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

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 or pouch (double-folded pouch), of whom 123 had a pouch (96 handsewn and 27 stapled) and 289 had a 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 pouches and 4·9 for 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 pouch and handsewn anastomosis than with a 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 pouch was associated with a better long-term functional outcome than the pouch in this patient population. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.