Exploring the impact of lymphoedema on individuals and if lymphatic venous anastomosis surgery effects perceptions on quality of life: A qualitative study.

PURPOSE: Lymphoedema is a chronic condition, a cancer consequence and causes physical, psychological, and social implications. A new super-micro surgical treatment Lymphatic Venous Anastomosis (LVA) may improve the symptoms of lymphoedema. This study aims to explore the impact of lymphoedema on individuals and if LVA Surgery changes perceptions on quality of life. METHOD: Semi-structured interviews were conducted with sixteen individual's pre-LVA surgery and repeated six months later post-LVA with ten of the participants. Transcripts were analysed using thematic analysis. RESULTS: Themes identified pre-LVA included: Impact of Living with Lymphoedema, Being Different, and Future Hopes and Emotions. Participants reported making significant changes to 'normal' life due to living with lymphoedema. Changes included alteration in shopping, cleaning, hobbies, familial roles, employment and sexual intimacy. The wearing of compression garments engendered feelings of being unattractive. Themes found post-LVA were: I am one of the Lucky Ones and Returning to Former Self. Post-LVA, participants described how life had become more normalised with fear and apprehension of developing cellulitis reduced. Positive changes had enabled usual activities of daily living to recommence. Some participants had decreased pain, aching, heaviness, stiffness and were wearing their compression garments less. CONCLUSION: The findings suggest that the real impact of living with lymphoedema is much more challenging than previously identified. The findings suggest that LVA can give a future of greater choice for some of its recipients, but further research should explore longer-term benefits. LVA could offer hope to some people with lymphoedema, but a realistic expectation is essential.

The Long-term Patency of Lymphaticovenular Anastomosis in Breast Cancer-Related Lymphedema.

BACKGROUND AND OBJECTIVES: Lymphedema is a condition that can greatly affect patient's quality of life. Promising results have been described with lymphaticovenular anastomosis (LVA) in the treatment of lymphedema. It is currently unknown at what rate anastomoses remain functional after a longer follow-up. The aim of this study was to determine LVA patency at 1-year follow-up. METHODS: Retrospective chart review was performed on patients who underwent LVA surgery. Patients who had indocyanine green lymphography performed at 12 months' follow-up after LVA were included in this study. Volume measurements were performed prior to surgery and at 6 and 12 months' follow-up. Patients quality of life was measured prior to surgery and at 6 months' follow-up. RESULTS: Twelve patients met inclusion criteria. In total, 15 (56.5%) of 23 LVAs were considered patent. In 8 patients (66.7%), at least 1 patent LVA was visible. The volume difference between the healthy and affected arms decreased 32.3% on average. Quality of life increased with 1.4 points on average. CONCLUSIONS: This study is, to our knowledge, the first to evaluate long-term patency of LVA in upper limb lymphedema. Our study demonstrates that at least 56.5% of the anastomoses created are patent after 1-year follow-up.

The colorectal surgeon's personality may influence the rectal anastomotic decision.

AIM: Colorectal surgeons regularly make the decision to anastomose, defunction or form an end colostomy when performing rectal surgery. This study aimed to define personality traits of colorectal surgeons and explore any influence of such traits on the decision to perform a rectal anastomosis. METHOD: Fifty attendees of The Association of Coloproctology of Great Britain and Ireland 2016 Conference participated. After written consent, all underwent personality testing: alexithymia (inability to understand emotions), type of thinking process (intuitive versus rational) and personality traits (extraversion, agreeableness, openness, emotional stability, conscientiousness). Questions were answered regarding anastomotic decisions in various clinical scenarios and results analysed to reveal any influence of the surgeon's personality on anastomotic decision. RESULTS: Participants were: male (86%), consultants (84%) and based in England (68%). Alexithymia was low (4%) with 81% displaying intuitive thinking (reflex, fast). Participants scored higher in emotional stability (ability to remain calm) and conscientiousness (organized, methodical) compared with population norms. Personality traits influenced the next anastomotic decision if: surgeons had recently received criticism at a departmental audit meeting; were operating with an anaesthetist that was not their regular one; or there had been no anastomotic leaks in their patients for over 1 year. CONCLUSION: Colorectal surgeons have speciality relevant personalities that potentially influence the important decision to anastomose and could explain the variation in surgical practice across the UK. Future work should explore these findings in other countries and any link of personality traits to patient-related outcomes.

