J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients

Br J Surg. 1998 Jun;85(6):800-3. doi: 10.1046/j.1365-2168.1998.00689.x.


Aim: The purpose of the study was to determine the risk of postoperative complications and the functional outcome after a hand-sewn ileal pouch-anal anastomosis (IPAA) for ulcerative colitis using a single J-shaped pouch design.

Methods: Preoperative function, operative morbidity and long-term functional outcome were assessed prospectively in 1310 patients who underwent IPAA between 1981 and 1994 for ulcerative colitis.

Results: Three patients died after operation. Postoperative pelvic sepsis rates decreased from 7 per cent in 1981-1985 to 3 per cent in 1991-1994 (P = 0.02). After mean follow-up of 6.5 (range 2-15) years, the mean number of stools was 5 per day and 1 per night. Frequent daytime and nighttime incontinence occurred in 7 and 12 per cent of patients respectively, and did not change over a 10-year period. The cumulative probability of suffering at least one episode of 'clinical' pouchitis was 18 and 48 per cent at 1 and 10 years and the cumulative probability of pouch failure at 1 and 10 years was 2 and 9 per cent respectively.

Conclusion: These results indicate that increased experience decreases the risk of pouch-related complications and that with time the functional results remain stable, but the failure rate increases.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Colitis, Ulcerative / physiopathology
  • Colitis, Ulcerative / surgery*
  • Defecation / physiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pouchitis / etiology
  • Proctocolectomy, Restorative / adverse effects
  • Proctocolectomy, Restorative / methods*
  • Risk Factors
  • Sexual Dysfunction, Physiological / etiology
  • Treatment Failure