Health-related quality of life after ileoanal pull-through evaluation and assessment of new health status measures

Provenzale, Dawn; Shearin, M.; Phillips-Bute, BG; Drossman, D. A.; Li, Z; Tillinger, Wolfgang; Schmitt, Colleen M.; Bollinger, R. Randal; Mj, Koruda

doi:10.1016/s0016-5085(97)70074-x

Cited by 88 publications

(52 citation statements)

References 3 publications

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“…8 Its validity and reliability have been well established in multiple populations, including the Japanese, 11 and in patients with IPAA. 12 With SF-36, we found no significant differences between the 2 anastomotic techniques in all subscales, and the recorded scores were almost equivalent to the published norms for the general Japanese population. IBDQ is the most widely used disease-specific health-related QOL questionnaire for patients with IBD and has been shown to be reliable in a clinical setting.…”

Section: Discussionsupporting

confidence: 75%

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Comparison of Functional Outcomes of Patients Who Underwent Hand-Sewn or Stapled Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Ishii

Kawai

Hata

et al. 2015

International Surgery

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Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for patients with ulcerative colitis (UC). The purpose of this study was to investigate the long-term functional outcomes and quality of life (QOL) associated with hand-sewn and stapled IPAA. Ninety-one patients with UC had undergone IPAA using hand-sewn anastomosis with mucosectomy (32 patients) or stapled anastomosis (59 patients) from January 1988 to May 2010. Patients were evaluated according to patient characteristics, postoperative complications, functional outcomes and QOL. The QOL of patients were evaluated using the Medical Outcomes Study Short Form 36 (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ). Numbers of patients with colorectal cancer or dysplasia were significantly greater in the hand-sewn IPAA group (P , 0.01). These patients had longer disease durations and were older (both P , 0.01). There was no difference in the incidence of complications between the groups, except for a greater incidence of postoperative anal fistula in the stapled group (P ¼ 0.03). In the early postsurgery period, both the frequency of bowel movements and the rate of soiling were significantly higher in the hand-sewn group, but in a later period, there was no difference in these events .3 years after surgery. The SF-36 and IBDQ results were similar in the two groups, indicating that hand-sewn and stapled IPAA result in similar QOL in the late postoperative Corresponding author: Hiroaki Ishii, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. Total proctocolectomy with ileal pouch-anal anastomosis (IPAA), which was first described in 1978 by Parks and Nicholls, 4 has become established as the standard surgical treatment for patients with UC. The problems with IPAA are that the excision close to the anal sphincter may result in impaired anal function that may cause neurologic damage to the rectum, in turn resulting in urinary and sexual dysfunction. The anastomosis of ileal pouch leads to diarrhea and frequent bowel movements that may adversely affect patients' quality of life (QOL). Two different anastomotic techniques are generally used in IPAA: handsewn anastomosis with mucosectomy, which removes all rectal mucosa to the dentate line, and stapled anastomosis (Fig. 1). Patients who undergo hand-sewn anastomosis are thought to develop impaired anal function and QOL more than that in patients who underwent stapled anastomosis.Although some reports have suggested that the stapled anastomosis provides a better functional outcome than the hand-sewn anastomosis, 5-7 no report has investigated the difference between a hand-sewn IPAA and a stapled IPAA with regard to QOL using validated questionnaires.We reviewed postoperative complications and evaluated postoperative function both objectively and subjectively. We compared long-term functional outcomes and QOL between these two techniques, using the Medical Outcomes Study Short Form 36 (SF-36), 8 which is a validated generic QOL instrument, and the inflammatory bowel di...

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Section: Discussionsupporting

confidence: 75%

“…This scale's validity and reliability have been well established. 11,12 According to normbased scoring, the national standard value is 50, and the standard deviation is 10. Higher scores are associated with better QOL.…”

Section: Medical Outcomes Study Short Form 36mentioning

confidence: 99%

Comparison of Functional Outcomes of Patients Who Underwent Hand-Sewn or Stapled Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Ishii

Kawai

Hata

et al. 2015

International Surgery

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“…[13][14][15][16][17] The present study is unique because, to our knowledge, it is the largest series in the literature to date that has a long duration of follow-up and that measures quality of life at multiple time points using a validated instrument. In addition, although previous large reports included a relatively high proportion of patients who underwent mucosectomy and hand-sewn anastomosis, the current study is confined to patients with a stapled IPAA, which in our opinion is now the procedure of choice unless specifically contraindicated.…”

Section: Discussionmentioning

confidence: 99%

“…7 It has previously been validated in patients after ileal pouch surgery. 17 The second prerequisite of a quality-of-life measure is responsiveness, or the sensitivity of the scale to measure change over time. We hypothesized that patients with a Outcome After Stapled Restorative Proctocolectomy clinically significant increase in stool frequency from below the median of the group to above the 90th percentile would undergo a decrease in the quality of life, and vice versa.…”

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confidence: 99%

“…The CGQL has the great advantage of its simplicity and ease of self-administration, particularly for repeated measures in large groups of patients. Like the time trade-off technique and the direct questioning of objectives technique, which are the other utility measures commonly applied in patients with inflammatory bowel disease and those who undergo pouch surgery, 16,17 the CGQL also has an advantage that the absence of very specific questions may avoid introducing a certain source of bias into the quality-of-life score. For example, use of increased stool frequency as an indicator of poor quality of life in patients with inflammatory bowel disease may bias the scale in favor of medical therapy; five or six bowel movements per day may be associated with disease activity and poor quality of life in medically treated patients with ulcerative colitis but may be irrelevant in patients with ileostomy and may be very well tolerated and associated with an excellent quality of life in patients with a pelvic pouch, as shown in the current study.…”

