THE SWISS EXPERIENCE WITH THE ILEAL POUCH-ANAL ANASTOMOSIS - COMPLICATIONS AND FUNCTIONAL RESULTS

Two hundred and thirteen ileal pouch-anal anastomoses were performed in Switzerland from August 1980 to December 1991, 174 (82 %) of them in 7 centres. One hundred and sixty four patients (77 %) were operated for ulcerative colitis, 47 (22 %) for familial polyposis and 2 others (1 %) for another reason. A J pouch was created in 176 cases (83 %), an S pouch in 35 cases (16 %) and a W pouch in 2 cases (1 %). Detailed results were available for 157 (74 %) of the 213 operated patients : 81 females (52 %) and 76 males (48 %) with a mean age of 33,5 years (10-65). One hundred and twenty seven patients (81 %) were operated for ulcerative colitis, including 42 as an emergency, and 30 (19 %) for familial polyposis. One hundred patients (64 %) developed complications which required one or several reoperations (laparotomy and/or perineal operation) in 64 cases (41 %). Pouchitis was the most frequent complication (19 %). Small bowel obstruction and pelvic abscess secondary to an anastomotic leak were the complications most frequently requiring second laparotomy with an incidence of 13 % and 11 %, respectively. The mean number of stools per 24 hours was 5,5 (2 to 14). 27 % of patients passed one or several nocturnal stools every night, 27 % occasionally, and 46 % never. Occasional faecal incontinence was reported by 8 patients (6 %) and 4 patients (3 %) reported uncontrollable urgency. Nine patients retained a permanent ileostomy (failure rate : 6 %).