[Clinical evaluation of restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis].

OBJECTIVE: To evaluate the clinical efficacies of restorative proctocolectomy with ileal pouch-anal anastomosis (RP-IPAA) for ulcerative colitis (UC).

METHODS: A total of 115 UC patients underwent the procedure of RP-IPAA during the period of 1989 to 2010. The data of surgical procedures, complications and long-term outcomes were collected. Stool frequency during the 24-hour period and the night were recorded at months 3 and 12 post-operation. Anal continence functions were evaluated by the Kirwan grading scale and the fecal characteristics identified by Bristol stool form scale. The patients' quality of life was objectively accessed by the Cleveland Global Quality of Life (CGQL) index.

RESULTS: No perioperative death was reported. The mean follow-up period was for at least 12 months. The postoperative complication rate was 20.9% (24/115), including infectious complications, wound infection and(or) abdominal abscess, anastomotic leak, pouch hemorrhage, pouch-vaginal fistula, pouchitis, terminal proctitis, urinary calculi and male sexual dysfunctions. Stool frequency per 24 hours and night was < 3 to 12 month post-operation (3.9 ± 1.7 vs 6.1 ± 2.6, 1.3 ± 0.7 vs 2.8 ± 1.8, both P < 0.05). No significant changes in anal continence functions existed between the above two time points [Grade I: 87.0% (n = 100) vs 92.2% (n = 106), Grade II: 7.8% (n = 9) vs 4.3% (n = 5), Grade III: 5.2% (n = 6) vs 3.5% (n = 4), all P > 0.05]. The postoperative CGQL results showed a much better quality of life than preoperative one.

CONCLUSION: As the first-choice operation for UC, RP-IPAA is safe and it offers satisfactory long-term outcomes and improved quality of life.