Effect of vaginal delivery on long-term pouch function

Abstract

Women who had RP and vaginal delivery with a high risk of obstetric injury had impaired continence with ageing and longer follow-up. Patients with RP should be informed about the considerable risk of vaginal delivery on long-term ileal pouch function.

Pouch function and gastrointestinal complications during pregnancy after ileal pouch-anal anastomosis

“…The review of gastrointestinal or pouch complications included eight of the 14 studies [4,7,9,10,12,14,16,18]. Of the six studies which were excluded, three did not report complications [13,15,17] and three included women reported in more recent publications [7,8,11]. Overall, the rate of complications in 283 pregnancies following IPAA was 12.7% (36/ 283; Table II).…”

“…The remainder used proprietary questionnaires. Some studies included all pregnancies after IPAA while others included only the first pregnancy after IPAA [8], most recent pregnancy [10], or did not differentiate between pregnancies before and after IPAA [17]. A cohort of women who became pregnant after appendectomy was used as controls in one study [18].…”

“…Only two studies utilized validated questionnaires including the colorectal functional outcome questionnaire [17], Short Form-36 quality of life questionnaire [16], American Society of Colorectal Surgeons fecal incontinence severity index [16], time trade-off method [16], and the Cleveland Global Quality of Life scale [16]. Only the Cleveland Global Quality of Life scale is specifically validated for IPAA.…”

“…Literature review identified 14 manuscripts pertaining to pregnancy after IPAA [4,[6][7][8][9][10][11][12][13][14][15][16][17][18] including eight case reports or series and six cohort or case-control studies (Table I).…”

Womenʼs Health Issues After Ileal Pouch Surgery

“…Two studies including patients undergoing vaginal delivery with similar follow-up periods (7.2 yr versus 8 yr) found contrasting results. One study (n ¼ 52) reported a high risk of obstetric injury and impaired continence, 91 whereas the other study (n ¼ 85) found the lack of adverse impact on pouch functions. 92 Additionally, other studies that compared vaginal delivery with C-section found no difference in pouch functional outcomes, despite one study having higher incidence of sphincter dysfunction in patients who underwent vaginal delivery.…”