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Background and Aim: Postoperative abdominal adhesion formation is a troublesome clinical problem and a common cause of intestinal obstruction, chronic pain and infertility. The aim of this study was to evaluate the effect of small bowel obstruction (SBO) on functional outcome and quality of life (QOL) in patients who experienced ileal pouch-anal anastomosis (IPAA).
Methods: A total of 2418 patients who had undergone IPAA were categorized into three groups: group 1 comprised patients who had no SBO episodes until the last follow-up; group 2 comprised patients who had one or more SBO episodes treated medically; and group 3 comprised patients who had one or more SBO episodes, at least one of which was treated surgically. Functional outcomes and QOL scores for patients in each group were evaluated at 1, 3, 5 and 10 years of follow-up using multivariate analysis.
Results: We found that patients who had SBO episodes which were treated medically were more likely to have a higher number of total bowel movements in a day in the first year of follow-up compared to patients without postoperative SBO (P = 0.03), and more seepage during the day at 10 years follow-up compared to patients with no SBO episodes or surgically treated SBO episodes (P = 0.01). The Cleveland Global Quality of Life (CGQL) scores were comparable between the three groups at 1, 3, 5 and 10 years of follow-up.
Conclusion: Medical management of SBO is associated with an increase in two symptoms, but QOL is comparable with surgical management.
Postoperative abdominal adhesion formation is a troublesome clinical problem and a common cause of intestinal obstruction, chronic pain and infertility. In addition, it increases costs by necessitating recurrent hospital admissions. Postoperative adhesion formation risk is specifically increased after colon and rectal surgeries, non-elective appendectomies and gynecological procedures for unknown reasons. About 75% of patients with intestinal obstruction secondary to intra-abdominal adhesions have undergone an operation for their infracolonic compartment. Although intra-abdominal adhesions usually involve the omentum, those affecting the small bowel are by far the most frequent causes of obstructive symptoms. There is a paucity of data regarding the precise timing of adhesive obstructions after surgeries. A study involving over 8000 abdominal operations revealed a figure of 0.63% for the risk of developing adhesive intestinal obstruction within 4 weeks following surgery. Another study showed that adhesive obstructions may be initially diagnosed any time after surgery, even after 10 years. Following the first episode of adhesive obstruction, the recurrence rate was found to range from 8-32%.
Ileal pouch-anal anastomosis (IPAA) has become the surgical procedure of choice for patients with ulcerative colitis and familial adenomatous polyposis. Theoretically, patients who have undergone IPAA have a higher risk of small bowel obstruction (SBO), because IPAA necessitates both abdominal and pelvic dissection. Diverting ileostomy is frequently performed during IPAA and some patients undergo a subtotal colectomy (staged procedure) before IPAA. IPAA may have more septic complications compared to other abdominal operations. Although in two large series the SBO rate after IPAA was reported to be 25% and 13%, respectively, the effect of SBO on functional outcome and the quality of life (QOL) of patients is still unclear.
Maintenance of postoperative QOL at an optimal level is an important concern for surgeons planning IPAA for their patients. Therefore, SBO may be a factor that adversely affects the QOL after IPAA.
The present study aimed to elucidate the effect of SBO and treatment modalities (medical or surgical) on functional outcome and QOL in patients who underwent IPAA.
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