A team from Minneapolis, Minnesota, USA, prospectively evaluated long-term ileoanal pouch function.
Surveys were sent to 235 patients with ileoanal pouches, who had returned similar surveys in 1992. Of these, 66% returned the surveys (mean age 47 years, 44% female).
There were 5 deaths, and 11 patients had pouches removed or were given a defunctioning ileostomy.
Bowel movement frequency did not change from 1992 to 2000 (24-hour frequency = 7.0 in 1992 vs 7.1 in 2000, night frequency = 2.0 vs 1.4).
Compared with 1992 data, major day incontinence was worse in 18% of patients, improved in 1%, and unchanged in 81%.
| Deterioration in ileoanal pouch function more common 12 or more years after surgery.
| Diseases of the Colon and Rectum |
Minor day incontinence was worse in 32%, improved in 9%, and unchanged in 59%.
The researchers found that major night-time incontinence was worse in 22%, improved in 6%, and unchanged in 72% of patients. Minor night incontinence was worse in 24%, improved in 22%, and unchanged in 54%.
It was found that change in continence was unrelated to gender, age, or age at operation. However, it was related to duration of follow-up.
Of those patients who had surgery 12 or more years previously, 27% and 33% reported worsened major daytime incontinence and major nighttime incontinence, respectively. This was compared with 9% and 10% of patients who had surgery less than 12 years beforehand.
Minor incontinence also worsened after 12 years.
Minor daytime incontinence was seen in 48% of patients followed up for more than 12 years versus 16% of those followed up for less than 12 years.
Minor night-time incontinence was 28% and 19%, respectively.
Author M. Kelli, of the Division of Colon and Rectal Surgery at the University of Minnesota, concluded on behalf of the group, "Most patients have stable pouch function over time.
"However, a small number improve and a larger number suffer measurable deterioration, particularly 12 or more years after surgery."