August 1993

Prospective Assessment of Functional Results After Ileal J Pouch—Anal Restorative Proctocolectomy

Author Affiliations

From the Department of Surgery, University of Chicago (Ill).

Arch Surg. 1993;128(8):889-895. doi:10.1001/archsurg.1993.01420200063011

Objective:  To document the functional results of 50 consecutive patients who underwent hand-sewn ileal J pouch—anal restorative proctocolectomy for ulcerative colitis between 1988 and 1991 (mean follow-up, 18.1 months; range, 6 to 48 months).

Design:  Patients recorded their observations daily over 1 week. The patients completed these weekly diaries every 3 months for the first year and then at 18, 24, 36, and 48 months after ileostomy closure.

Study Participants:  Fifty patients (mean age, 31 years; 24 males).

Setting:  The University of Chicago (Ill).

Results:  Stool frequency at 3, 6, 12, and 24 months was 6.3±2.1, 5.5±2.4, and 5.1±1.9, and 5.9±1.6 per day, respectively, without urgency. Fifty-four percent were perfectly continent; 18% had occasional spotting (one or two leaks per week); 12% had minor leakage (three to seven per week); and 16% had major leakage (more than seven per week). In these three groups, loss of solid feces never occurred in 84%, 88%, and 65% of patients, respectively. Females had more severe incontinence than males, but continence improved over time for both sexes. Twenty-two percent of female patients developed dyspareunia; no males developed impotence, but 19% had retrograde ejaculation. The probability of experiencing pouchitis increased with time from 15% at 6 months to 40% at 12 months, and 50% after 24 months.

Conclusions:  These results represent an accurate assessment of patient function after ileal J pouch—anal anastomosis. We encourage the use of a prospective, patient-completed protocol to obtain a realistic assessment of functional results.(Arch Surg. 1993;128:889-895)