Background: Laparoscopic total proctocolectomy and ileal pouch anal-anastomosis (IPAA) is widely used surgical treatment in severe, therapy refractory ulcerative colitis (UC). Our aim was to assess influence of timing of IPAA surgery (urgent vs. elective procedure) on long-term functional outcome, early and late complication rates, patient reported outcome self-image and quality of life in UC patients who underwent IPAA surgery.
Methods: Demographic and clinical data was collected. Pouch function was established with the Öresland score. Body self-image after IPAA surgery was assessed with Dunker's body image questionnaire. Quality of life (physical, social, emotional status) was measured with Short Inflammatory Bowel Disease Questionnaire. Data were compared concerning the timing of surgical intervention.
Results: 30 patients were enrolled in this prospective study. 46.7% of the patients underwent IPAA surgery due to the acute, severe UC and 53.3% of the cases because of chronic, therapy refractory UC or UC related colorectal carcinoma. The most common early complication was suture failure (23.3%) and subileus/ileus (30%) whereas the most frequent late complication was pouchitis (53.3%) and anastomosis stricture (23.3%). No difference was found between the urgent vs elective group regarding early complications and re-operation rate after IPAA procedure (p=0.3; p=0.7). Body mass index increased significantly after IPAA surgery (p=0.0003). Pouchitis was observed in 43.3% of patients and cuffitis was present in 20% of subjects during the follow-up. No significant difference was found between patients with and without pouchitis regarding to daily stool number and fecal incontinence. Rate of fecal incontinence was 26.6% at daytime and 53.3% at night. 59% of our patients think that they have some social disadvantage due to their health condition. However, self-image of the patients presented no significant difference before and after surgery independently of the timing. Patient reported outcome (PRO) was positive in more than three-quarter of the patients after IPAA procedure.
Conclusions: Our results shows that quality of life, PRO and self-image seems to be good among UC patients after IPAA surgery despite of frequent long-term functional abnormalities and complications independently of timing of surgery.