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Pouch function and quality of life after successful management of pouch-related septic complications in patients with ulcerative colitis

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Abstract

Purpose

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis is associated with pouch-related septic complications (PRSC) in 10% of patients. This study questioned if PRSC have a negative impact on pouch function and quality of life.

Patients and methods

One hundred thirty consecutive patients undergoing IPAA for ulcerative colitis between 1997 and 2009 were reviewed. At 1-year follow-up, patients were asked to complete questionnaires including a pouch function score (Oresland score, 0–16 points, 0 optimum) and two quality of life scores [Short Inflammatory Bowel Disease Questionnaire (SIBDQ), 1–7 points, 7 optimum; Gastrointestinal Quality of Life Index (GIQLI), 0–144 points, 144 optimum].

Results

Twelve out of 130 patients (9.2%) undergoing IPAA developed PRSC. These included anastomotic dehiscence (five), pouch leakage (three, one patient had a combined leak), peripouchal abscess (three), pouch-anal fistula (one), and pouch-vaginal fistula (one). Omission of diverting ileostomy was a risk factor for PRSC (OR 4.62, CI 1.17–18.4). PRSC led to four pouch failures (33%), whereas no failure occurred in the control group (p < 0.001). Median 3 (range, 1–10) further operations were necessary until the pouch was salvaged or definitively lost. If the pouch was salvaged, functional Oresland score (8.2 ± 1.3 vs. 6.6 ± 0.5; p = 0.127), SIBDQ (5.0 ± 0.5 vs. 5.5 ± 0.1; p = 0.203), and GIQLI (95.8 ± 8.4 vs. 107.3 ± 2.6; p = 0.119) were not significantly inferior to uncomplicated controls.

Conclusions

In case of PRSC, even multiple surgical approaches are worthwhile as the outcome of salvaged pouches in terms of function and quality of life is not substantially inferior to patients without septic complications.

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References

  1. Parks AG, Nicholls RJ (1978) Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 2:85–88

    Article  PubMed  CAS  Google Scholar 

  2. Berndtsson I, Lindholm E, Oresland T, Borjesson L (2007) Long-term outcome after ileal pouch-anal anastomosis: function and health-related quality of life. Dis Colon Rectum 50:1545–1552

    Article  PubMed  Google Scholar 

  3. 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. Colorectal Dis 5:228–232

    Article  PubMed  CAS  Google Scholar 

  4. Lovegrove RE, Tilney HS, Heriot AG, von Roon AC, Athanasiou T, Church J, Fazio VW, Tekkis PP (2006) A comparison of adverse events and functional outcomes after restorative proctocolectomy for familial adenomatous polyposis and ulcerative colitis. Dis Colon Rectum 49:1293–1306

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  6. Holubar S, Hyman N (2003) Continence alterations after ileal pouch-anal anastomosis do not diminish quality of life. Dis Colon Rectum 46:1489–1491

    Article  PubMed  Google Scholar 

  7. Kohler LW, Pemberton JH, Hodge DO, Zinsmeister AR, Kelly KA (1992) Long-term functional results and quality of life after ileal pouch-anal anastomosis and cholecystectomy. World J Surg 16:1126–1131, discussion 1131–1132

    Article  PubMed  CAS  Google Scholar 

  8. Hueting WE, Buskens E, van der Tweel I, Gooszen HG, van Laarhoven CJ (2005) Results and complications after ileal pouch anal anastomosis: a meta-analysis of 43 observational studies comprising 9,317 patients. Dig Surg 22:69–79

    Article  PubMed  Google Scholar 

  9. Weston-Petrides GK, Lovegrove RE, Tilney HS, Heriot AG, Nicholls RJ, Mortensen NJ, Fazio VW, Tekkis PP (2008) Comparison of outcomes after restorative proctocolectomy with or without defunctioning ileostomy. Arch Surg 143:406–412

    Article  PubMed  Google Scholar 

  10. Raval MJ, Schnitzler M, O’Connor BI, Cohen Z, McLeod RS (2007) Improved outcome due to increased experience and individualized management of leaks after ileal pouch-anal anastomosis. Ann Surg 246:763–770

    Article  PubMed  Google Scholar 

  11. Heuschen UA, Allemeyer EH, Hinz U, Lucas M, Herfarth C, Heuschen G (2002) Outcome after septic complications in J pouch procedures. Br J Surg 89:194–200

