Is Age Relevant to Functional Outcome After Restorative Proctocolectomy for Ulcerative Colitis?

Takao, Yoshihiko; Gilliland, R.; Nogueras, Juan J.; Weiss, Eric G.; Wexner, Steven D.

doi:10.1097/00000658-199802000-00006

Cited by 61 publications

(42 citation statements)

References 34 publications

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“…[5][6][7]21,22 In a recent National Surgical Quality Improvement Plan (NSQIP) study, patients older than 60 years undergoing IPAA had a similar mean number of postoperative complications and only a small, nonsignificant increase in the length of hospital stay. 23 Interestingly, a recent study described that the use of end ileostomy in patients aged 61 to 70 years is decreasing over time because the aforementioned evidence accumulates that IPAA is an acceptable option for older patients with CUC.…”

Section: Discussionmentioning

confidence: 99%

Results at Up to 30 Years After Ileal Pouch–Anal Anastomosis for Chronic Ulcerative Colitis

Lightner

Mathis

Dozois

et al. 2017

Inflammatory Bowel Diseases

122

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Section: Discussionmentioning

confidence: 99%

Results at Up to 30 Years After Ileal Pouch–Anal Anastomosis for Chronic Ulcerative Colitis

Lightner

Mathis

Dozois

et al. 2017

Inflammatory Bowel Diseases

122

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“…One possible factor is a decrease in anal function with advancing age, 30,31 although Takao et al have shown that age at the time of surgery does not influence functional outcome after pouch surgery. 32 We have previously reported on the effect of factors such as pouch size and compliance, internal and external sphincter tone, stool consistency, and the completeness of evacuation on fecal continence, 33 but these factors were not addressed in the current study. Nevertheless, even at Ͼ8 years after surgery, the prevalence of incontinence in the current study was no higher than that reported before surgery.…”

mentioning

confidence: 86%

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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“…Although it has been suggested in recent years that IPAA did not have good functional outcomes in patients above the age of 50, it was demonstrated that restorative proctocolectomy could be safely performed even in patients above 70 years (14,15). Twelve of our cases were above the age of 50 and three of them were above the age of 70.…”

Section: Discussionmentioning

confidence: 51%

“…Their mean age was 45 years . The mean length of hospital stay was 11 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) days. Twenty two (63%) were treated due to FAP, 12 (34%) for colon tumor or polyp with concomitant rectum cancer and 1 (3%) for severe dysplasia in ulcerative colitis.…”

Section: Resultsmentioning

confidence: 99%

Review of our ileal pouch experience in the light of literature

Çakır

Doğan

Küçükkartallar

et al. 2015

UCD

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Objective: Retrospective proctocolectomy is a distinguished, sphincter saving treatment used for the treatment of ulcerative colitis and FAP disease. We aimed to evaluate ileal pouch interventions performed at our clinic and their results in the light of literature. Material and Methods:Medical records of 35 restorative proctocolectomy and J pouch ileo-anal anastomosis surgeries performed at Necmettin Erbakan University, Meram School of Medicine between the years 2006-2013 were retrospectively examined. The patients were assessed according to their age, gender, length of hospital stay, diagnosis, follow-up duration and pouch-related complications. All patients were contacted by phone and they were scheduled for controls at the outpatient clinic.Results: Nineteen patients were male (54%) and 16 were female (46%). Their mean age was 45 years (21-74). The mean length of hospital stay was 11 (5-20) days. Twenty two (63%) patients were operated on due to FAP, 12 (34%) due to synchronous rectum cancer and colon tumor or polyp, and one (3%) due to ulcerative colitis. All patients received J pouch and protective ileostomy. After the closure of ileostomy, two cases were identified to have J pouch fistulas. The patients were followed up for 6 months to 7 years. They were contacted by phone and they were questioned about their active complaints, number of defecations, urinary and sexual dysfunctions. It was identified that they had 5 (3-8) defecations per day on average and that 4 (11%) cases had one nocturnal defecation. No pouchitis was identified in the follow-up endoscopic examinations. Conclusion:Restorative proctocolectomy and ileo-anal anastomosis technique is a surgical procedure that can be performed with low rates of morbidity and mortality, including the elderly.

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Is Age Relevant to Functional Outcome After Restorative Proctocolectomy for Ulcerative Colitis?

Abstract: Although anorectal function is transiently somewhat impaired after restorative proctocolectomy, the impairment is not an age-related phenomenon.

Cited by 61 publications

References 34 publications

Results at Up to 30 Years After Ileal Pouch–Anal Anastomosis for Chronic Ulcerative Colitis

Results at Up to 30 Years After Ileal Pouch–Anal Anastomosis for Chronic Ulcerative Colitis

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

Review of our ileal pouch experience in the light of literature

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