The optimal method of childbirth for women with a restorative proctocolectomy has yet to be determined.
Little is known about long-term ileal pouch function after vaginal delivery, especially when childbirth occurred before restorative proctocolectomy.
Dr Polle and colleagues evaluated the effect of vaginal delivery before or after restorative proctocolectomy on long-term pouch function.
All 267 women who underwent restorative proctocolectomy between 1985 and 2004 were invited to participate.
The research team assessed functional outcome by colorectal functional outcome questionnaire.
|60% had an increased risk of obstetric injury|
|British Journal of Surgery|
Patients were asked about their pregnancies and risk factors for obstetric injury.
The research team performed linear regression analysis to study potential risk factors for poor pouch function.
The researchers found that the response rate was 83%.
Median follow-up after pouch surgery was 7 years.
The team noted that 100 patients had at least 1 delivery.
The researchers observed that 60% of the patients who attempted a vaginal delivery had an increased risk of obstetric injury.
In these patients ageing and longer follow-up were significant risk factors for impaired incontinence.
Women who had restorative proctocolectomy and vaginal delivery with a high risk of obstetric injury had impaired continence with ageing and follow-up.
Dr Polle's team concludes, “Patients with restorative proctocolectomy restorative proctocolectomy should be informed about the considerable risk of vaginal delivery on long-term ileal pouch function.”