Is ileoanal pouch function stable with time? - Results of a prospective audit

PURPOSE: Good continence is reported after ileal pouch-anal reconstruction, but little is known about long-term durability. Our aim was to prospectively evaluate long-term function in these patients. METHODS: Surveys were sent to 235 patients who had returned similar surveys in 1992; paired data were then compared with contingency tables. RESULTS: A total of 154 patients (66 percent) returned surveys. Mean age was 47 (range, 25-72) years. Median follow-up was 12 (range, 8-19) years. Sixty-eight patients (44 percent) were female. There were 5 deaths, and 11 patients had pouches removed or were given a defunctioning ileostomy. Bowel movement frequency did not change from 1992 to 2000 (24-hour frequency = 7 in 1992 vs. 7.1 in 2000; night frequency = 2 vs. 1.4; P = NS), Compared with 1992 data, major day incontinence was worse in 18 percent of patients, improved in 1 percent, and unchanged in 81 percent. Minor day incontinence was worse in 32 percent, improved in 9 percent, and unchanged in 59 percent. Major nighttime incontinence was worse in 22 percent, improved in 6 percent, and unchanged in 72 percent of patients, whereas minor night incontinence was worse in 24 percent, improved in 22 percent, and unchanged in 54 percent. Change in continence was unrelated to gender, age, or age at operation but was related to duration of follow-up. Twenty-seven percent of patients 12 or more years after surgery reported worsened major daytime incontinence vs. 9 percent of patients who were < 12 years after surgery (P < 0.05); 33 percent reported more major nighttime incontinence (vs. 10 percent; P < 0.05). Minor incontinence also worsened after 12 years. Minor daytime incontinence was seen in 48 percent of patients followed up > 12 years vs. 16 percent of those followed up < 12 years (P < 0.05); minor nighttime incontinence was 28 vs. 19 percent, respectively. CONCLUSION: Most patients have stable pouch function over time. However, a small number improve and a larger number suffer measurable deterioration, particularly 12 or more years after surgery.