Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1987 Oct;206(4):504–513. doi: 10.1097/00000658-198710000-00011

Ileal pouch-anal anastomosis for chronic ulcerative colitis. Long-term results.

J H Pemberton 1, K A Kelly 1, R W Beart Jr 1, R R Dozois 1, B G Wolff 1, D M Ilstrup 1
PMCID: PMC1493214  PMID: 3662660

Abstract

The aim of this study was to determine the long-term outcome among 390 patients with ulcerative colitis who underwent ileal J pouch-anal anastomosis and whether patient or operative factors influenced results. The combined operative morbidity rate for the pouch-anal anastomosis and the subsequent closure of the temporary ileostomy was 29% (bowel obstruction, 22%; pelvic sepsis, 5%), with one death due to pulmonary embolus. The probability of a successful outcome at 5 years was 94%. Of the 24 patients who failed (6% of total), 18 did so within 1 year (4%), three during year 2 (1%), three during year 3 (1%), and none thereafter. Stool frequency (7 stools/24 h), the occurrence of pouchitis (14%), and satisfactory daytime continence (94% of patients) remained stable over 4 years after operation, whereas nocturnal fecal spotting decreased (51% of patients to 20%). Women had more spotting than men, whereas patients over 50 years old had more stools per day than those 50 years or younger. In conclusion, ileal pouch-anal anastomosis achieved a reasonable stool frequency and satisfactory continence in patients with ulcerative colitis over the long-term. These results support the ileal pouch-anal anastomosis as a safe, satisfactory alternative to permanent ileostomy.

Full text

PDF
509

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ballantyne G. H., Pemberton J. H., Beart R. W., Jr, Wolff B. G., Dozois R. R. Ileal J pouch-anal anastomosis. Current technique. Dis Colon Rectum. 1985 Mar;28(3):197–202. doi: 10.1007/BF02554246. [DOI] [PubMed] [Google Scholar]
  2. Becker J. M., Raymond J. L. Ileal pouch-anal anastomosis. A single surgeon's experience with 100 consecutive cases. Ann Surg. 1986 Oct;204(4):375–383. doi: 10.1097/00000658-198610000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. DUTHIE H. L., GAIRNS F. W. Sensory nerve-endings and sensation in the anal region of man. Br J Surg. 1960 May;47:585–595. doi: 10.1002/bjs.18004720602. [DOI] [PubMed] [Google Scholar]
  4. Daly D. W., Brooke B. N. Ileostomy and excision of the large intestine for ulcerative colitis. Lancet. 1967 Jul 8;2(7506):62–64. doi: 10.1016/s0140-6736(67)92058-2. [DOI] [PubMed] [Google Scholar]
  5. Grüner O. P., Naas R., Fretheim B., Gjone E. Marital status and sexual adjustment after colectomy. Results in 178 patients operated on for ulcerative colitis. Scand J Gastroenterol. 1977;12(2):193–197. doi: 10.1203/00006450-199404000-00018. [DOI] [PubMed] [Google Scholar]
  6. Harms B. A., Pellett J. R., Starling J. R. Modified quadruple-loop (W) ileal reservoir for restorative proctocolectomy. Surgery. 1987 Feb;101(2):234–237. [PubMed] [Google Scholar]
  7. Jones F., Munro A., Ewen S. W. Colectomy and ileorectal anastomosis for colitis: report on a personal series, with a critical review. Br J Surg. 1977 Sep;64(9):615–623. doi: 10.1002/bjs.1800640903. [DOI] [PubMed] [Google Scholar]
  8. Martin L. W., LeCoultre C., Schubert W. K. Total colectomy and mucosal proctectomy with preservation of continence in ulcerative colitis. Ann Surg. 1977 Oct;186(4):477–480. doi: 10.1097/00000658-197710000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Metcalf A. M., Dozois R. R., Kelly K. A., Beart R. W., Jr, Wolff B. G. Ileal "J" pouch-anal anastomosis. Clinical outcome. Ann Surg. 1985 Dec;202(6):735–739. doi: 10.1097/00000658-198512000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Nicholls R. J., Pezim M. E. Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatous polyposis: a comparison of three reservoir designs. Br J Surg. 1985 Jun;72(6):470–474. doi: 10.1002/bjs.1800720622. [DOI] [PubMed] [Google Scholar]
  11. O'Connell P. R., Kelly K. A., Brown M. L. Scintigraphic assessment of neorectal motor function. J Nucl Med. 1986 Apr;27(4):460–464. [PubMed] [Google Scholar]
  12. O'Connell P. R., Pemberton J. H., Brown M. L., Kelly K. A. Determinants of stool frequency after ileal pouch-anal anastomosis. Am J Surg. 1987 Feb;153(2):157–164. doi: 10.1016/0002-9610(87)90807-5. [DOI] [PubMed] [Google Scholar]
  13. O'Connell P. R., Rankin D. R., Weiland L. H., Kelly K. A. Enteric bacteriology, absorption, morphology and emptying after ileal pouch-anal anastomosis. Br J Surg. 1986 Nov;73(11):909–914. doi: 10.1002/bjs.1800731121. [DOI] [PubMed] [Google Scholar]
  14. Pemberton J. H., Heppell J., Beart R. W., Jr, Dozois R. R., Telander R. L. Endorectal ileoanal anastomosis. Surg Gynecol Obstet. 1982 Sep;155(3):417–424. [PubMed] [Google Scholar]
  15. Roy P. H., Sauer W. G., Beahrs O. H., Farrow G. M. Experience with ileostomies. Evaluation of long-term rehabilitation in 497 patients. Am J Surg. 1970 Jan;119(1):77–86. doi: 10.1016/0002-9610(70)90016-4. [DOI] [PubMed] [Google Scholar]
  16. Schjonsby H., Halvorsen J. F., Hofstad T., Hovdenak N. Stagnant loop syndrome in patients with continent ileostomy (intra-abdominal ileal reservoir). Gut. 1977 Oct;18(10):795–799. doi: 10.1136/gut.18.10.795. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Utsunomiya J., Iwama T., Imajo M., Matsuo S., Sawai S., Yaegashi K., Hirayama R. Total colectomy, mucosal proctectomy, and ileoanal anastomosis. Dis Colon Rectum. 1980 Oct;23(7):459–466. doi: 10.1007/BF02987076. [DOI] [PubMed] [Google Scholar]
  18. Watts J. M., de Dombal F. T., Goligher J. C. Long-term complications and prognosis following major surgery for ulcerative colitis. Br J Surg. 1966 Dec;53(12):1014–1023. doi: 10.1002/bjs.1800531203. [DOI] [PubMed] [Google Scholar]
  19. Williams N. S., Johnston D. The current status of mucosal proctectomy and ileo-anal anastomosis in the surgical treatment of ulcerative colitis and adenomatous polyposis. Br J Surg. 1985 Mar;72(3):159–168. doi: 10.1002/bjs.1800720302. [DOI] [PubMed] [Google Scholar]
  20. Wong W. D., Rothenberger D. A., Goldberg S. M. Ileoanal pouch procedures. Curr Probl Surg. 1985 Mar;22(3):1–78. doi: 10.1016/0011-3840(85)90017-6. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES