What Can an Aging Pouch Tell Us? Outcomes of Ileoanal Pouches Over 20 Years Old.
Background: Little is known about the long-term functional outcomes of restorative proctocolectomy.
Objective: The aim of this study was to examine ileoanal pouch outcomes 20 and 30 years postoperatively.
Methods: Retrospective case series. Methods: Tertiary care referral center. Methods: Patients who underwent restorative proctocolectomy between 1980 and 1994 were identified. Those with ≥ 20 years of in-person follow-up were included. Methods: Pouch function, pouchitis, anal stricture and pouch failure rates were analyzed.
Results: A total of 203 patients had ≥20 years of follow-up. Of those, 71 had ≥30 years of follow-up. Initial diagnoses included ulcerative colitis (83%), indeterminate colitis (9%), familial adenomatous polyposis (4%), and Crohn's disease (3%). 21% of those with ulcerative or indeterminate colitis later transitioned to Crohn's disease. Average daily stool frequency was 7 (interquartile range 6-8), 38% experienced seepage, 31% had anal stenosis, 47% experienced pouchitis, and 18% had pouch failure. Over time, stool frequency increased in 41% of patients, stayed the same in 43%, and decreased in 16%. Patients over age 50 at the time of construction had more daily bowel movements (median 8 vs. 6, p=0.02) and more seepage (77% vs. 35%, p=0.005) than those under 50. Patients with Crohn's disease had higher stool frequency (median 8 vs. 6, p<0.001), and higher rates of anal stenosis (44% vs. 26%, p=0.02), pouchitis (70% vs. 40%, p<0.001), and pouch failure (38% vs. 12%, p<0.001) compared to non-Crohn's patients. Patients with ≥30 years of follow-up had similar function as those with 20-30 years of follow-up.
Conclusions: This was a retrospective, single-institution study. Only 35% of pouches created during the study period had >20 years of follow-up. Conclusions: Most patients maintain reasonably good function and retain their pouches after 20 years. Over time, stool frequency and seepage increase. Older age and Crohn's disease are associated with worse outcomes. See Video Abstract at http://links.lww.com/DCR/B801.