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Quality of Life Ten and More Years After Restorative Proctocolectomy for Patients With Familial Adenomatous Polyposis Coli

Ganschow, Petra M.D.; Pfeiffer, Ulrike; Hinz, Ulf M.Sc.; Leowardi, Christine M.D.; Herfarth, Christian M.D.; Kadmon, Martina M.D.

Diseases of the Colon & Rectum:
doi: 10.1007/DCR.0b013e3181e56feb
Original Contribution

PURPOSE: Few studies on long-term quality of life after restorative proctocolectomy and ileal pouch-anal anastomosis have been published. Most of them survey a mixed patient population of familial adenomatous polyposis and ulcerative colitis. The present study analyzes long-term results more than 10 years after ileal pouch-anal anastomosis for patients with familial adenomatous polyposis, exclusively.

METHODS: One hundred thirty-five patients who underwent ileal pouch-anal anastomosis more than 10 years ago were identified from the prospective familial adenomatous polyposis registry at Heidelberg University hospital. They received the German version of the health-specific Short Form 36 Health Survey and the disease-specific Gastrointestinal Quality of Life Index by mail. To assess the impact of disease-specific factors, 10 questions asking for ability to work, current medication, pouchitis, and extracolonic manifestations of familial adenomatous polyposis were added to the Gastrointestinal Quality of Life Index questionnaire.

RESULTS: Among 84 patients who answered the questionnaires the median follow-up was 13.4 years (range, 10.3–23.8 y).The results of the Short Form 36 Health Survey were comparable to a German normative population in all dimensions, whereas the overall score for the Gastrointestinal Quality of Life Index was significantly reduced compared with healthy individuals (111.8 vs 120.8, P = .0014). Carcinoma at the time of ileal pouch-anal anastomosis, desmoid tumors, or duodenal adenomas had no significant influence on quality of life. More than 7 bowel movements during the daytime were found to reduce quality of life significantly (103.5 vs 115, P = .0127). More than 2 defecations per night diminished the score further (101 vs 125, P < .0001). Patients younger than 40 years at the time of ileal pouch-anal anastomosis had significantly better results than older patients (120 vs 109.5, P = .0076).

CONCLUSION: Ileal pouch-anal anastomosis is a safe surgical procedure with a high quality of life comparable to that of a normative population after long-term follow-up of patients with familial adenomatous polyposis.

Author Information

Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

Fincancial Disclosure: None reported.

Poster presentation at the meeting of the German Association of General Surgery, Munich, Germany, May 1 to 4, 2007.

Correspondence: Petra Ganschow, M.D., Department of General, Visceral and Transplantation Surgery, Im Neuenheimer Feld 110, University of Heidelberg, 69120 Heidelberg, Germany. E-mail:

© The ASCRS 2010