Pouch surgery has long-term costs for young patients

Restorative proctocolectomy with ileal pouch-anal anastomosis is associated with high complication rates and poor body image in patients who undergo the procedure at a young age, research shows, with women at additional risk for sexual dysfunction.

"Young people undergoing this operation are at a vulnerable period in their lives, in which long-term relationships are established and career plans are made. Therefore, it is important to minimize the effects of the surgical procedure on normal life," say Stephanie Breukink (Maastricht University Medical Center, the Netherlands) and colleagues.

The study included 26 patients aged 10-24 years with ulcerative colitis or familial adenomatous polyposis, who underwent the procedure over a 16-year period, and were followed up for a median of 12. 5 years using medical records and questionnaires.

The patients experienced high rates of postoperative complications, with 13 (50%) having short-term complications, and 23 (88%) having long-term complications. The authors also found that bowel function, quality-of-life, body image, and cosmesis scores were lower in patients than in historical populations of healthy individuals.

Additionally, while no male patients reported sexual dysfunction, 50% of women who underwent the procedure did. The authors note that long-term bowel function and sexual function in women were related to the number of postoperative complications, highlighting the imperative to minimize these.

The study is one of only a few in this age group to assess long-term outcomes of the procedure, which is favored by surgeons for the treatment of ulcerative colitis and familial adenomatous polyposis. The authors also believe this to be the first study to examine sexual function among patients who undergo the procedure at a young age.

While some authors have previously suggested that surgery should be delayed in younger patients, Breukink et al say that further studies are needed with larger populations and to compare outcomes with those of the healthy population.

Reporting in Diseases of the Colon and Rectum, they also note that, despite the negativity of some of their findings, for many patients, surgery may still provide the greatest quality of life. However, they stress that patients must appreciate the risks before surgery, emphasizing that "surgeons should be aware of all consequences and inform patients as to what to expect."

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