Sierra-Montenegro E, Fernández-Rivero JM, Villanueva-Sáenz E, Peña-Ruiz EJP, Martínez-Hernández MP, Soto-Quirino R

Language: Spanish
References: 20
Page: 449-452
PDF size: 46.43 Kb.

ABSTRACT

Background: Restorative proctocolectomy with ileal pouch-anal anastomosis has become the most common treatment in patients with ulcerative colitis. This procedure removes the entire colon, conserving the sphincteric complex and, therefore, preserving continence. The most important goal of this surgery is to improve quality of life.
Methods: We reviewed the files of patients who underwent restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis from January 1995 to December 2004 .We administered questionnaire SF-36 to evaluate quality of life. We used an observational, retrospective, and transversal method.
Results: Twenty “J” pouch procedures were done, of which files of 14 patients were reviewed. As far as quality of life, we were able to interview only eight patients and the average was as follows: physical function 75, physical status 50, corporal pain 51, general health 77, vitality 47.5, social function 62.5, emotional status 83 and mental health 74.
Discussion: Previous reports exist showing that proctocolectomy is a safe and effective procedure for patients with ulcerative colitis and where ileostomy is accompanied by one definitive, independent continent or pouch.
Conclusions: The presence of stoma and fecal incontinence are factors that contribute to deterioration of quality of life after proctocolectomy; thus, both should be avoided. Of the patients who we interviewed, 87.5% consider that their health status has improved during 1 year.

REFERENCES

1. Andres PG, Friedman LS. Epidemiology and the natural course of inflammatory bowel disease. Gastroenterol Clin North Am 1999;28:255-281.

2. 2. Wexner SD, Rosen L, Lowry A, et al. Practice parameters for the treatment of mucosal ulcerative colitis: supporting documentation. Dis Colon Rectum 1997;40:1227-1285.

3. 3. Takahashi T, Arch J, Gómez-Méndez T. Alternativas quirúrgicas para el tratamiento de la colitis ulcerativa crónica inespecífica. Rev Gastroenterol Mex 1996;61:134-138.

4. 4. Nelly KA, Pemberton JH, Wolf BG. Ileal pouch-anal anastomosis. Curr Prob Surg 1992;29:61-131.

5. 5. Carter FM, McLeod RS, Cohen Z. Subtotal colectomy for ulcerative colitis: complications related to the rectal remnant. Dis Colon Rectum 1991;34:1005-1009.

6. 6. Parc R, Legrand M, Frileux P, et al. Comparative clinical results of ileal-pouch anal anastomosis and ileorectal anastomosis in ulcerative colitis. Hepato-Gastroenterology 1989;36:235-239.

7. 7. Cohen Z. Panproctocolectomy and ileostomy. Surgery of the Colon, Rectum, and Anus, 5th ed. Oxford: Butterworth-Heinemann;1993. pp. 513-522.

8. 8. Michelassi F, Hurst R. Restorative proctocolectomy with J-pouch ileoanal anastomosis. Arch Surg 2000;135:347-353.

9. 9. Ravitch MM, Sabiston DC Jr. Anal ileostomy with preservation of the sphincter¾a proposed operation in patients requiring total colectomy for benign lesions. Surg Gynecol Obstet 1947;84:1095-1099.

10. 10. Utsunomiya J, Iwama T, Imajo M, et al. Total colectomy, mucosal proctectomy, and ileoanal anastomosis. Dis Colon Rectum 1980;23:459-466.

11. 11. Parks AG, Nicholls RJ, Belliveau P. Proctocolectomy with ileal reservoir and anal anastomosis. Br J Surg 1980;67:533-538.

12. 12. Sagar PM, Taylor BA. Pelvic ileal reservoirs: the options. Br J Surg 1994;81:325-332.

13. 13. Ware JE, Jr, Kosinski M, Bayliss MS, et al. A comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Medical Care 1995;33(4Suppl):AS264-AS279.

14. 14. Aaronson NK, Acquadro C, Alonso J, et al. International Quality of Life Assessment (IQOLA) Project. Quality of Life Research 1992;1:349-351.

15. 15. Kock NG, Myrvold HE, Nilsson LO. Progress report on the continent ileostomy. Arch Surg 1969;99:223-231.

16. 16. Dozois RR, Kelly KA, Beart RW, et al. Improved results with continent ileostomy. Ann Surg 1980;192:319-324.

17. Pemberton JH, Phillips SF, Ready RR, et al. Quality of life after Brooke ileostomy and ileal pouch-anal anastomosis. Ann Surg 1989;209:620-628.

18. 18. Strong SA, Fazio VW. Surgical Therapy of Crohn’s disease. 5th ed. Philadelphia: WB Saunders;2000. pp. 658-709.

19. 19. Kock NG, Myrvold HE, Nilsson LO. Progress report on the continent ileostomy. World J Surg 1980;4:143-148.

20. 20. Barnett WO. Current experiences with the continent intestinal reservoir. Surg Gynecol Obstet 1989;168:1-5.