Functional and Clinical Results of Patients Who Underwent an Ileal Pouch Anal AnastomosisFunctional and Clinical Results of Patients Who Underwent an Ileal Pouch Anal Anastomosis

Functional and Clinical Results of Patients Who Underwent an Ileal Pouch Anal AnastomosisFunctional and Clinical Results of Patients Who Underwent an Ileal Pouch Anal Anastomosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Functional and Clinical Results of Patients Who Underwent an Ileal Pouch Anal AnastomosisFunctional and Clinical Results of Patients Who Underwent an Ileal Pouch Anal Anastomosis Aydin Yavuz, Huseyin Gobut, Omer Kubat, Saygin Altiner, Kursat Dikmen, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-154490/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Our aim is to evaluate the patients who underwent IPAA in our clinic, in terms of their characteristics, early and late complications, the results, and the problems that may emerge after the IPAA such as the quality of life. Methods: Twenty-two of the 26 patients, who underwent IPAA were included in the study. Evaluations were made on the demographic characteristics of the patients, surgical indications, the type of operation, pathological diagnosis, early and late postoperative complications, and functional outcomes. Cleveland Global Quality of Life scoring was administered in order to evaluate the quality of life. Results: Ten of the patients had UC and 12 had FAP. Nineteen of the patients underwent a two-stage surgical procedure. In postoperative period, ileus occurred in 4 patients (18.2%), 5 had wound infections (22.7%), 3 had a pelvic abscess (13.6%), and other complications developed in 5 patients (22.7%). Two patients had pouchitis (9.1%), 2 had anastomotic stenosis (9.1%), and 2 had pouch dysfunction (9.1%). There was incontinence with fluid in 6 (27.3%) patients. Four patients (18.2%) used pads during the day, requiring defecation with an average of (4.31±2.37) times during the day and (1.04±0.89) times at night. Half of them (50%) had complaints of sexual dysfunction. The life quality score was observed to be significantly better in patients with FAP (0.85±0.13) compared to patients with UC patients (0.71±0.11). Conclusion: This procedure could be applied safely with low comorbidity and good functional outcomes in experienced health centers with high caseloads. Gastroenterology & Hepatology Restorative Proctocolectomy Ileal Pouch-Anal Anastomosis Ulcerative Colitis Familial Adenomatous Polyposis Results Background Restorative proctocolectomy (RP) with ileal pouch-anal anastomosis (IPAA) is a surgical procedure with proven effectiveness in the surgical treatment of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). ( 1 ). They can be performed in experienced hands with acceptable functional outcomes and high success rates. Ulcerative colitis is an inflammatory bowel disease that often develops in the 3rd and 8th decades, involving the colorectal mucosa. Indications for surgery include unresponsiveness to medical treatment, severe bleeding, cancer risk, obstruction, perforation, and toxic megacolon ( 2 ). Familial adenomatous polyposis is an inherited, autosomal dominant disease caused by the germline mutation of the adenomatous polyposis coli gene ( 3 ). If the FAP is left untreated, colorectal cancer is inevitable. It has been demonstrated that the complete removal of the colorectal mucosa prevents the lifelong development of colorectal cancer ( 4 ). In the present study, our aim is to evaluate the patients who underwent IPAA in our clinic, in terms of their characteristics, early and late complications, the results, and the problems that may emerge after the IPAA such as the quality of life. Methods Following the approval obtained from Gazi University Clinical Research Ethics Committee (24074710-06), 26 patients, who underwent IPAA between November 2007 and November 2019 in Gazi University Faculty of Medicine General Surgery Clinic, were included in the study. Demographic characteristics of the patients such as age and gender were recorded along with the surgical indications, the type of operation (one, two, or three stages), and the results such as the pathological diagnosis. The early and late postoperative complications such as anastomotic stenosis, obstruction, pelvic sepsis, pouchitis, postoperative bleeding, wound infection, pouch failure, anastomotic leakage, and fistula formation were examined. Question forms were created to evaluate the functional outcomes regarding the number of defecations per day including day and night, fecal incontinence, use of pads, presence of urinary and sexual dysfunction, use of antidiarrheal medication, and the history of post-operative pregnancy. Cleveland