Impact on quality of life and sexual satisfaction of continent cystostomy with enterocystoplasty in an adult neurologic population.

AIMS: To evaluate long-term general and urinary quality of life (QOL) and sexual satisfaction in adult neurologic patients undergoing continent cystostomy surgery associated with a bladder enlargement to treat neurogenic lower urinary tract dysfunction. METHODS: Monocentre, retrospective series of adult neurologic patients who underwent continent cystostomy with bladder enlargement and followed-up in the long-term. We assessed during follow-up, urinary and renal function and patients filled QOL questionnaires on general QOL, sexuality and urinary (short form Qualiveen) disability. RESULTS: Fifty-three patients were included and followed-up 77 months on average. Rates of patients' satisfaction, stomal and urethral continences were respectively of 98.7% (n = 51), 94.1% (n = 48), and 80.4% (n = 41). Impact of surgery on general QOL and autonomy were strong and positive (respective mean scores of 4.8 and 4.7 on a scale ranging from 1 to 5). Mean overall urinary Qualiveen QOL score was 0.8 (0.09-2.67) indicating a low negative impact of urinary disability on QOL. In patients <45 years, 52.6% (n = 10) reported a moderate to important improvement of their sexuality after surgery. Renal function remained stable during follow-up. CONCLUSION: In the long-term, continent cystostomy with bladder enlargement provides great satisfaction to almost most patients. It has a strong positive impact on general and specific urinary QOL, patients' autonomy and urinary continence. In young patients a positive impact on sexuality was also noticed. These encouraging data, that need to be confirmed, constitute interesting information to provide to neurologic patients to help them deciding whether they are willing to undergo continent cystostomy surgery.

Long-term Outcomes of Sphincter-Saving Procedures for Diffuse Crohn's Disease of the Large Bowel.

BACKGROUND: Total abdominal colectomy with ileorectal anastomosis for Crohn's colitis is acceptable in the presence of a suitable rectum. Intentional IPAA has been proposed for diffuse Crohn's proctocolitis without enteric or anoperineal disease. OBJECTIVE: The aim of this study was to evaluate the long-term outcomes of sphincter-saving procedures for large-bowel Crohn's disease. DESIGN: Patients with preoperative Crohn's disease diagnosis undergoing intentional IPAA and ileorectal anastomosis were included. SETTINGS: The study was conducted at a tertiary care research center. PATIENTS: Ileorectal anastomosis was performed in 75 patients with Crohn's disease, whereas 32 patients underwent intentional IPAA. MAIN OUTCOME MEASURES: Long-term functional results and permanent stoma requirement of sphincter-saving operations were assessed. Quality of life and postoperative medication use were also compared with a control group of patients undergoing total proctocolectomy and end ileostomy. RESULTS: Patients undergoing ileorectal anastomosis were older and had longer disease duration, higher prevalence of perianal and penetrating disease, and history of small-bowel resection than those receiving IPAA. Indications for surgery, preoperative use of immunomodulators, and postoperative use of biologics were also significantly different. Although functional defecatory outcomes were comparable, reported quality of life 3 years after surgery was significantly better in patients who underwent IPAA than in patients with ileorectal anastomosis. Patients with IPAA were associated with significantly lower cumulative rates of surgical recurrence (HR = 0.28 (95% CI, 0.09-0.84); p = 0.017), indefinite stoma diversion (HR = 0.35 (95% CI, 0.13-0.99); p = 0.039), and proctectomy with end ileostomy (HR = 0.27 (95% CI, 0.07-0.96); p = 0.030) than those with ileorectal anastomosis. LIMITATIONS: The study was limited by its retrospective nature and small sample size. CONCLUSIONS: Contemporary patients selected to have intentional IPAA for Crohn's colitis have disease characteristics very different from those selected to have ileorectal anastomosis. Long-term follow-up confirms intentional IPAA as an acceptable option in selected patients with Crohn's colitis.

Presurgical Psychological and Neuroendocrine Predictors of Psychiatric Morbidity After Major Vascular Surgery: A Prospective Longitudinal Study.

