Long-term functional outcome and quality of life after ileal pouch anal anastomosis: retrospective, tertiary-center study, over 19 years.

Purpose: Restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) is a well codified procedure with low morbi-mortality and increasingly satisfactory functional results. We aimed to evaluate long-term quality of life and functional outcome of this procedure.

Methods: Retrospective, descriptive study of IPAA cases carried out over a period of 19 years [2001-2019], in the visceral and digestive surgery department of Sahloul Hospital. Anal incontinence was assessed using the St. Mark's Incontinence Score (SMIS). We evaluated functional outcome using the Öresland Score (OS) and the Pouch Functional Score (PFS), and quality of life (QoL) using Cleveland Global Quality of Life (CGQL).

Results: 125 patients (50,4% females) with a median age at surgery of 40.5 ± 14.9 years. Response rate to the questionnaires was 91,2% (n = 114). Only the "J" shaped ileal pouch was made. The global postoperative morbidity was 36%. Most patients had a good functional outcome with a median OS of 5.3 ± 3.6 and a median PFS of 7,3 ± 6,1. The average diurnal bowel mouvement is 5 ± 2.1, while 83,3% (n = 96) had less than 7 diurnal bowel movements. The average of nocturnal bowel movement is 2.14 ± 1.59 while 70,1% (n = 80) had less than 2 nocturnal bowel movements. Most patients had a good QoL with a median CGQL of 18,4 ± 4,3.

Conclusion: The IAA with « J » shaped ileal pouch is a procedure ensuring sphincter function compatible with normal life. Future sexual and quality of life studies will need to elicit preoperative baselines.

Trial registration number: Research registry 9509.