Global Quality of Life (CGQL) scoring was administered in order to evaluate the quality of life. The forms were filled out by reaching the patients on the phone or via e-mail. Results IPAA was performed to a total of 26 patients in our clinic. All surgeries were performed as open surgeries. In the preoperative evaluations of the patients, upper GI endoscopy, colonoscopy, pathological analysis, upper abdominal tomography, pelvic MRI, gynecological examinations, and genetic studies were performed as a routine. It was found that 2 of the patients died during their follow-up due to the reasons independent of the operation. One of these two patients had been operated due to FAP and the other one had been operated for a colon tumor with a diagnosis of UC. In one of the patients that we had operated for ulcerative colitis, abdominoperineal resection was performed due to anastomotic recurrence. In a patient we had operated for FAP, ileostomy closure was not performed due to the development of pouch fistula. Therefore, these four patients were excluded from the study. Of the 22 patients, 14 were female and 8 were male. At the time of the surgery, the mean age was 40.7 ± 14.2 and the mean body mass index was 26.4 ± 4.3 kg/m 2 . Ten of the patients had UC and 12 had FAP (Table 1 ). Postoperative pathology results indicated adenocarcinoma in 2 patients with ulcerative colitis and 4 patients with FAP. A 2-stage surgical procedure (ileostomy closure after IPAA) was performed to 19 patients, a 3-stage surgical procedure (complete colectomy + RP complementary to ileostomy, followed by ileostomy closure) was performed on 3 patients. All three-stage surgeries were performed on patients with a diagnosis of UC. After proctocolectomy with total mesorectal excision in all patients, the J pouch of 12-13cm was formed with a stapler, and IPAA was performed with the 25 mm circular stapler. The mean duration of ileostomy closure after the procedure was 4.2 ± 2.7 months. While the mean duration of ileostomy closure in patients with UC was 5.5 ± 3.65 months, it was 3.25 ± 0.86 in patients with FAP. The mean postoperative follow-up period of the patients was 43 (7-115) months. Before ileostomy closure, the pouch was evaluated using endoscopic and imaging methods. Table 1 Demographic Characteristics According to Diagnoses n = 22 UC FAP P Age, year, mean ± SD 40,7 ± 14,2 44,8 ± 16,5 37,3 ± 11,6 0.229 Gender (F / M) 14/8 6/4 8/4 0.746 BMI, kg/m 2 , mean ± SD 26,4 ± 4,3 26,9 ± 4,4 25,9 ± 4,3 0.611 Ileostomy closure time, month 46,7 ± 96,7 5,5 3,25 0.052 Surgery Type (two / three stage) 4,2 ± 2,7 7/3 12/0 0.043 Follow-up time, month, median (min-max) 19/3 44 (10–86) 42.5 (7-115) 0.878 In the early postoperative period (< 3 months), 4 patients had ileus (18.2%), 5 patients had wound infections (22.7%), 3 patients had a pelvic abscess (13.6%), and other complications such as DVT, urinary tract infection and pneumonia developed in 5 patients (22.7%). In the late postoperative period (> 3 months), 2 patients had pouchitis (9.1%), 2 patients had anastomotic stenosis (9.1%), and 2 patients had pouch dysfunction (9.1%). The effect of the final diagnosis on the complications ( Table 2 ) Table 2 Distribution of complications by diagnosis Complications n (%) UC FAP P Pouchits 2 (9.1) 1(10) 1(8,3) 0.892 Anastomotic stricture 2 (9.1) 1(10) 1(8,3) 0.892 Pouch fistula - - - - Anastomotic leak - - - - Ileus 4 (18.2) 3(30) 1(8,3) 0.293 Pelvic abscess 3 (13.6) 3(30) - 0.041 Pouch dysfunction 2 (9.1) 1(10) 1(8,3) 0.892 Wound infection 5 (22.7) 3(30) 2(16,6) 0.221 Others 5 (22.7) 4(40) 1(8,3) 0.078 One of the patients with pouchitis had been diagnosed with UC and the other with FAP (10% versus 8.3%, p = 0.892). Anastomotic stenosis was observed in one patient (10% versus 8.3%, p = 0.892). Crohn's disease developed in 1 patient during follow-up. The patient was excluded from the study since the ileostomy closure had not yet been performed due to the development of pelvic abscess and pouch-vaginal fistula. 3 patients with UC and 1 patient with FAP had ileus (30% versus 8.3%, p = 0.293). A pelvic abscess was observed in 3 patients with UC; however, it was not observed in patients with FAP (30% versus 0, p = 0.041). Pouch dysfunction was observed in one patient (10% versus 8.3%, p = 0.892). Wound infection was observed in 3 patients with UC and 2 patients with FAP (30% versus 16.6%, p = 0.221). In 4 patients with UC, complications such as DVT, urinary infection, and pneumonia were observed, whereas one patient with FAP had a urinary infection (40% versus 8.3%, p = 0.078). Functional Outcomes And Quality Of Life (table ) Table 3 Quality of life and functional results of patients according to diagnosis n = 22 UC FAP P CQOL,mean + SD 0,78 ± 0,13 0,71 ± 0,11 0,85 ± 0,13 0.015 Defecation number daytime, mean + SD 4,31 ± 2,37 3,6 ± 1,26 4,91 + 2,93 0.203 Defecation number at night, mean + SD 1,04 ± 0,89 1,2 + 0,78 0,91 + 0,99 0.475 Incontinence, n (%) 6 (27,3) 4 (40) 2 (16,7) 0.221 Pad usage, n (%) 4 (18,2) 3 (30) 1 (8,3) 0.190 Urinary dysfunction, n (%) 1 (4,5) - 1 (8,3) 0.350 Sexual dysfunction, n (%) 11(50) 6 (60) 5 (41,7) 0.392 Antidiarretic drug use, n (%) 2 (9,1) 1 (10) 1 (8,3) 0.892 Pregnancy, n (%) 1 (4,5) 1 (10) - 0.262 There was fecal incontinence in 6 (27.3%) of the patients. It was found that 4 (18.2%) of them used pads during the day. The patients were observed to require defecation with an average of (4.31 ± 2.37) times during the day and (1.04 ± 0.89) times at night. Half of the patients (50%) had complaints of sexual dysfunction. Two patients (9.1%) were using antidiarrheal drugs. It was found that 1 patient (4.5%) got pregnant twice after the operation and gave birth by cesarean section. The effects of their final diagnosis on functional outcomes and quality of life According to the results of the questionnaire that was administered by reaching all patients, the quality of life score was found to be significantly better in patients with FAP patients (0.85 ± 0.13) compared to the patients with UC (0.71 ± 0.11). There was no significant difference between the groups in terms of other results. Discussion The colon and rectum are completely resected with RP and IPAA, ensuring the intestinal continuity of the patients and defecation via the anus ( 1 ). Park et al. first described this procedure in 1978 as the anastomosis of the S-shaped pouch manually to the dentate line level after mucosectomy was performed in the remaining rectum ( 5 ). Over the years, J, W, and K-shaped pouch designs have also been defined. Since the 1980s, J pouch and stapler anastomosis have become the most common techniques with the development of surgical stapler technology. It has a simple design, the construction with the linear stapler is easier compared to the other techniques, and the application time is shorter ( 6 ). IPAA procedure has various complications such as the postoperative anastomotic leak, stricture, fistula, pelvic abscess, obstruction, and pouchitis. In addition, there are consequences that negatively affect daily life activities, social life, and quality of life, such as an increase in the number of defecations during the day and at night, the urgent need to urinate, excessive weight loss, fecal and gas incontinence problems, which are defined as the functional outcomes of this surgery after the procedure. In the present study, we evaluated the postoperative functional outcomes, complications, approaches to complications, and quality of life in patients, who underwent IPAA in our clinic. The results of this procedure have been discussed since the day Park et al. presented their IPAA results in 1978. According to the previous studies, morbidity rates after IPAA varied between 30–60% ( 7 – 10 ). The surgical technique is constantly changing and improving to reduce these morbidity rates. We used total mesorectal excision and J pouch stapler anastomosis technique in all our patients. In many studies, the J pouch has been reported as the most common pouch type due to its ease of application and good long-term functional outcomes ( 11 – 13 ). The studies comparing stapled anastomosis with hand-sewn anastomosis concluded that the functional outcomes were observed to be better. ( 11 , 14 ). Considering the functional outcomes of the patients, we avoided mucosectomy in patients with no suspicion of dysplasia and neoplasia in the anal canal ( 15 ). The most common complications we encountered in our study were wound infection, pouchitis, anastomotic stenosis, pelvic abscess, and pouch dysfunction. Fazio et al. demonstrated that such complications affected functional outcomes and the quality of life ( 16 , 17 ). Tiainen & Matikainen ( 18 ) mentioned that pouchitis was the most common complication after IPAA. Similar to our study, certain studies reported that small bowel obstruction was one of the most common complications of restorative proctocolectomy and is encountered in 12–17% of all patients ( 19 – 21 ). When we compared the patients with UC and FAP, the development of ileus and pelvic abscess in patients with UC was significantly higher compared to the patients with FAP. In a study, Fazio et al. reported the increase of many complications in patients with UC ( 22 ). Kıran et al. mentioned that the protective ileostomy would not prevent pelvic sepsis; ( 23 ) and some other studies indicated that protective ileostomy did not prevent anastomotic leaks ( 24 , 25 ). However, we performed protective ileostomy in all patients and closed the ileostomies after controlling with endoscopy and pouch radiography in an average of 4.2 months. When we identified problems such as pouch fistula and pouchitis on endoscopy and pouch radiography, we postponed the ileostomy closure process and started treatment, where necessary. We performed the 2-stage RP surgery in all patients diagnosed with FAP and the patients with UC, who underwent elective surgery. 