OBJECTIVES: Major life stressors, including major surgeries, are often followed by psychiatric symptoms and disorders. Prior retrospective work found abdominal aortic aneurysm (AAA) repair is followed by increased psychiatric morbidity, which may adversely influence physical and functional recovery. Identifying risk factors before surgery, such as dysregulation in stress response systems, might be useful in improving preventative intervention. METHODS: Two hundred sixteen patients receiving open AAA or aortofemoral bypass surgeries, endovascular AAA repair, or nonsurgical AAA treatment were recruited from two vascular surgery services. Psychiatric symptoms and salivary cortisol measures (waking, 4 PM, and 11 PM, before and after low-dose dexamethasone) were obtained at intake and 3- and 9-month follow-ups. RESULTS: After open surgeries, 18% of patients had new psychiatric disorders, compared with 4% of patients receiving endovascular AAA repair or nonsurgical treatment (odds ratio = 6.0, 95% confidence interval = 1.6-22.1, p = .007). Having a history of major depression predicted the onset of new disorders in surgical patients. Presurgical cortisol levels were associated with both baseline (r = 0.23, p < .05) and 9-month (r = 0.32, p < .01) psychiatric symptoms (cortisol B = 1.0, standard error = 0.48, p < .05, in repeated-measures mixed model). CONCLUSIONS: Open AAA repair surgery is prospectively linked to the development of psychiatric morbidity, and history of depression elevates risk. Cortisol measures before surgery are associated with current and future psychological functioning, suggesting potential neurobiological mechanisms that may contribute to vulnerability. These results can help identify surgical patients at risk and point to potential targets for risk reduction interventions.

Psychological Factors in Irritable Pouch Syndrome and Other Pouch Disorders.

BACKGROUND: Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice for patients with medically refractory ulcerative colitis. Postsurgery, functional and inflammatory complications of the ileal pouch often occur. Our previous study demonstrated that irritable pouch syndrome (IPS) is associated with the use of antidepressants or anxiolytics, suggesting an influence of psychological factors on patients' symptoms. The aim of this study was to identify the specific psychological factors and coping strategies in patients with functional (IPS) and inflammatory (pouchitis, cuffitis, Crohn's disease of the pouch) pouch disorders. METHODS: Consecutive patients with functional pouch disorders (IPS), inflammatory pouch conditions, and asymptomatic ileal pouch-anal anastomosis patients were surveyed using validated measures of quality of life (the Cleveland Global Quality of Life [CGQL] and Irritable Bowel Syndrome-Quality of Life [IBS-QOL]), daily functional impairment (WSAS), coping mechanisms (brief COPE) and anxiety/depression (DASS-21). RESULTS: Of 243 patients surveyed, 157 (64.6%) completed the surveys, of whom 137 (56.4%) met inclusion criteria and were included in the analysis. Sixty-one percent of respondents had pouch inflammation (pouchitis, N = 35; cuffitis, N = 14; and Crohn's disease of the pouch, N = 35), 20% had IPS (N = 27) and 19% (N = 26) had asymptomatic normal pouches. The age of participants ranged from 20 to 79 years with the mean ages of patients with normal pouches, IPS and inflammatory pouch conditions being 51.7 ± 12.5, 47.1 ± 15.0, 47.2 ± 15.1 years, respectively. Patients with IPS were more likely to be taking antidepressants, anxiolytics, or narcotics than the other groups (P < 0.04). Patients with IPS or inflammatory pouches had significantly poorer quality of life (CGQL, P < 0.001; IBS-QOL, P < 0.003) than those with asymptomatic pouches, with differences particularly in the areas of food avoidance, activity interference, and sexual difficulties. Those with IPS (median = 11; interquartile range [IQR]: 3-19) or inflammatory pouch conditions (median = 7; IQR: 3-18) had a greater impairment in the domains of daily functioning related to the pouch condition than those with normal pouches (median = 1.5; IQR: 0-6; P = 0.003). The mean depression symptom scores were significantly higher in the IPS group than in the normal pouch group (11.7 ± 9.7 versus 4.4 ± 6.2; P = 0.012). CONCLUSIONS: IPS patients were more likely to have depressive symptoms and had a greater amount of impairment in daily functioning related to their pouch condition. Additionally, patients with functional pouch disorders are more likely to be concurrently treated with antidepressants, anxiolytic or narcotic agents than those with inflammatory pouches or normal pouches.

Quality of life after peripheral bypass surgery: a 1 year follow-up.

