Long Term Out Come and Quality of Life After Restorative Proctocolectomy in a Cohort of 955 Canadian Patients
Marco Scarpa*1, Brenda I. O'Connor2, J Charles Victor2, Robin S. Mcleod2
1Clinica Chirurgica I, University of Padova, Padova, Italy; 2Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
Background and aims Restorative proctocolectomy (RPC) is the procedure of choice for ulcerative colitis (UC) and familial adenomatous polyposis (FAP) but it has an important impact on quality of life (HRQL). The aims of this cross sectional study were to validate an English version of the Padova Inflammatory Bowel Disease Quality of Life questionnaire (PIBDQL) in patients undergoing RPC to investigate the possible predictors of long term HRQL. Functional outcome was also investigated. Patients and methods In 2005, the English PIBDQL, the Short Inflammatory Bowel Disease Questionnaire, Short Form-36 and the Pelvic Pouch Follow-up questionnaires were mailed to 1379 patients who underwent RPC at the Mount Sinai Hospital between 1982 and 2004. Nine hundred sixty-nine (69%) returned the questionnaires. The translation and validation of PIBDQL into English language implied the assessment of test-retest reliability, internal consistency, construct validity and discriminative ability. Results The test-retest reliability, internal consistency, construct validity and discriminative ability of the English version of PIBDQL were adequate. Multivariate analysis showed that although female patients experienced the same rate of complications and stool frequency as males, they obtained worse PIBDQL scores (p<0.01); patients with Crohn’s disease (CD) experience worse long term HRQL compared to UC or FAP patients (p<0.01); patient who had pouch reconstruction obtained significantly worse scores than patients who had not.In our study group the 67% of patients reported a full continence during the day time after a follow up of about 9 years. Only very few patients (<1%) reported a complete day time incontinence. The bowel movement frequency in the 24 hours was 7.7+/-3.2 and mean frequency during the night was 1.7+/-1.3. Female patients reported more frequent sexual restrictions due to pelvic pouch.Conclusions As far as we know, this is the largest series of RPC patients to be investigated with a disease specific tool for the measurement of HRQL and in this series female gender, CD and pouch redoing were significant risk factors for a worse HRQL long term outcome.
