Document Detail


Functional outcome and quality of life following restorative proctocolectomy for ulcerative colitis in Indians.
MedLine Citation:
PMID:  20532530     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The functional outcome and quality of life after sphincter-saving operations for ulcerative colitis have not been previously assessed in Indian patients whose dietary habits and socio-cultural practices differ considerably from those in western countries. PATIENTS AND METHODS: Between 1996 and 2002, we performed 46 J-pouch ileoanal anastomoses (IPAA), for patients with ulcerative colitis. Thirty-eight of these patients had had their ileostomy closure more than 4 years previously of whom 31 could be assessed by interviews and a telephonic questionnaire. Their quality of life was objectively assessed using the Cleveland Global Quality of Life (CGQL) index, a validated index for IPAA, the score being 1 in normal people. There were 20 males and 11 females with a mean age of 38 years. In the same period, six of the nine patients who did not opt to have an IPAA (permanent stoma) were assessed. These included four males and two females, mean age 45 years (36-52). RESULTS: One patient died in the postoperative period and another died 3 months after surgery from multiple small bowel perforations. Other complications included intestinal obstruction in seven, pouchitis in four and incisional hernia in two. One pouch had to be converted to a permanent ileostomy following development of a fistula because of Crohn's disease. The mean daily postoperative stool frequency was seven (range 2-20). Eighty-one percent had perfect daytime continence and 81% used dietary restrictions. Eighty-four percent rated their pouch function to be excellent or good. All patients preferred IPAA to an ileostomy citing mainly social and cultural reasons and were willing to choose it again. The mean preoperative CGQL score (0.27) increased significantly after colectomy (0.50) and after closure of ileostomy (0.77; p < 0.001). The mean CGQL in the "permanent stoma" group did not improve significantly after surgery (0.62 vs. 0.50) and four of these expressed a wish to have an IPAA. CONCLUSIONS: Restorative proctocolectomy provides a good functional outcome and improves the quality of life in Indians with ulcerative colitis and may be the most appropriate procedure for such patients in developing countries.
Authors:
Uday Somashekar; Subash Gupta; Arvinder Soin; Samiran Nundy
Publication Detail:
Type:  Journal Article     Date:  2010-06-08
Journal Detail:
Title:  International journal of colorectal disease     Volume:  25     ISSN:  1432-1262     ISO Abbreviation:  Int J Colorectal Dis     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-06-23     Completed Date:  2010-09-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8607899     Medline TA:  Int J Colorectal Dis     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  967-73     Citation Subset:  IM    
Affiliation:
Department of Surgical Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India.
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MeSH Terms
Descriptor/Qualifier:
Adult
Colitis, Ulcerative / physiopathology,  surgery*
Female
Humans
Ileostomy
India
Male
Middle Aged
Postoperative Complications / etiology
Preoperative Care
Proctocolectomy, Restorative / adverse effects,  methods*
Quality of Life*
Time Factors
Treatment Outcome
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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