OBJECTIVES: The aim of the study was to assess quality of life (QoL) in patients with peripheral arterial disease (PAD) after aortobifemoral bypass. METHODS: QoL assessments were completed by 78 patients, 61 (78.2 %) men and 17 (21.8 %) women. QoL was measured, using Medical Outcome Survey Short Form 36 (SF-36), before surgery and 1 year later. RESULTS: QoL significantly improved after revascularization in about two-third of patients with PAD. Improvement was present in all the SF-36 subscales with the exception of the score for mental health which significantly decreased after operation. Mean SF-36 scores, which were for almost all subscales significantly decreased in patients with PAD in comparison with reference populations, after operation reached or exceeded values of the populations with which they were compared. CONCLUSIONS: In the present study 1 year after revascularization QoL in patients with PAD was significantly improved in comparison with QoL before operation. Long-term follow-up is needed in order to assess duration of this beneficial effect of bypass surgery.

Reliability and validity of a survey to measure bowel function and quality of life in long-term rectal cancer survivors.

PURPOSE: Examination of reliability and validity of a specialized health-related quality of life questionnaire for rectal cancer (RC) survivors (≥5 years post-diagnosis). METHODS: We mailed 1,063 Kaiser Permanente (KP) RC survivors (313 ostomy and 750 anastomosis) a questionnaire containing the Modified City of Hope Quality of Life-Ostomy (mCOH-QOL-O), SF-12v2, Duke-UNC Functional Social Support Questionnaire (FSSQ), and Memorial Sloan-Kettering Cancer Center Bowel Function Index (BFI). We adapted certain BFI items for use by subjects with intestinal ostomies. We evaluated reliability for all instruments with inter-item correlations and Cronbach's alpha. We assessed construct validity only for the BFI in the ostomy group, because such use has not been reported. RESULTS: The overall response rate was 60.5 % (577 respondents/953 eligible). Compared with non-responders, participants were on average 2 years younger and more likely non-Hispanic white, resided in educationally non-deprived areas, and had KP membership through a group. The mCOH-QOL-O, SF-12, and FSSQ were found to be highly reliable for RC survivors. In the ostomy group, BFI Urgency/Soilage and Dietary subscales were found to be reliable, but Frequency was not. Factor analysis supported the construct of Urgency/Soilage and Dietary subscales in the ostomy group, although one item had a moderate correlation with all three factors. The BFI also demonstrated good concurrent validity with other instruments in the ostomy group. CONCLUSIONS: With possible exception of the BFI Frequency subscale in populations with ostomies, components of our survey can be used for the entire population of RC survivors, no matter whether they received anastomosis or ostomy.

Sexual function and body image are similar after laparoscopy-assisted and open ileal pouch-anal anastomosis.

BACKGROUND: Ileal pouch-anal anastomosis (IPAA) is performed in patients with ulcerative colitis and familial adenomatous polyposis where the majority of patients are sexually active. Laparoscopic surgery is becoming the preferred technique for most colorectal interventions, and we examined postoperative sexual function and body image compared to those after open surgery IPAA. METHODS: Patients treated with IPAA in the period from October 2008 to March 2012 were included. Evaluation of sexual function, body image, and quality of life was performed using the Female Sexual Function Index (FSFI), the International Index of Erectile Function (IIEF), the Body Image Questionnaire (BIQ), and the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). RESULTS: We included 72 patients (38 laparoscopy-assisted and 34 open). Response rate was 74 %. There were no differences in demographics, functional outcome, quality of life (SIBDQ score: 53 vs. 53), or time of follow-up (637 vs. 803 days). All women and men showed scores above the cutoff line of normal sexual function. There was no significant difference in sexual function between the laparoscopic and open groups. We found no differences in BIQ between open and laparoscopic IPAA; however, there was a tendency toward lower postoperative self-esteem among women compared to men (p = 0.07). We also found a tendency toward a better body image among laparoscopy-treated women compared to open-treated women (p = 0.07). CONCLUSIONS: Although there might be a tendency toward better body image among laparoscopy-treated women, the two surgical techniques seem equal with respect to postoperative sexual function.

Quality of life after coloanal anastomosis and abdominoperineal resection for distal rectal cancers: sphincter preservation vs quality of life.

