What are reported outcomes for IPAA to treat ulcerative colitis (UC)?

Updated: Apr 01, 2019
  • Author: E Stanton Adkins, III, MD; Chief Editor: Harsh Grewal, MD, FACS, FAAP  more...
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Answer

Research suggests that after restorative proctocolectomy with IPAA, patients tend to have inferior functional outcomes and poorer long-term health-related quality of life (HRQOL) as compared with study controls. [23, 24]  Such results were found in a study by Andersson et al, who compared HRQOL in 105 patients with UC (and five patients with familial adenomatous polyposis [FAP]), all with an intact pouch, with that of 4152 individuals from the general population. [23]

In the study by Andersson et al, [23] median patient follow-up time was 12 years (range, 2-22 years) after surgery. IPAA patient scores in four of six health domains on the Short Form (SF)-36 questionnaire were slightly, but significantly, lower than in members of the general population. In addition, IPAA patients had median defecation frequencies of seven bowel movements during the day and two per night. Moreover, 40% of the patients reported the need to make lifestyle alterations because of urgency of defecation, and most of the patients experienced fecal incontinence.

In a multicenter study that included 351 respondents to a cross-sectional survey of consecutive UC patients older than 18 years who had had a colectomy within the past 10 years, 84% of respondents had better quality of life after the procedure, but 81% had problems in one or more of the following areas: depression, work productivity, restrictions in diet, body image, and sexual function. [25]

Every patient who undergoes an IPAA procedure, as currently performed, must be able to accept the possibilities of stool seepage or incontinence and frequent bowel movements, with a minimum of four to six per day. Although the procedure results in removal of the diseased organ and is more technically advanced than end ileostomy, it is not a perfect solution. Surgical techniques can be improved to ensure better postoperative functional outcomes.


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