QUALITY-OF-LIFE AFTER RESTORATIVE PROCTOCOLECTOMY

An audit of 18 patients whom the author managed by abdominal colectomy, rectal mucosectomy and ileo‐anal reservoir anastomosis was undertaken to assess the resulting quality of life. Sixteen patients had ulcerative colitis and two had familial adenomatous polyposis. In each case. a temporary loop ileostomy was performed at the time of reservoir construction. The minimum time since stoma closure was 12 months. The mean number of daily evacuations after stoma closure was eight (range: 4–15). Six patients usually had daytime soiling and eight overnight soiling. Nine patients always wore a perincal pad. Six patients had significant urgency of defecation and 15 patients took medication to reduce bowel frequency. Anorectal problems were noted by all but one of the 18 patients. However, of 14 patients who had lost time from work prior to operation. 12 have returned to uninterrupted employment. Of 11 patients who were unable to travel because of colitis symptoms, eight have no restrictions postoperatively. Twelve patients noted that their diets were more varied since surgery. Of fourteen patients who had restricted sex lives because of colitis symptoms. 11 were subsequently not restricted. On the other hand, during the 3 months the ileostoiny was required, scxual activity was restricted in all but one patient. Other aspects of life also restricted by the stonia were sporting activity (14) and social life (15). Improvement followed stoma closure. Overall. the patients graded the success of the reservoir surgery as excellent (7), very good (3), good (2), satisfactory (4), poor (0), or prefer ileostomy (2). Thirteen patients believed their total lifestyle had improved. The survey suggests that, although not perfect, restorative proctocolectomy is a reasonable option for patients who require surgery for ulcerative colitis or adenomatous polyposis. Copyright © 1990, Wiley Blackwell. All rights reserved