Purpose: To determine whether perioperative manometry is useful in predicting long term functional status following ileal-pouch anal anastamosis (IPAA).
Methods: Prospectively collected perioperative anal monometry data from 1247 patients was compared to postoperative functional status at 6 months, 1 year and 2 years following IPAA. A validated questionnaire was used to obtain information regarding retrictions of diet, work, social and sexual activity, urgency, fecal seepage or incontinence, energy level, happiness and quality of life. Subgroup analysis of stapled vs. hand sewn anastamoses was performed. The correlation between the degree of seepage and incontinence and the patient's perceived quality of life, health, energy level and happiness was also evaluated.
Results: Low (<40mmHg) pre and postoperative resting pressures were associated with poorer postoperative outcome as indicated by several outcome variables (see table). Compared to hand sewn anastamoses, patient's with stapled anastamoses experienced decreased day seepage (44.4% vs. 16.1%, P<0.001), night seepage(72.9% vs.29.9%, P<0.001) and incontinence (50.5% vs. 26.9%, p<0.001). There was a high correlation (P<0.001) between seepage and degree of incontinence to quality of health, quality of life, energy level and level of happiness.
Conclusion: Pre and postoperative anal resting pressures are useful in predicting postoperative functional outcome following IPAA. Resting pressures are less useful in predicting quality of life parameters.
Resting pressure vs. outcome (2 years)
<40mmHg >=40mmHg P* <40mmHg >=40mmHg P*
Social restrictions 11.5% 12.3% 0.07 17.0% 11.6% 0.014
Day Seepage 34.5% 19.3% 0.001 37.7% 15.4% <0.001
Night Seepage 44.8% 35.3% 0.012 51.6% 29.8% <0.001
Incontinence 35.5% 30.2% 0.007 39.1% 27.8% <0.001
*Age adjusted P value