Quality of life after restorative proctocolectomy for ulcerative colitis: preoperative status and long-term results

Inflamm Bowel Dis. 2007 Oct;13(10):1228-35. doi: 10.1002/ibd.20175.


Background: Restorative proctocolectomy has become the surgical procedure of choice in patients with ulcerative colitis. Only smaller studies have compared postoperative to preoperative quality of life (QoL).

Methods: Patients with ulcerative colitis who had undergone restorative proctocolectomy at least 5 years before and who had filled out a disease-specific validated questionnaire (Gastrointestinal Quality of Life Index, GIQLI) prior to surgery (n = 128) were included into this follow-up study. Factors potentially influencing QoL at the time of operation were investigated with regard to pre- and postoperative QoL in univariate and multivariate analysis.

Results: A total of 105 patients responded (82%). QoL at least 5 years after colectomy was significantly improved compared to the preoperative situation (109 versus 75). This improvement was evident in all 5 dimensions (P < 0.0001). The Colitis Activity Index (CAI) (P < 0.00001), a shorter duration of the disease (P < 0.05), and a 3-staged procedure (<0.001) were negatively correlated with preoperative QoL, whereas neoplasia (P < 0.001) was positively correlated. Colectomy was the reason for most of the increase in QoL. Ileostomy closure resulted in a further improvement in 3 of 5 dimensions but not in overall QoL. Uni- and multivariate analysis of the difference in QoL before and 5 years after colectomy revealed CAI, the type of operation (both P < 0.001), and neoplasia as significant factors (P < 0.05).

Conclusions: The patients in the worst clinical situation profit the most from restorative proctocolectomy.

MeSH terms

  • Adult
  • Colitis, Ulcerative / psychology*
  • Colitis, Ulcerative / surgery
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Postoperative Period
  • Proctocolectomy, Restorative / psychology*
  • Prospective Studies
  • Quality of Life*
  • Surveys and Questionnaires
  • Time Factors
  • Treatment Outcome