Total proctocolectomy (TPC) with ileal pouch anal anastomosis
(IPAA) is the operation of choice for ulcerative colitis (UC) patients with
medically refractory symptoms, steroid dependence and/or dysplasia or cancer.
The IPAA constructs a functional reservoir using a length of small bowel folded over to
create a neorectum
and attaches it to the preserved sphincters to maintain continence.
Overall, this operation has a high rate of patient
satisfaction. However, a subgroup of patients experience poor quality of life
(QOL) after pouch creation with continued physical symptoms and/or a decrease
in emotional or social QOL.
Although it has been suggested that females and those with
pouchitis or inflammation of the pouch are generally unhappier after IPAA,
results are conflicting and confounded by the inclusion of patients with
indeterminate colitis and Crohn’s disease. Presently, there are few studies
identifying clear clinical or histological variables that can predict poor
pouch outcome to aid in surgical decision making preoperatively.
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