DEFINING LONG-TERM QUALITY OF LIFE AND FUNCTIONAL OUTCOMES AFTER REDO ILEAL POUCH ANAL ANASTOMOSIS: WHAT SHOULD PATIENTS AND PROVIDERS EXPECT?
Authors: Maspero Marianna , Lavryk Olga , Holubar Stefan , Lipman Jeremy , Qazi Taha , Cohen Benjamin , Steele Scott , Hull Tracy 
Published: January 2023

Abstract

BACKGROUND
Pouch failure after restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) occurs in up to 15% of cases. A redo pouch procedure can be offered to maintain intestinal continuity after pouch failure, but little is known on quality of life (QoL) after redo pouch. We aimed to describe long-term QoL and functional outcomes after redo pouch.

METHODS
We retrospectively analyzed our prospectively collected redo pouch registry, and identified patients who had completed at least one Cleveland Global Quality of Life (CGQL) questionnaire after redo pouch. Figures are number (proportion) or median (interquartile range).

RESULTS
Out of 532 patients, CGQL were available for 375 (70%): 212 (57%) females, median age at redo pouch 40 (28 – 48) years. Diagnosis at index pouch was ulcerative colitis in 325 (87%) cases, indeterminate colitis in 13 (3%), Crohn’s disease in 15 (4%), familial adenomatous polyposis in 21 (6%). The median interval between index and redo pouch was 4 (2 – 6) years. The indication for redo pouch was sepsis in 230 (61%) cases, mechanical in 114 (31%), functional in 19 (5%), and dysplasia or cancer in 11 (3%). The anastomosis was handsewn in 72% cases.
After redo pouch, 351 (95%) had their stoma closed, while 18 (5%) never had stoma closure due to complications, and 5 (1%) due to patient preference. The median interval between redo pouch and latest CGQL was 4 (1 – 9) years. The overall CGQL score (0 – 1) was 0.7 (0.5 – 0.8), with median quality of life 7 (5 – 9), quality of health 7 (5 – 8) and quality of energy 6.5 (5 – 8). There were no differences in CGQL scores in patients who had a redo pouch due to septic complications versus other indications. The median number of bowel movements was 6 (5 – 8) during the daytime, 2 (1 – 3) during the nighttime, for a total of 8 (6 – 10) bowel movements per 24 hours. Dietary restrictions were reported by 50% patients, social restrictions by 34%, work restrictions by 38%, and sexual restrictions by 37% (Figure 1). Urgency occurring daily or most days was reported by 24% patients, incontinence by 10%. Consistency of stool was reported as liquid by 76% of patients. Seepage during the day was experience by 52% of patients, nocturnally in 68%, with 53% of patients reporting daytime pad use, and 61% at night. Median happiness with surgery was 8 (5 – 10): 80% patients would undergo surgery again, and 84% patients would recommend it to other people. During follow-up, 84 (22.5%) pouch failures occurred.

CONCLUSION
A redo pouch procedure allows a majority of patients to maintain intestinal continuity with good quality of life. Most patients would undergo redo pouch again and recommend it to others. Before redo pouch, patients need to be counselled regarding function expectations in regards to stool frequency and consistency, urgency, incontinence, seepage, and overall success rates.