Restorative proctocolectomy with two different pouch designs: few complications with good function.

Autor: Sunde ML; Department of Colorectal Surgery, Akershus University Hospital, Lørenskog, Norway.; Clinic of Surgical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway., Øresland T; Department of Colorectal Surgery, Akershus University Hospital, Lørenskog, Norway.; Clinic of Surgical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway., Faerden AE; Department of Colorectal Surgery, Akershus University Hospital, Lørenskog, Norway.
Jazyk: angličtina
Zdroj: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2017 Apr; Vol. 19 (4), pp. 363-371.
DOI: 10.1111/codi.13478
Abstrakt: Aim: The object of this study was to compare function and quality of life after restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) surgery having two different pouch designs.
Method: Patients having RPC in an academic unit from 2000 who had had the loop-ileostomy closed by June 2013 were identified from the hospital medical records. They were sent a questionnaire regarding quality of life and interviewed using a pouch function score (PFS) described by Oresland (score 0-16, higher scores denote worse function).
Results: One hundred and three patients underwent surgery, of whom 56 had a J-pouch design and 47 a K-pouch design, this being a double-folded Kock pouch without the nipple valve. No patients have had the pouch removed or defunctioned due to failure at a mean of 8 years. The reoperation rate was 11.6%. The mean PFS was 5.43 and 5.27 for J- and K-pouches, respectively (P = 0.766). More patients with a J-pouch reported a social handicap due to poor bowel function (P = 0.041). Patients with a PFS ≥ 8 had a poorer quality of life. A score of ≥ 8 was reported by 16% of K-pouch and 25% of J-pouch patients (P = 0.29).
Conclusion: RPC is a safe procedure with a low complication rate and good functional outcome. Small improvements in function have an impact on a patient's quality of life. Although the J-pouch is the most commonly used, the K-pouch has some advantages. Other pouch designs deserve further evaluation.
(Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.)
Databáze: MEDLINE
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