Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice for patients with medically refractory ulcerative colitis, ulcerative colitis with dysplasia or cancer, or familial adenomatous polyposis (FAP), regardless of their age. The aim of the paper was to report our 6-year experience of restorative proctocolectomy and ileal pouch-anal anastomosis in elderly population at the tertiary referral centre. Chart review was performed for four patients undergoing ileal pouch-anal anastomosis from 2006 to 2010. Preoperative histopathologic diagnosis was ulcerative colitis. We collected data regarding patients’ demographics, type and duration of disease, previous operations and indications for surgery. We analyzed the operative protocols and postoperative pathologic diagnosis. Early (within 30 days after surgery) and late complications were noted. Follow-up was conducted upon annual function and quality of life questionnaire, physical examination and endoscopic evaluation of the pouch. Postoperative histopathologic diagnoses were: ulcerative colitis (n = 2) and indeterminate colitis (n = 2). The average age of the operated patients was 59 years. The mean duration of the follow-up was four years. We report two cases of steroid use prior to operation as well as two cases of extraintestinal manifestations. We report no septic complications and two cases of pouchitis. Functional results and quality of life were good to excellent in all four cases of ileal pouch-anal anastomosis. Restorative proctocolectomy with ileal pouch-anal anastomosis in elderly people is a safe procedure with low morbidity rate. Functional results are generally good and patient satisfaction is high.
Chapman JR. Ileal Pouch–Anal Anastomosis. Archives of Surgery. 2005;140(6):534.
2.
COHEN Z, McLEOD RS, STEPHEN W, STERN HS, OʼCONNOR B, REZNICK R. Continuing Evolution of the Pelvic Pouch Procedure. Annals of Surgery. 1992;216(4):506–12.
3.
Gorfine SR, Gelernt IM, Bauer JJ, Harris MT, Kreel I. Restorative proctocolectomy without diverting ileostomy. Diseases of the Colon & Rectum. 1995;38(2):188–94.
4.
Alves A, Panis Y, Trancart D, Regimbeau J, Pocard M, Valleur P. Factors Associated with Clinically Significant Anastomotic Leakage after Large Bowel Resection: Multivariate Analysis of 707 Patients. World Journal of Surgery. 2002;26(4):499–502.
5.
Lovegrove RE, Constantinides VA, Heriot AG, Athanasiou T, Darzi A, Remzi FH, et al. A Comparison of Hand-Sewn Versus Stapled Ileal Pouch Anal Anastomosis (IPAA) Following Proctocolectomy. Annals of Surgery. 2006;244(1):18–26.
6.
Heuschen UA, Hinz U, Allemeyer EH, Autschbach F, Stern J, Lucas M, et al. Risk Factors for Ileoanal J Pouch-Related Septic Complications in Ulcerative Colitis and Familial Adenomatous Polyposis. Annals of Surgery. 2002;235(2):207–16.
7.
Yu CS, Pemberton JH, Larson D. Ileal pouch-anal anastomosis in patients with indeterminate colitis. Diseases of the Colon & Rectum. 2000;43(11):1487–96.
8.
NELSON H. Predictors of surgical outcomes. Journal of Gastroenterology and Hepatology. 2002;17(s1).
9.
Pinto RA, Canedo J, Murad-Regadas S, Regadas SF, Weiss EG, Wexner SD. Ileal pouch-anal anastomosis in elderly patients: is there a difference in morbidity compared with younger patients? Colorectal Disease. 2011;13(2):177–83.
10.
Dayton MT, Larsen KR. Should older patients undergo ileal pouch-anal anastomosis? The American Journal of Surgery. 1996;172(5):444–8.
11.
Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. BMJ. 1978;2(6130):85–8.
12.
Takao Y, Gilliland R, Nogueras JJ, Weiss EG, Wexner SD. Is Age Relevant to Functional Outcome After Restorative Proctocolectomy for Ulcerative Colitis? Annals of Surgery. 1998;227(2):187–94.
13.
Tulchinsky H, Hawley PR, Nicholls J. Long-Term Failure After Restorative Proctocolectomy for Ulcerative Colitis. Annals of Surgery. 2003;238(2):229–34.
14.
Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-Sphincter Disruption during Vaginal Delivery. New England Journal of Medicine. 1993;329(26):1905–11.
15.
Lewis WG, Sagar PM, Holdsworth PJ, Axon AT, Johnston D. Restorative proctocolectomy with end to end pouch-anal anastomosis in patients over the age of fifty. Gut. 1993;34(7):948–52.
16.
Berndtsson I, Öresland T, Hultén L. Sexuality in patients with ulcerative colitis before and after restorative proctocolectomy: a prospective study. Scandinavian Journal of Gastroenterology. 2004;39(4):374–9.
17.
Delaini GG, Scaglia M, Colucci G, Hultén L. The ileoanal pouch procedure in the long–term perspective: a critical review. Techniques in Coloproctology. 2005;9(3):187–92.
18.
Shen B, Lashner BA, Bennett AE, Remzi FH, Brzezinski A, Achkar JP, et al. Treatment of Rectal Cuff Inflammation (Cuffitis) in Patients with Ulcerative Colitis Following Restorative Proctocolectomy and Ileal Pouch-Anal Anastomosis. The American Journal of Gastroenterology. 2004;99(8):1527–31.
19.
Fazio VW, Ziv Y, Church JM, Oakley JR, Lavery IC, Milsom JW, et al. IIeal Pouch-Anal Anastomoses Complications and Function in 1005 Patients. Annals of Surgery. 1995;222(2):120–7.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
