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ORIGINAL CONTRIBUTION

A Longitudinal Study of Quality of Life and Functional Outcome of Patients With Ulcerative Colitis After Proctocolectomy With Ileal Pouch-Anal Anastomosis
Hagit Tulchinsky, M.D.1,2 • Iris Dotan, M.D.1,3 • Zamir Halpern, M.D.3 Joseph M. Klausner, M.D.2 • Micha Rabau, M.D.2
1 Comprehensive Pouch Clinic, Tel-Aviv Sourasky Medical Center, affiliated with the Sackler Facultyof Medicine, Tel-Aviv University, Tel-Aviv, Israel 2 Department of Surgery B, Tel-Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel 3 IBD Center, Department of Gastroenterology and Liver Diseases, Tel-Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

PURPOSE:Ileal pouch-anal anastomosis is considered the surgical treatment of choice for patients with ulcerative colitis. It is safe and effective but associated with longterm complications, making functional outcome and quality of life important factors in determining patient outcome. Longitudinal studies on long-term functional outcome and quality of life are sparse. The purpose of this study was tolongitudinally evaluate the long-term functional outcome and quality of life of ulcerative colitis patients who underwent proctocolectomy with ileal pouch-anal anastomosis. METHODS: The study group was composed of ulcerative

RESULTS: Data were obtained for 63 of the 77 patients (82%) who had answered the first questionnaire. The mean interval between responding to the 2 questionnaires was 73 3months. Functional outcome did not deteriorate over time. Some quality of life scores (bodily pain, general health perception, and the physical component summary) worsened over time, whereas the other scales of the Short Form 36 scores did not change. CONCLUSION: The functional outcome of ulcerative

colitis patients who underwent pouch operation in our institution between 1990 and 2001 who hadfilled in quality of life and functional outcome questionnaires 60 months (mean) after ileostomy closure and responded to the same questionnaires at 133 months (mean) after ileostomy closure. They served as their own controls. Quality of life was scored using the Medical Outcomes Study Short Form 36. Global Assessment of Functioning Scale was used to evaluate functional outcome.

colitis patientsafter a pouch operation did not change significantly over time. The overall quality of life was generally stable, however, some aspects did deteriorate over time. These findings merit further investigation.
KEY WORDS: Functional outcome; Ileal pouch-anal

anastomosis; Quality of life; Ulcerative colitis. estorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) was first described in1978 by Parks and Nicholls1 and has become the procedure of choice for the surgical treatment of patients with ulcerative colitis (UC). The goals of removing the diseased mucosa and preserving the natural route of defecation are achieved in most patients. This procedure has been proven safe and effective, with a perioperative mortality rate of 1% and a pouch failure rate of 10%.2– 6 Nevertheless,long-term complications, such as pouchitis, small-bowel obstruction, and incontinence occur in a significant number of patients.5–7 The benefits of avoiding an ileostomy on the one hand and the significant continuing risk of short- and long-term

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Financial Disclosure: None reported. Hagit Tulchinsky and Iris Dotan contributed equally to this study. Correspondence: H. Tulchinsky, M.D.,Proctology Unit, Department of Surgery B, Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel-Aviv 64239, Israel. E-mail: hagitt@tasmc.health.gov.il Dis Colon Rectum 2010; 53: 866 – 873 DOI: 10.1007/DCR.0b013e3181d98d66 ©The ASCRS 2010

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complications on the other raise several...