AIM: A permanent colostomy is considered to have an adverse impact on quality of life (QOL). However, functional outcomes following sphincter preservation also affect QOL. Our aim was to determine differences in QOL of patients undergoing coloanal anastomosis (CAA) or abdominoperineal resection (APR) for distal rectal cancer. METHOD: Eighty-five patients underwent CAA (72 with intestinal continuity and 13 with a stoma because of complications) and 83 patients underwent APR for a distal rectal cancer between 1995 and 2001 at a single institution and responded to our survey. QOL was evaluated using the EORTC QLQ-C30 and QLQ-CR38. RESULTS: Patients with CAA were younger than APR patients (mean age 57 vs 62 years, P < 0.001), but gender distribution, tumour stage and proportion of subjects receiving radiotherapy was not significantly different. Patients undergoing CAA had higher scores (better QOL) for physical functioning; lower scores (fewer symptoms) for fatigue, pain, financial difficulties, weight loss and chemotherapy side effects; and higher scores (more symptoms) for constipation and gastrointestinal symptoms compared with APR patients. CAA patients had higher scores (better QOL) for body image in men but not in women. Sexual functioning scores in men and women were lower (worse QOL) in CAA patients compared with APR patients. CONCLUSIONS: QOL after APR is comparable to sphincter preservation, although there are some differences that need to be considered. QOL and functional results should be taken into account with the oncological outcome when devising management strategy for distal rectal cancer.

[Ways to improve the quality of life of elderly and senile patients after the operation by Brikker].

The present study is devoted to improving quality of life of patients in elderly and senile age after operation of Bricker by finding the optimal method of forming ureterointestinal anastomosis. From 2007 to 2009 103 patients of elderly and senile age with diseases requiring removal of the bladder were treated in the Lenigrad Regional Oncology Centre. All the patients were made cystectomy. Patients were divided into two groups: In 1st group, the ureterointestinal anastomosis was formed a classical way "end to side" described Bricker, in the 2nd group ureterointestinal anastomosis was performed by the method of Wallace - "common area". Pathological conditions developed in patients in late postoperative period were as follows: hydronephrosis in early and later stages, obstructive pyelonephritis, frequent attacks of chronic pyelonephritis, chronic renal failure, urinary fistula. Formation of ureterointestinal anastomosis by Wallace during surgery reduces the amount of later postoperative complications. Quality of life was better after the formation of ureterointestinal anastomosis by Wallace.

Genital and subjective sexual response in women after restorative proctocolectomy with ileal pouch anal anastomosis--a prospective clinical trial.

INTRODUCTION: Sexual dysfunction after ileo pouch anal anastomosis (IPAA) is common. The most systematic physical reaction to sexual stimulation is an increase in vaginal vasocongestion. Genital response can be assessed by vaginal pulse amplitude (VPA) using vaginal photoplethysmography. AIM: To assess whether restorative proctocolectomy with IPAA is associated with autonomic pelvic nerve damage and changes in subjective indices of sexual function in women. METHODS: Female patients undergoing IPAA between April 2004 and January 2006 were included. During sexual stimulation (visual and vibrotactile) changes in vaginal vasocongestion were measured by vaginal photoplethysmography. Concurrently, quality of life (SF-36) and sexual functioning (FSFI, FSDS) were assessed using validated questionnaires. MAIN OUTCOME MEASURES: Primary endpoint was difference in VPA pre- and postoperatively. Secondary endpoints were differences in feelings of sexual arousal and estimated lubrication pre- and postoperatively and difference in psychological and sexual functioning pre-and postoperatively. RESULTS: Eleven patients were included. For eight patients (median age 37 [22-49 years]) pre- and postoperative data were collected. VPA analysis showed a significant reduction in vaginal vasocongestion during sexual stimulation postoperatively, P = 0.012. Subjective sexual arousal and estimated lubrication during the experiment, reported psychological and sexual functioning pre- and postoperative were not different. CONCLUSIONS: Vaginal vasocongestion after IPAA was significantly reduced in this small study; indicating that IPAA in women might possibly be associated with autonomic pelvic nerve damage or partial devascularization of the vagina. Subjectively reported sexual arousal, estimated lubrication, psychological and sexual functioning were not diminished. Future research should focus on the possible advantage of a full close rectal dissection in these patients.

Comparison of outcomes after hand-sewn versus stapled ileal pouch-anal anastomosis in 3,109 patients.

