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Pouch design and long-term functional outcome after ileal pouch-anal anastomosis.

Journal article
Authors Mattias Block
Lars Börjesson
Elisabet Lindholm
Tom Öresland
Published in The British journal of surgery
Volume 96
Issue 5
Pages 527-32
ISSN 1365-2168
Publication year 2009
Published at Institute of Clinical Sciences, Department of Surgery
Pages 527-32
Language en
Links dx.doi.org/10.1002/bjs.6590
Keywords Adolescent, Adult, Aged, Anal Canal, surgery, Anastomosis, Surgical, Colonic Diseases, physiopathology, surgery, Colonic Pouches, physiology, Defecation, physiology, Fecal Incontinence, etiology, Female, Humans, Male, Middle Aged, Postoperative Complications, etiology, Prosthesis Design, Surgical Stapling, Suture Techniques, Treatment Outcome, Young Adult
Subject categories Medical and Health Sciences, Surgery

Abstract

BACKGROUND: Functional outcome is of utmost importance after ileal pouch-anal anastomosis. Although pouch design and construction of the anastomosis are known technical determinants of function, there are few long-term results. This retrospective study evaluated functional outcome for two different pouch designs, and for handsewn versus stapled pouch-anal anastomoses. METHODS: The analysis included 412 patients who had either a J or K pouch (double-folded J pouch), of whom 123 had a J pouch (96 handsewn and 27 stapled) and 289 had a K pouch (95 handsewn and 194 stapled). Functional outcome was evaluated by a mailed questionnaire to achieve an Oresland score (0 to 15; 15 worst). RESULTS: Mean functional scores were 6.1 for J pouches and 4.9 for K pouches (P < 0.001). Regression analysis showed that reservoir design and age at surgery were predictors of functional outcome (P < 0.001). A higher proportion of patients with a J pouch and handsewn anastomosis than with a K pouch and stapled anastomosis had a score of 8 or more, a level previously demonstrated to impact negatively on quality of life (32 versus 16 per cent; P = 0.006). CONCLUSION: The K pouch was associated with a better long-term functional outcome than the J pouch in this patient population.

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