Ileoanal pouch operation: long-term outcome with or without diverting ileostomy.
Arch Surg
; 135(4): 463-5; discussion 465-6, 2000 Apr.
Article
em En
| MEDLINE
| ID: mdl-10768713
ABSTRACT
HYPOTHESIS:
Avoiding a diverting ileostomy does not influence the long-term overall morbidity and functional outcome of patients after ileoanal pouch operation (IAP).DESIGN:
All patients undergoing IAP were prospectively entered into a database, and those undergoing operation from October 1, 1989, through January 31, 1996, were contacted by mail questionnaire.SETTING:
Tertiary referral center. PATIENTS One hundred thirty unselected sequential patients.INTERVENTIONS:
The IAP was completed by a stapled method without diverting ileostomy, provided the patient agreed, and there were no other complicating factors. MAIN OUTCOMEMEASURES:
Need for reoperation, fecal leakage, pouch frequency, ability to defer evacuation, pouchitis, and overall quality of life.RESULTS:
Of 102 patients (78.5%) who initially underwent IAP without diverting ileostomy, 10 (9.8%) developed an anastomotic leak and required a diverting ileostomy. Additional surgery was required in 12 (9.2%) of the 130 patients for bowel obstruction and in 3 (2.3%) for pouch excision. Two patients died of unrelated causes, leaving 125 functioning pouches (96.2%). Questionnaires were completed in 111 (88.8%) of the 125; 75 patients (67.6%) reported perfect continence for gas and stool, 10 patients (9.0%), regular nighttime leakage, and 24 patients (21.6%), occasional fecal leakage. Pouch evacuation frequency (+/-SD) per 24 hours was 7.8+/-2.4 (range, 4-12), and 95.5% of patients could defer pouch evacuation. Of the 111 patients, 42.3% reported pouchitis, with 7.2% receiving long-term antibiotic therapy. Of the patients, 74.8% reported total satisfaction, and 84.7% regarded themselves as being in perfect health.CONCLUSION:
Long-term outcome after IAP remains favorable with or without diverting ileostomy.
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Bases de dados:
MEDLINE
Assunto principal:
Ileostomia
/
Colite Ulcerativa
/
Proctocolectomia Restauradora
Limite:
Adolescent
/
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Arch Surg
Ano de publicação:
2000
Tipo de documento:
Article
País de afiliação:
Estados Unidos