Ileoanal pouch operation -: Long-term outcome with or without diverting ileostomy

Hypothesis: Avoiding a diverting ileostomy does not influence the long-term overall morbidity and functional outcome of patients after ileoanal pouch operation (IAP). Design: All patients undergoing IAP were prospectively entered into a database, and those undergoing operation from October 1, 1989, through January 31, 1996, were contacted by mail questionnaire. Setting: Tertiary referral center. Patients: One hundred thirty unselected sequential patients. Interventions: The IAP was completed by a stapled method without diverting ileostomy, provided the patient agreed, and there were no other complicating factors. Main Outcome Measures: Need for reoperation, fecal leakage, pouch frequency, ability to defer evacuation, pouchitis, and overall quality of life. Results: Of 102 patients (78.5%) who initially underwent IAP without diverting ileostomy, 10 (9.8%) developed an anastomotic leak and required a diverting ileostomy. Additional surgery was required in 12 (9.2%) of the 130 patients for bowel obstruction and in 3 (2.3%;,) for pouch excision. Two patients died of unrelated causes, leaving 125 functioning pouches (96.2%). Questionnaires were completed in 1 11 (88.8%) of the 125; 75 patients (67.6%) reported perfect continence for gas and stool, 10 patients (9.0%), regular nighttime leakage, and 24 patients (21.6%)1 occasional fiscal leakage. Pouch evacuation frequency (+/-SD) per 24 hours was 7.8 +/- 2.4 (range, 4-12), and 95.5% of patients could defer pouch evacuation. Of the 111 patients, 42.3% reported pouchitis, with 7.2% receiving long-term antibiotic therapy. Of the patients, 74.8%;, reported total satisfaction, and 84.7% regarded themselves as bring in perfect health. Conclusion:: Long-term outcome after IAP remains favorable with or without diverting ileostomy.