Background: Reconstructive procedures for failed IPAA frequently require total reconstruction with a combined abdominal and perineal approach. The purpose of this study was to compare the functional results and quality of life in this group of patients to that of patients who did not require reconstruction.
Methods: A 29 item questionnaire relating to bowel function and quality of life was mailed to all patients who underwent the IPAA at our institution. Those who had pouch reconstruction (group 1) were identified, and were then matched to two controls: group 2, which consisted of patients who did not have an IPAA leak, and group 3, who had a peri-operative IPAA leak but did not require reconstruction. The three groups were matched with respect to age, sex, diagnosis, and type of anastomosis.
Results: Twenty-three patients with a functioning IPAA reconstruction answered the questionnaire. All patients have had a functioning pouch for more than one year. Only 26% of patients in group 1 have less than 6 bowel movements per day, compared to 57% in group 2 (p=0.036) and 43% in group 3 (p=ns). 74% of patients in group 1 have good daytime continence, compared to 96% in group 2 (p=0.013), and 76% in group 3 (p=ns). In contrast, only 56% of patients in group 1 have good nighttime continence, compared to 87% in group 2 (p=0.013) and 71% in group 3(p=0.078). Urgency occurs in less than 15% of all patients. 61% of paients in group 1 and 57% of group 3 reported that their bowel function does not interfere with their daily activities, compared to 78% in group 2 (p=0.005). Over 75% of patients in all three groups usually feel well, over 90% usually have a good appetite, and about two thirds usually have a good energy level. Over 80% of patients reported good physical and psychological health, and self-esteem. More than 75% of all patients felt that they are unrestricted in participating in sports, hobbies, and in pursuing their career.
Conclusions: Functional results are inferior after reconstructive surgery, but the alteration may be due to the leak at the initial operation rather than the reconstructive surgical procedure itself. However, despite the less optimal functional results, quality of life remains high.