BACKGROUND: The aim of this study was to compare outcomes after primary hand-sewn versus stapled ileal pouch-anal anastomosis (IPAA). METHODS: Patients undergoing a primary IPAA (1983-2007) were identified from a prospective pelvic pouch database. Differences between group A (hand-sewn) and group B (stapled) for pre-operative and peri-operative factors, complications, functional outcomes, and quality of life (QOL) were investigated. RESULTS: Of 3,382 patients with a primary IPAA, 3,109 were included. Median follow-up was 7.1 years (0.1-24). Mean age was 37.9 +/- 13.2 years. Overall, 1,741 patients (56%) were male. Group A (n = 474) and group B (n = 2635) had similar age (P = .28), sex (P = .8), albumin level (P = .74), prior colectomy (P = .98), and use of steroids (P = .1). Group A had a greater use of ileostomy (P = .001) and a longer duration of stay (P < .001). Group B had a greater body mass index (P < .001) and J-pouch (P < or = .001). Wound infection (P = .42) and pouchitis (P = .59) were similar. Anastomotic stricture (P = .002), septic complications (P = .019), bowel obstruction (P = .027), and pouch failure (P < .001) were greater in group A. At most recent follow-up, bowel frequency (P = .74) and rate of urgency were similar (P = .71). A greater proportion of patients in group A described incontinence (P < .001), seepage (P < .001), pad usage (P < .001), dietary (P < .001), social (P < .001), and work restrictions (P = .025). The Cleveland Global QOL score (P = .018) was greater in group B. CONCLUSION: Patients undergoing a stapled IPAA had better outcomes and QOL than those undergoing a hand-sewn IPAA.

A prospective evaluation of sexual function and quality of life after ileal pouch-anal anastomosis.

PURPOSE: This study was designed to assess the effect of ileal pouch-anal anastomosis on sexual function and quality of life in men and women. METHODS: Sexual function of patients undergoing ileal pouch-anal anastomosis from February 2005 to June 2006 was prospectively evaluated using the International Index of Erectile Function in men and Female Sexual Function Index in women. Quality of life was assessed using the Short Inflammatory Bowel Disease Questionnaire. Preoperative scores were compared with scores at 6 and 12 months postoperatively. RESULTS: Of 110 patients eligible for inclusion, 59 (53.6 percent) agreed to participate. Male sexual function and erectile function scores remained high 12 months after surgery (mean International Index of Erectile Function score 51.7 preoperative vs. 58.3 at 12 months postoperative; P = not significant (NS)). Abnormal sexual function decreased from 33.3 percent before surgery to 22.7 percent 12 months after surgery (P = NS). Female sexual function improved 12 months after surgery (mean Female Sexual Function Index score 19.2 preoperative vs. 27 at 12 months postoperative; P = 0.031). Abnormal sexual function decreased from 73.1 percent before surgery to 25 percent 12 months after surgery (P = 0.001). Quality of life significantly improved after ileal pouch-anal anastomosis in both sexes. CONCLUSIONS: In men, ileal pouch-anal anastomosis does not have an adverse effect on sexual function, whereas sexual function in women seems to improve 12 months after surgery.

Population-based study of surgical factors in relation to health-related quality of life after oesophageal cancer resection.

BACKGROUND: Oesophagectomy for cancer has a negative impact on health-related quality of life (HRQL), but factors influencing postoperative HRQL have been sparsely studied. This study explored how selected surgical factors affected HRQL 6 months after operation. METHODS: This population-based study was based on a Swedish network of physicians with almost complete nationwide coverage and data on oesophageal cancer surgery collected prospectively between 2001 and 2005. Patients completed validated HRQL questionnaires 6 months after operation. Mean scores with 95 per cent confidence intervals were calculated and clinically relevant differences between groups were analysed in a linear regression model, adjusted for potential confounders. RESULTS: Some 355 patients were included in the analysis (participation rate 79.6 per cent). Extensive surgery, as indicated by a transthoracic approach, more extensive lymphadenectomy, wider resection margins and a longer duration of operation, was not associated with worse HRQL measures than less extensive operations. Dysphagia was similar in patients who had handsewn and stapled anastomoses. Technical surgical complications had significant deleterious effects on several aspects of HRQL. CONCLUSION: This study provides no evidence to suggest that less extensive surgery for oesophageal cancer should be recommended from the perspective of HRQL. It is essential, however, that attention be paid to minimizing technical surgical complications.

Sexual function, body image, and quality of life after laparoscopic and open ileal pouch-anal anastomosis.

