DENVER—Patients who undergo redo ileal pouch–anal anastomosis surgery can expect sustained quality of life for decades, according to a new study presented at the 2023 annual Crohn’s & Colitis Congress.
Patients who underwent redo IPAA surgery showed a median quality-of-life score of 7 out of 10 and a median happiness score of 8 out of 10, with 80% of patients indicating that they would undergo the surgery again. However, the data also show functional challenges associated with the technically demanding procedure, including excessive bowel movements, urgency, incontinence and seepage.
“Overall, our study suggests that patients can expect to have a good quality of life after redo pouch surgery, with high levels of satisfaction with the procedure,” said lead researcher Marianna Maspero, MD, a colon and rectal surgeon at Cleveland Clinic, in Cleveland. “While there may be some changes in quality of life and functional outcomes over time, patients can still expect to have a good quality of life and functional outcomes, even after 20 years.”
Whether caused by septic complications, mechanical failure, poor function or the development of neoplasia, pouch failure can occur in approximately 5% to 15% of patients, Dr. Maspero said. When a pouch fails, patients have the option of getting a permanent ileostomy or, in selected cases, a redo pouch. However, a redo pouch is a technically demanding operation with higher morbidity and a higher risk for pouch failure than an index pouch, she explained, making it crucial for patients to understand what their long-term quality of life and function will look like.
To describe long-term quality of life and functional outcomes in patients with a redo IPAA, Dr. Maspero and her co-investigators conducted a retrospective review of a prospectively maintained pouch database at Cleveland Clinic (abstract 15). The researchers analyzed results of the Cleveland Global Quality of Life Survey (CGQL; range 0-1), a validated survey specifically designed for pouch patients that measures four domains: quality-of-life score, function, restrictions and satisfaction. The study population consisted of 375 patients (median age, 40 years; 57% women) who had completed the CGQL. At median follow-up, 50% of patients had an ostomy, and the most common diagnosis was ulcerative colitis. The cause of redo failure was sepsis in more than 60% of patients.
High Patient Satisfaction, Quality of Life
Results of the survey showed a median CGQL score of 0.7 and a median quality-of-life score of 7 out of 10, while the median quality of energy score was slightly lower at 6.5.
Functional outcomes were also good, said Dr. Maspero, who noted that, on average, patients reported six bowel movements during the day and two during the night, for a total of eight per 24 hours. Additionally, 24% of patients reported experiencing urgency and 10% reported incontinence.
However, seepage was much more prevalent, with nearly 70% of patients experiencing seepage during the night. Half of patients also had dietary restrictions, while one-third of patients reported social, work and sexual restrictions.
Despite these restrictions, satisfaction with the surgery was very high, Dr. Maspero said. In addition to the 80% of patients who would undergo surgery again, 84% would recommend redo IPAA surgery to other patients.
“The overall message is that it is very important to counsel these patients preoperatively to set realistic expectations of what their function and quality of life is going to be,” Dr. Maspero concluded. “Patients are likely to have high number of bowel movements, seepage, urgency and have a higher risk of pouch failure than an index pouch, but they can still experience a good quality of life.”
Asked to comment on the findings, GI psychologist Alyse Bedell, PhD, an assistant professor of psychiatry and behavioral neuroscience, and assistant professor of medicine at the University of Chicago, highlighted the significant percentage of survey respondents (37%) who reported sexual restrictions following redo pouch surgery. “Results of the study showed that more than one-third of patients experienced sexual restrictions,” said Dr. Bedell, who noted that the survey response to this question was only a yes or no. “I would be interested to see that question expanded to include the type of sexual restrictions these patients experienced and how these restrictions differed based on gender and other variables.”
—Chase Doyle
The sources reported no relevant financial disclosures.
This article is from the April 2023 print issue.