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confidence: 99%

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Long-Term Functional Outcome and Quality of Life After Stapled Restorative Proctocolectomy

Fazio¹,

O’Ríordáin²,

Lavery³

et al. 1999

Annals of Surgery

419

286

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ObjectiveTo evaluate prospectively long-term quality of life and functional outcome after restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis, and to evaluate and validate a novel quality-of-life indicator in this group of patients. Summary Background DataRestorative proctocolectomy with ileal pouch-anal anastomosis is now the preferred option when total proctocolectomy is required for ulcerative colitis or familial adenomatous polyposis, but long-term data on functional outcome and quality of life after the procedure are lacking. MethodsPatients (n ϭ 977) who underwent RPC with stapled anastomosis for colitis or polyposis coli and who were followed for Ն12 months were included. Quality of life, fecal incontinence, and satisfaction with surgery were prospectively evaluated by structured interview or questionnaire for 1 to 12 years after surgery (median 5.0). Quality of life was scored using the Cleveland Global Quality of Life (CGQL) instrument (Fazio Score). This is a novel score developed over the past 15 years by the senior author. Quality of life was also evaluated in a subgroup of patients with the Short Form 36 (SF-36). The CGQL was validated by determining its reliability, responsiveness, and validity as well as its correlation with the SF-36 score. ResultsPostoperative quality of life as measured by SF-36 was excellent and compared well with published norms for the general U.S. population. The CGQL was found to be reliable, responsive, and valid, and there was a high correlation with the SF-36 scores. Using the CGQL, quality of life was shown to increase after the first 2 years after surgery, and there was no deterioration thereafter. The prevalence of perfect continence increased from 75.5% before surgery to 82.4% after surgery, and although this deteriorated somewhat Ͼ2 years after surgery, it was no worse than preoperative values. Ninety-eight percent of patients would recommend the surgery to others. ConclusionsLong-term quality of life after ileal pouch surgery is excellent and the level of continence is satisfactory. This surgery is an excellent long-term option in patients requiring total proctocolectomy. The CGQL is a simple, valid, and reliable measure of quality of life after pelvic pouch surgery and may well be applicable in many other clinical conditions.Reconstructive proctocolectomy (RPC) with formation of ileal pouch-anal anastomosis (IPAA) was introduced by Parks and Nicholls in 1978. 1 Panproctocolectomy with IPAA is considered the preferred option for the surgical treatment of inflammatory bowel disease because it removes the diseased bowel, reduces the risk of cancer, and preserves a natural route for defecation while maintaining fecal continence and avoiding the need for a permanent stoma. 2Restorative proctocolectomy is also recommended for the majority of patients with familial adenomatous polyposis, particularly where the rectum is significantly affected by adenomas. We and others have shown that the operation is safe and effective in the majority of patients. [3][4...

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Effect of Surgery on Health-Related Quality of Life in Patients With Inflammatory Bowel Disease

Thirlby

Land²,

Fenster³

et al. 1998

Arch Surg

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Background: Health-related quality of life (HRQL) has increasingly become a factor in management decisions in patients with chronic diseases. Objective: To measure the effect of surgical resection on quality of life in patients with inflammatory bowel disease (IBD). Design: A consecutive series of patients undergoing surgery for IBD between June 1994 and December 1997 were prospectively investigated as a cohort outcomes study. Patients: Data were obtained in 63 patients. The primary diagnoses were Crohn's disease (n = 36) and ulcerative colitis (n = 27). Intervention: Patients with Crohn's disease underwent resection with or without stricturoplasty for intractable disease; all but 3 patients with ulcerative colitis underwent ileoanal anastomoses with ileoanal resevoir. Main Outcome Measure: Health status was measured using the Health Status Questionnaire preop-eratively and every 3 months postoperatively. Results: Preoperative measures of HRQL of the patients were low, with values well below the general population in all 8 scales of the Health Status Questionnaire. Postoperatively, HRQL measures improved significantly (PϽ.05) in both patients with Crohn's disease and those with ulcerative colitis, with scores equal to the general population in most scales. For example, average raw scores for general health in previously studied patient groups were 59 in patients with asthma, 55 in those with diabetes mellitus, 74 in the general population, and 54 and 73 preoperatively and postoperatively, respectively, in the present study. Conclusions: The results of this study confirm that HRQL scores are low in many patients with IBD referred for operation and HRQL scores improve postoperatively to levels comparable to those of the general population. We believe these data justify early surgical intervention in many patients with symptomatic IBD.

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Health-related quality of life after ileoanal pull-through evaluation and assessment of new health status measures

Abstract: HRQL of patients with ileoanal pull-through is excellent. The SF-36 and RFIPC are valid health status measures that can be used by clinicians and researchers in these patients.

Cited by 88 publications

References 3 publications

Comparison of Functional Outcomes of Patients Who Underwent Hand-Sewn or Stapled Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Comparison of Functional Outcomes of Patients Who Underwent Hand-Sewn or Stapled Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Long-Term Functional Outcome and Quality of Life After Stapled Restorative Proctocolectomy

Effect of Surgery on Health-Related Quality of Life in Patients With Inflammatory Bowel Disease

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