    PubMed  CAS  Google Scholar 

  12. Sagap I, Remzi FH, Hammel JP, Fazio VW (2006) Factors associated with failure in managing pelvic sepsis after ileal pouch-anal anastomosis (IPAA)—a multivariate analysis. Surgery 140:691–703, discussion 703–694

    Article  PubMed  Google Scholar 

  13. Farouk R, Dozois RR, Pemberton JH, Larson D (1998) Incidence and subsequent impact of pelvic abscess after ileal pouch-anal anastomosis for chronic ulcerative colitis. Dis Colon Rectum 41:1239–1243

    Article  PubMed  CAS  Google Scholar 

  14. Tulchinsky H, Cohen CR, Nicholls RJ (2003) Salvage surgery after restorative proctocolectomy. Br J Surg 90:909–921

    Article  PubMed  CAS  Google Scholar 

  15. Chessin DB, Gorfine SR, Bub DS, Royston A, Wong D, Bauer JJ (2008) Septic complications after restorative proctocolectomy do not impair functional outcome: long-term follow-up from a specialty center. Dis Colon Rectum 51:1312–1317

    Article  PubMed  Google Scholar 

  16. Selvaggi F, Sciaudone G, Limongelli P, Di Stazio C, Guadagni I, Pellino G, De Rosa M, Riegler G (2010) The effect of pelvic septic complications on function and quality of life after ileal pouch-anal anastomosis: a single center experience. Am Surg 76:428–435

    PubMed  Google Scholar 

  17. Hallberg H, Stahlberg D, Akerlund JE (2005) Ileal pouch-anal anastomosis (IPAA): functional outcome after postoperative pelvic sepsis. A prospective study of 100 patients. Int J Colorectal Dis 20:529–533

    Article  PubMed  Google Scholar 

  18. Breen EM, Schoetz DJ Jr, Marcello PW, Roberts PL, Coller JA, Murray JJ, Rusin LC (1998) Functional results after perineal complications of ileal pouch-anal anastomosis. Dis Colon Rectum 41:691–695

    Article  PubMed  CAS  Google Scholar 

  19. Oresland T, Fasth S, Nordgren S, Hulten L (1989) The clinical and functional outcome after restorative proctocolectomy. A prospective study in 100 patients. Int J Colorectal Dis 4:50–56

    Article  PubMed  CAS  Google Scholar 

  20. Irvine EJ, Zhou Q, Thompson AK, Archambault A, Feagan B, Fedorak R, Groll R, Laupacis A, McDonald JWD, Rochon J et al (1996) The short inflammatory bowel disease questionnaire: a quality of life instrument for community physicians managing inflammatory bowel disease. Am J Gastroenterol 91:1571–1578

    PubMed  CAS  Google Scholar 

  21. 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  PubMed  CAS  Google Scholar 

  22. 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  PubMed  CAS  Google Scholar 

  23. Tulchinsky H, Hawley PR, Nicholls J (2003) Long-term failure after restorative proctocolectomy for ulcerative colitis. Ann Surg 238:229–234

    PubMed  Google Scholar 

  24. Forbes SS, O’Connor BI, Victor JC, Cohen Z, McLeod RS (2009) Sepsis is a major predictor of failure after ileal pouch-anal anastomosis. Dis Colon Rectum 52:1975–1981

    Article  PubMed  Google Scholar 

  25. de Montbrun SL, Johnson PM (2009) Proximal diversion at the time of ileal pouch-anal anastomosis for ulcerative colitis: current practices of North American colorectal surgeons. Dis Colon Rectum 52:1178–1183

    Article  PubMed  Google Scholar 

  26. Kiran RP, da Luz Moreira A, Feza H, Remzi FH, Church JM, Lavery I, Hammel J, Fazio VW (2010) Factors associated with septic complications after restorative proctocolectomy. Ann Surg 251:442–446

    Article  Google Scholar 

  27. Dayton MT, Larsen KP (1997) Outcome of pouch-related complications after ileal pouch-anal anastomosis. Am J Surg 174:728–731, discussion 731–722

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of General and Visceral Surgery, University Hospital Muenster, Waldeyerstr. 1, 48149, Muenster, Germany

    Rudolf Mennigen, Norbert Senninger, Matthias Bruewer & Emile Rijcken

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  1. Rudolf Mennigen
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  2. Norbert Senninger
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  3. Matthias Bruewer
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  4. Emile Rijcken
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Correspondence to Rudolf Mennigen.

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Mennigen, R., Senninger, N., Bruewer, M. et al. 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 (2012). https://doi.org/10.1007/s00423-011-0802-y

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