PURPOSE: This study was designed to compare self-reported sexual function, body image, and quality of life outcomes among ulcerative colitis patients undergoing laparoscopic or open ileal pouch-anal anastomosis. METHODS: Between 1978 and 2004, 100 laparoscopic and 189 open operations were performed in patients who were identified from a previously published cohort. Patients were surveyed one year after operation to evaluate sexual function, body image, and quality of life. RESULTS: A total of 125 of 289 patients (43 percent) returned completed surveys. There were no significant differences in terms of demographics, complications, or long-term functional outcomes between those who completed the surveys and those who did not. There were no clinical differences in results between laparoscopic and open patients using the three survey instruments. Orgasmic function scores were lower in men who underwent laparoscopic ileal pouch-anal anastomosis (P < 0.05) compared with open ileal pouch-anal anastomosis. Overall, sexual function scores were equal to or better than normal values for men but were lower in women. Finally, overall body image and quality of life scores were above the means published for the United States. CONCLUSIONS: After ileal pouch-anal anastomosis, men and women reported excellent body image and high cosmetic and quality of life scores regardless of operative approach. Female sexual function was more adversely affected after ileal pouch-anal anastomosis than was male sexual function.

Mental disorder and psychologic distress in patients with ulcerative colitis after ileal pouch-anal anastomosis.

PURPOSE: The aim of this study was to determine if ileal pouch-anal anastomosis in patients with ulcerative colitis is a psychologic burden for patients, the frequency of mental disorders, the amount of psychologic distress, and their possible disease-related determinants. These factors were studied in patients with ulcerative colitis after ileal pouch anal anastomosis and were compared with ulcerative colitis patients without ileal pouch-anal anastomosis and the general German population. METHODS: A total of 37 patients with ulcerative colitis after ileal pouch-anal anastomosis (age 46.8 +/- 11.8 years; 35 percent female) and 62 patients with ulcerative colitis without ileal pouch-anal anastomosis (age 44.4 +/- 13.9 years; 37 percent female) completed the following questionnaires: medical and sociodemographic questionnaire of the German Competence Network "Inflammatory Bowel Diseases" and the German version of the Hospital Anxiety and Depression Scale. Disease activity was measured in patients with ileal pouch-anal anastomosis by the Pouch Disease Activity Index and in patients without ileal pouch-anal anastomosis by the German Inflammatory Bowel Disease Activity Index. Psychologic distress was assessed by the subscale scores of the Hospital Anxiety and Depression Scale. A probable mental disorder was identified if a patient scored 11 or higher in at least one subscale of the Hospital Anxiety and Depression Scale. RESULTS: The frequency of a probable psychiatric disorder in patients with ileal pouch-anal anastomosis (16 percent) and without ileal pouch-anal anastomosis (23 percent) did not differ from that in the general German population (17 percent). Ulcerative colitis patients with or without ileal pouch-anal anastomosis did not differ in the amount of psychologic distress. Ileal pouch-anal anastomosis patients had higher levels of anxiety than the general population (P < 0.01). Regression models of disease-related factors predicting mental disorder and psychologic distress showed no significant results. CONCLUSIONS: Ileal pouch-anal anastomosis neither increases nor decreases the frequency of mental disorders or the amount of psychologic distress in ulcerative colitis patients.

Quality of life associated with surgery for esophageal cancer: differences between collar and intrathoracic anastomoses.

Postoperative survival and complication rates have traditionally been the standard parameters of outcome after oncologic surgery. In tumors with poor patient survival, such as esophageal cancer, studies about quality of life are rare. The objectives of this study were to assess outcomes in terms of quality of life in patients with esophageal cancer when investigating differences between two surgical reconstructive procedures: intrathoracic anastomosis and collar anastomosis. A total of 108 patients with esophageal cancer had undergone surgery for esophageal cancer in our department from 1992 to 2000. Median survival was 36 months with no significant differences between patients undergoing collar or intrathoracic anastomosis. After determining the survival status, questionnaires on quality of life were sent to all patients 1 to 2 years after surgery. We received data from 46 patients. The responders were divided into groups of intrathoracic anastomosis ( n = 24) and collar anastomosis ( n = 22). Patients with the collar anastomosis showed significantly better physical and social functioning and global health status. From the viewpoint of postoperative quality of life, reflux-related symptoms were the major problem for patients with an intrathoracic anastomosis. These symptoms cause significant insomnia and impair social and physical function. The study showed that assessing quality of life with specific and general instruments is helpful for determining the differences between surgical procedures where standard parameters such as survival have their limitations.