Complications and functional outcomes of restorative proctocolectomy for ulcerative colitis in the elderly

Abstract

BackgroundRestorative proctocolectomy with ileopouch-anal anastomosis (IPAA) is the treatment of choice for intractable or complicated ulcerative colitis (UC). Debate exists concerning outcomes of IPAA in the elderly and literature data are scarce. We report our experience of IPAA in older population.MethodsWe gathered data on a prospective database of patients undergoing IPAA for UC over 70 years of age in our Unit from January 1990 through January 2010. Patients were compared with randomly selected younger controls on a 1:3 ratio. Patients underwent IPAA in 2 or 3 stages. Demographical data, disease characteristics, comorbidities, concomitant medications, peri-operative management, intra- and post-operative complications were analyzed. Function and quality of life were assessed by clinical visit and Inflammatory Bowel Disease Questionnaire 1 and 3 years after ileostomy takedown.ResultsTwenty-seven elderly patients underwent IPAA for UC in the study period; these were compared with 81 younger controls. The former had more comorbidities and higher ASA score. All patients underwent loop-ileostomy closure. There were no differences between groups concerning the rate of major complications, but elderly patients more frequently had nuisances due to stoma output. Younger patients experienced significantly more episodes of small bowel obstruction. No significant differences in bowel control and health-related quality of life was observed, except for an higher rate of elderly patients taking antidiarrhoeals at 1-year follow-up; this observation was not confirmed at 3-year follow-up. A minimal decrease in continence was observed, but this did not affect overall satisfaction.ConclusionsIPAA can be safely offered to selected elderly UC patients who are strongly motivated and with no clinical disturbances of continence. In experienced hands no differences are likely to be expected concerning complications, quality of life and function. Results are stable with time and comparable to those of younger patients.

Thyroid Surgery in the Elderly: A Comparative Experience of 400 Patients From an Italian University Hospital

“…[14][15][16][17][18] This has been possible due to technical 19,20 and technological advancements 5,6,17,20,21 in perioperative management of frail patients, who have some peculiarities.…”

Endoscopic Detection and Surgical Treatment of Colorectal Cancer in Octogenarians

“…Conversely, diagnostic as well as surgical advances have recently allowed performing even complex procedures in older patients, with good outcomes [4][5][6].…”

Pouch-related fistula and intraoperative tricks to prevent it

“…Irrespective of age at surgery and disease duration [2,3], IPAA achieves optimal functional results, and this is reflected in health-related quality of life (HRQoL). Early postoperative pelvic sepsis, which is responsible for significant functional disturbances [4] and impaired HRQoL in the long term [1][2][3][4][5][6], is the most dreaded complication of IPAA [4,5]. Up to 25 % of IPAA patients are affected to some degree [1][2][3][4][5][6][7] and are at greater risk of pouch-related fistula.…”

“…In spite of the advances in the medical treatment for UC, up to 30 % of patients may still require surgery [1]. Irrespective of age at surgery and disease duration [2,3], IPAA achieves optimal functional results, and this is reflected in health-related quality of life (HRQoL). Early postoperative pelvic sepsis, which is responsible for significant functional disturbances [4] and impaired HRQoL in the long term [1][2][3][4][5][6], is the most dreaded complication of IPAA [4,5].…”

“…Early postoperative pelvic sepsis, which is responsible for significant functional disturbances [4] and impaired HRQoL in the long term [1][2][3][4][5][6], is the most dreaded complication of IPAA [4,5]. Up to 25 % of IPAA patients are affected to some degree [1][2][3][4][5][6][7] and are at greater risk of pouch-related fistula. The risk of pelvic sepsis is inversely proportional to the surgeon's experience with pouch surgery, suggesting that some factors responsible for pelvic sepsis and late formation of pouch-related fistulae are modifiable.…”