jr., Snow KK, Kosinski M, Gandek B (1993) SF-36 health survey: manual and interpretation guide. The Health Institute, New England Medical Center

  8. Fazio VW, O’Riordain MG, Lavery IC, Church JM, Lau P, Strong SA, Hull T (1999) Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230:575–584, discussion 84-6

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmulling C, Neugebauer E, Troidl H (1995) Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg 82:216–222

    Article  CAS  PubMed  Google Scholar 

  10. Eypasch E, Wood-Dauphinee S, Williams JI, Ure B, Neugebauer E, Troidl H (1993) The Gastrointestinal Quality of Life Index. A clinical index for measuring patient status in gastroenterologic surgery. Chirurg 64:264–274

    CAS  PubMed  Google Scholar 

  11. Han SW, Gregory W, Nylander D, Tanner A, Trewby P, Barton R, Welfare M (2000) The SIBDQ: further validation in ulcerative colitis patients. Am J Gastroenterol 95:145–151

    Article  CAS  PubMed  Google Scholar 

  12. Rose M, Fliege H, Hildebrandt M, Korber J, Arck P, Dignass A, Klapp B (2000) Validation of the new German translation version of the “Short Inflammatory Bowel Disease Questionnaire” (SIBDQ). Z Gastroenterol 38:277–286

    Article  CAS  PubMed  Google Scholar 

  13. Mennigen R, Senninger N, Bruewer M, Rijcken E (2012) Pouch function and quality of life after successful management of pouch-related septic complications in patients with ulcerative colitis. Langenbecks Arch Surg 397:37–44

    Article  PubMed  Google Scholar 

  14. Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC (2000) Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 43:9–16, discussion -7

    Article  CAS  PubMed  Google Scholar 

  15. Browning GG, Parks AG (1983) Postanal repair for neuropathic faecal incontinence: correlation of clinical result and anal canal pressures. Br J Surg 70:101–104

    Article  CAS  PubMed  Google Scholar 

  16. Delaney CP, Fazio VW, Remzi FH, Hammel J, Church JM, Hull TL, Senagore AJ, Strong SA, Lavery IC (2003) Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch-anal anastomosis. Ann Surg 238:221–228

    PubMed Central  PubMed  Google Scholar 

  17. Richards DM, Hughes SA, Irving MH, Scott NA (2001) Patient quality of life after successful restorative proctocolectomy is normal. Color Dis 3:223–226

    Article  CAS  Google Scholar 

  18. Wuthrich P, Gervaz P, Ambrosetti P, Soravia C, Morel P (2009) Functional outcome and quality of life after restorative proctocolectomy and ileo-anal pouch anastomosis. Swiss Med Wkly 139:193–197

    PubMed  Google Scholar 

  19. Andersson T, Lunde OC, Johnson E, Moum T, Nesbakken A (2011) Long-term functional outcome and quality of life after restorative proctocolectomy with ileo-anal anastomosis for colitis. Color Dis 13:431–437

    Article  CAS  Google Scholar 

  20. Leowardi C, Hinz U, Tariverdian M, Kienle P, Herfarth C, Ulrich A, Kadmon M (2010) Long-term outcome 10 years or more after restorative proctocolectomy and ileal pouch-anal anastomosis in patients with ulcerative colitis. Langenbecks Arch Surg 395:49–56

    Article  PubMed  Google Scholar 

  21. Hahnloser D, Pemberton JH, Wolff BG, Larson DR, Crownhart BS, Dozois RR (2004) The effect of ageing on function and quality of life in ileal pouch patients: a single cohort experience of 409 patients with chronic ulcerative colitis. Ann Surg 240:615–621, discussion 21-3

    PubMed Central  PubMed  Google Scholar 

  22. 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

    Article  CAS  PubMed  Google Scholar 

  23. Steens J, Meijerink WJ, Masclee AA, van Hogezand RA, Griffioen G, Post WJ, Bemelman WA (2000) Limited influence of pouch function on quality of life after ileal pouch-anal anastomosis. Hepatogastroenterology 47:746–750

