Pouch size: The important functional determinant after restorative proctocolectomy

Abstract

Sixty-seven patients with a J-shaped ileonanal pouch were studied over a 2-year period with regular recording of sphincter and pouch characteristics and analysis of their role in functional outcome. Although there was a 27 per cent permanent reduction in resting anal pressure (RAP) (P less than 0.001), two-thirds of the patients still had a RAP within the normal range. The mean(s.d.) pouch volume increased during the first year from 132(46) ml to 282(85) ml. RAP was not related to functional outcome and preoperative RAP was not predictive of subsequent function. Large pouch volume and compliance correlated with low defaecation frequency (range of r = 0.27-0.36; P less than 0.05) and good overall function (r = 0.37-0.56; P less than 0.01). The initial pouch volume was predictive of subsequent overall function. The ileal length used for pouch construction predicted subsequent pouch volume (r = 0.48; P less than 0.001) and to some extent functional outcome (r = 0.28-0.37; P less than 0.05). However, the studied variables accounted for only 21 per cent of the total variance of functional outcome.

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

“…Some of this improvement in quality of life in the long term may be the result of increased coping mechanisms. 27 This series confirmed the findings of other large series showing a high level of patient satisfaction with pelvic pouches. 14,25 As it was for quality of life, this satisfaction was maintained over time.…”

Long-Term Functional Outcome of Colonic J-pouch Reconstruction After Low Anterior Resection for Rectal Cancer

“…This scoring system, which has been used by several investigators, was designed to quantify overall functional results and is calculated by the simple addition of all arbitrary scores. 26,[52][53][54][55] The distance from the anal verge to the anastomosis in colonic J-pouch reconstruction has been reported to range from 1 to 8 cm, 7,[9][10][11]19,21,23 although the ideal anastomotic location for colonic J-pouch reconstruction has not been established. In a previous study, we tried to determine the level at which J-pouch reconstruction provides a functional advantage over straight anastomosis and found that colonic J-pouch reconstruction is indicated when the anastomosis is less than 8 cm from the anal verge, and is essential when it is less than 4 cm from the anal verge.…”

Salvage surgery after restorative proctocolectomy

“…Of these 32 were symptomatic and 28 needed treatment. The symptoms of retained inflamed mucosa are those of proctitis, including bleeding, burning and urgency 109,110 . Disordered evacuation with the frequent passage of small amounts of stool may also occur, and patients are at continuing risk of neoplastic transformation 111 .…”