LONG-TERM RESULTS OF THE ILEONAL POUCH PROCEDURE

Many surgeons consider the ileoanal pouch procedure to be the procedure of choice for patients who require surgery for ulcerative colitis and familial adenomatous polyposis. To determine long-term results, 460 patients (mean+/-SD age, 31+/-9 years) who underwent the ileoanal pouch procedure from 1980 through 1991 were prospectively observed by computerized registry. The leading indication for operation was ulcerative colitis (n=382; 83%). A J-shaped reservoir was created in 434 patients (94%). More than 5 years after ileostomy closure, the mean number of bowel movements was 5.8+/-2.2, and 13% of patients had leakage. Most patients (94%) were satisfied with their results. Sixteen patients (3.5%) required recreation of a permanent stoma for pouch failure. Complications (major and minor) occurred in 266 patients (58%) and included obstruction (n=94; 20%), pouch fistula (n=26; 6%), anastomotic stricture (n=40; 9%), anastomosis separation (n=14; 3%), and pouchitis (n=83; 18%). Modifications in technique and increased operative experience have significantly decreased the incidence of obstruction (P=.05) and pouch-related complications (P=.004). Despite complications, long-term results are acceptable, and patient satisfaction remains high.