2000 Abstract: 2244: Function, Quality of Life and Complications After Ileal Pouch-Anal Anastomosis in Patients over 70 Years of Age.
Abstracts
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Concerns about morbidity and functional outcome have lead some authors to suggest that ileal pouch-anal anastomosis (IPAA) should not be performed in older patients. This paper evaluates the outcome of patients who were over 70 years old at the time of IPAA surgery. Seventeen of 1911 patients undergoing IPAA were over 70 years of age. All had ulcerative colitis (UC) for a median of 6.3 (IQR 4.0-27.2) years and had surgery for dysplasia (n=5), failed medical therapy (n=5), cancer prevention (n=3) and other reasons (n=4). All had J pouches with the pouch-anal anastomosis being double-stapled in 14, and hand-sewn with mucosectomy in 3. Final pathology revealed UC in 12 patients, indeterminate colitis in 2, and Crohn’s disease in 3. Two radiological leaks (sinus tracts) required delay of ileostomy closure. One anastomotic stenosis and one small bowel obstruction (SBO) resolved spontaneously. One intra-abdominal abscess 6 months post IPAA caused SBO requiring surgery. The patient died of septic complications. Another abscess 18 months post IPAA required revision of the tip of the J pouch and the refashioned loop ileostomy has not been reversed to date. Patients have 5.5±1.8 bowel motions per day and 1.7±1.3 motions per night. Median quality of life, health, energy and happiness were 9 (IQR 7-10), 9 (7-10), 8 (5-10) and 9.5 (7-10), respectively. There was complete continence in 38%, rare incontinence in 12% and some incontinence in 50%. Nobody was usually or always incontinent. Overall, 82.1% would undergo pouch surgery again and 89% would recommend it to others. Although functional outcome after IPAA is not ideal in patients over 70 years, appropriate case selection yields patients who are very happy with their function and quality of life. |