    CAS  PubMed  Google Scholar 

  24. Fichera A, Silvestri MT, Hurst RD, Rubin MA, Michelassi F (2009) Laparoscopic restorative proctocolectomy with ileal pouch anal anastomosis: a comparative observational study on long-term functional results. J Gastrointest Surg 13:526–532

    Article  PubMed  Google Scholar 

  25. Kiran RP, El-Gazzaz G, Remzi FH, Church JM, Lavery IC, Hammel J, Fazio VW (2011) Influence of age at ileoanal pouch creation on long-term changes in functional outcomes. Color Dis 13:184–190

    Article  CAS  Google Scholar 

  26. 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 238:433–441, discussion 42-5

    PubMed Central  PubMed  Google Scholar 

  27. Silvestri MT, Hurst RD, Rubin MA, Michelassi F, Fichera A (2008) Chronic inflammatory changes in the anal transition zone after stapled ileal pouch-anal anastomosis: is mucosectomy a superior alternative? Surgery 144:533–537, discussion 7-9

    Article  PubMed  Google Scholar 

  28. Chapman JR, Larson DW, Wolff BG, Dozois EJ, Cima RR, Pemberton JH, Crownhart BS, Larson DR (2005) Ileal pouch-anal anastomosis: does age at the time of surgery affect outcome? Arch Surg 140:534–539, discussion 9-40

    Article  PubMed  Google Scholar 

  29. Brisinda G, Vanella S, Valenza V, Crocco A, Perotti G, Di Giuda D, Maria G (2011) Surgical prophylaxis of pouchitis in ulcerative colitis. Dig Dis Sci 56:1257–1265

    Article  PubMed  Google Scholar 

  30. Rokke O, Iversen K, Olsen T, Ristesund SM, Eide GE, Turowski GE (2011) Long-term follow-up with evaluation of the surgical and functional results of the ileal pouch reservoir in restorative proctocolectomy for ulcerative colitis. ISRN Gastroenterol 2011:625842

    PubMed Central  PubMed  Google Scholar 

  31. Schmidt C, Hauser W, Giese T, Stallmach A (2007) Irritable pouch syndrome is associated with depressiveness and can be differentiated from pouchitis by quantification of mucosal levels of proinflammatory gene transcripts. Inflamm Bowel Dis 13:1502–1508

    Article  PubMed  Google Scholar 

  32. Turina M, Pennington CJ, Kimberling J, Stromberg AJ, Petras RE, Galandiuk S (2006) Chronic pouchitis after ileal pouch-anal anastomosis for ulcerative colitis: effect on quality of life. J Gastrointest Surg 10:600–606

    Article  PubMed  Google Scholar 

  33. Carmon E, Keidar A, Ravid A, Goldman G, Rabau M (2003) The correlation between quality of life and functional outcome in ulcerative colitis patients after proctocolectomy ileal pouch anal anastomosis. Color Dis 5:228–232

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Ludwig-Maximilians-University, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany

    Steffen Koerdt, Martin E. Kreis & Michael S. Kasparek

  2. Department of Surgery, Oberschwabenklinik Krankenhaus St. Elisabeth, Elisabethenstrasse 15, 88212, Ravensburg, Germany

    Ekkehard C. Jehle

  3. Department of Surgery, Charité Medical School, Hindenburgdamm 30, 12200, Berlin, Germany

    Martin E. Kreis

Authors
  1. Steffen Koerdt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ekkehard C. Jehle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin E. Kreis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael S. Kasparek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael S. Kasparek.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Koerdt, S., Jehle, E.C., Kreis, M.E. et al. Quality of life after proctocolectomy and ileal pouch-anal anastomosis in patients with ulcerative colitis. Int J Colorectal Dis 29, 545–554 (2014). https://doi.org/10.1007/s00384-013-1814-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-013-1814-6

Keywords

Search

Navigation