Objective: The aim of this study was to evaluate long-term quality of life (QOL) and functional outcome in patients who had undergone proctocolectomy with ileal pouch anal anastomosis (IPAA).
Background: IPAA is considered the surgical procedure of choice in ulcerative colitis (UC) and familiar adenomatous polyposis (FAP). QOL and defecatory function are important factors for evaluating outcome.
Methods: A total of 156 patients with UC or FAP who underwent IPAA at Aker University Hospital (AUS) or Ullevål University Hospital (UUS) during the period 1984 2003, and who still had an intact pouch, were included. QOL was evaluated with the SF-36 questionnaire, and the patients were compared with 4152 individuals from the general Norwegian population. Functional outcome in the patient group was evaluated with the Wexner Continence Grading Scale.
Results: Of the 156 patients, 110 (71 %) answered the questionnaires, 60 (55 %) of whom were men. A total of 105 patients had UC, four had FAP and one had indeterminate colitis. Median (range) age at interview was 47 (19 66) years, and time after surgery was 12 (2 22) years. Forty-three (39 %) of the patients had had pouchitis in the course of the follow-up period.
IPAA patients scored slightly, but significantly, lower in four of six SF-36 health dimensions than the controls, adjusted for age and gender. Multiple regression analysis showed faecal incontinence score, urgency of defecation, pouchitis and female sex to be independent negative prognostic factors for QOL. Defecatory function was affected in a large number of patients; they had median (range) 7 (3 12) bowel movements during the day and 2 (0 6) at night, the majority reported some degree of faecal incontinence with a median (range) Wexner score of 8 (0 17), and 40 % reported urgency of defecation necessitating alterations in lifestyle.
Conclusion: Patients with IPAA reported slightly lower QOL than the general population and had an inferior functional outcome. This should be taken into account when informing and counselling patients with colitis about treatment alternatives.
Keywords: Faecal incontinence, functional outcome, ileal pouch anal anastomosis (IPAA), QOL, SF-36, ulcerative colitis, Wexner Continence Grading Scale.