3-stage surgery is recommended for patients with acute severe colitis, who received steroid therapy or anti-TNF therapy for a long time ( 11 , 26 ). We performed the 3-stage surgery to 3 patients diagnosed with UC. Patients, who undergo IPAA, are expected to have defecations 4–6 times during the day and 0–1 times at night, with complete continence ( 27 , 28 ). In our study, it was observed that the number of day and night defecations were compatible with the literature, 27.3% of the patients, 2 of whom used pads, had fecal incontinence; and these results were found to be acceptable ( 29 ). Half of the patients stated that they suffered from sexual dysfunction; and one of our patients got pregnant after the operation. We saw that our patients were satisfied with the IPAA operation and the quality of life score was similar to the study conducted by Özdemir et al. ( 1 ). When we compared the patients with UC and FAP, it was seen that the results of patients with FAP were better in terms of complications, functional outcomes, and quality of life score. It is believed that the patients with UC required emergency surgery, which was caused by the preoperative treatments received by the patients and malnutrition during the preoperative period. It was observed that the IPAA procedure had a certain complication rate as well as functional outcomes and results affecting the quality of life; however, these were at an acceptable level when compared to the preoperative period. In a study by Lichtenstein et al., 10 clinical studies investigating the quality of life after IPAA were examined. The quality of life was found to have increased in 8 of the studies, remained the same in one of the studies, and was worse than the general population in the other study. The insufficient number of patients and the retrospective nature of the study have been the limitations. However, the postoperative complication rates, functional outcomes, and quality of life of the patients were similar when compared with the literature. This procedure could be applied safely with low comorbidity and good functional outcomes in experienced health centers with high caseloads. Abbreviations RP Restorative Proctocolectomy IPAA Ileal Pouch-anal Anastomosis UC Ulcerative Colitis FAP Familial Adenomatous Polyposis CGQL Cleveland Global Quality of Life Declarations Ethics Committee Approval: Gazi University, School of Medicine, 24074710-06, 10.02.2020 Informed Consent: Informed consent was obtained from all individual participants included in the study. Data availability: The data that support the findings of this study are available from the corresponding author on request. Conflict of Interest: The authors have no conflict of interest to declare Financial Disclosure: The authors declared that this study has received no financial support Author Contributions: Concept – AY,OY; Design - AY; Supervision – AY,OY; Resources - AY; Materials – AY,OY; Data Collection and/or Processing – HG,OK,SA; Analysis and/or Interpretation – KD,HB; Literature Search - AY; Writing Manuscript - AY; Critical Review – KD,OY Acknowledgements: Not applicable References Ozdemir Y, Kiran RP, Erem HH, Aytac E, Gorgun E, Magnuson D, et al. Functional outcomes and complications after restorative proctocolectomy and ileal pouch anal anastomosis in the pediatric population. J Am Coll Surg. 2014;218(3):328–35. Griffiths AM. Inflammatory bowel disease. Nutrition (Burbank, Los Angeles County, Calif). 1998;14(10):788–91. Groden J, Thliveris A, Samowitz W, Carlson M, Gelbert L, Albertsen H, et al. Identification and characterization of the familial adenomatous polyposis coli gene. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-154490","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":8899779,"identity":"d13ea977-0988-403d-b18d-487ff34ab913","order_by":0,"name":"Aydin Yavuz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYHACgwMQmvkAA2MDaVrYEojXAqV5DIjTwj8jeePhwja7xA3nz3yT+LnDRo6B/fDRDfi0SNxIKzg8sy05ccOBs9ske8+kGTPwpKXdwGvNjRyDw7xtzMYGB3u3SfC2HU5skOAxw6tFHqKl3tjgMM8zyb/EaDGAaDksZ3CMh02aKFsMzzwrOMxz7ric5Bk2Y2vZtjRjNkJ+kTuevPkzT1k1D9/5ww9vvm2zkeNnP3wMv/cFEhgYGNnATBYJEMmGVzkI8B8AEn/ATOYPBFWPglEwCkbBiAQAZvBO5Kyvd8MAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-0091-7997","institution":"Gazi University Faculty of Medicine: Gazi Universitesi Tip Fakultesi","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Aydin","middleName":"","lastName":"Yavuz","suffix":""},{"id":8899780,"identity":"99b7b87a-2ac9-4c11-9c0c-ed0af2a5defd","order_by":1,"name":"Huseyin Gobut","email":"","orcid":"","institution":"Gazi University Faculty of Medicine: Gazi Universitesi Tip Fakultesi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Huseyin","middleName":"","lastName":"Gobut","suffix":""},{"id":8899781,"identity":"4f97e034-cb5c-494d-a8d4-1c413512cdee","order_by":2,"name":"Omer Kubat","email":"","orcid":"","institution":"Gazi University Faculty of Medicine: Gazi Universitesi Tip Fakultesi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Omer","middleName":"","lastName":"Kubat","suffix":""},{"id":8899782,"identity":"39a8626b-9994-48d6-941f-f671ef8612d0","order_by":3,"name":"Saygin Altiner","email":"","orcid":"","institution":"Gazi University Faculty of Medicine: Gazi Universitesi Tip Fakultesi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Saygin","middleName":"","lastName":"Altiner","suffix":""},{"id":8899783,"identity":"e057edf3-dc0d-4038-ad6e-b6afd4d52c49","order_by":4,"name":"Kursat Dikmen","email":"","orcid":"","institution":"Gazi University Faculty of Medicine: Gazi Universitesi Tip Fakultesi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kursat","middleName":"","lastName":"Dikmen","suffix":""},{"id":8899784,"identity":"8314ffb8-5f21-4d04-80f4-5fffaa5a1d62","order_by":5,"name":"Hasan Bostanci","email":"","orcid":"","institution":"Gazi University Faculty of Medicine: Gazi Universitesi Tip Fakultesi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hasan","middleName":"","lastName":"Bostanci","suffix":""},{"id":8899785,"identity":"c9d27913-13c8-4712-85f2-c431ebc5bb93","order_by":6,"name":"Osman Yuksel","email":"","orcid":"","institution":"Gazi University Faculty of Medicine: Gazi Universitesi Tip Fakultesi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Osman","middleName":"","lastName":"Yuksel","suffix":""}],"badges":[],"createdAt":"2021-01-25 18:49:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-154490/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-154490/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13654454,"identity":"098b94ab-0168-4884-8d2b-e881e9000751","added_by":"auto","created_at":"2021-09-17 09:57:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":298038,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-154490/v1/eb624795-de9d-4783-83af-143ae9f415f5.pdf"}],"financialInterests":"","formattedTitle":"Functional and Clinical Results of Patients Who Underwent an Ileal Pouch Anal AnastomosisFunctional and Clinical Results of Patients Who Underwent an Ileal Pouch Anal Anastomosis","fulltext":[{"header":"Background","content":" \u003cp\u003eRestorative proctocolectomy (RP) with ileal pouch-anal anastomosis (IPAA) is a surgical procedure with proven effectiveness in the surgical treatment of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). They can be performed in experienced hands with acceptable functional outcomes and high success rates.\u003c/p\u003e \u003cp\u003eUlcerative colitis is an inflammatory bowel disease that often develops in the 3rd and 8th decades, involving the colorectal mucosa. Indications for surgery include unresponsiveness to medical treatment, severe bleeding, cancer risk, obstruction, perforation, and toxic megacolon (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Familial adenomatous polyposis is an inherited, autosomal dominant disease caused by the germline mutation of the adenomatous polyposis coli gene (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). If the FAP is left untreated, colorectal cancer is inevitable. It has been demonstrated that the complete removal of the colorectal mucosa prevents the lifelong development of colorectal cancer (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the present study, our aim is to evaluate the patients who underwent IPAA in our clinic, in terms of their characteristics, early and late complications, the results, and the problems that may emerge after the IPAA such as the quality of life.\u003c/p\u003e "},{"header":"Methods","content":" \u003cp\u003eFollowing the approval obtained from Gazi University Clinical Research Ethics Committee (24074710-06), 26 patients, who underwent IPAA between November 2007 and November 2019 in Gazi University Faculty of Medicine General Surgery Clinic, were included in the study. Demographic characteristics of the patients such as age and gender were recorded along with the surgical indications, the type of operation (one, two, or three stages), and the results such as the pathological diagnosis. The early and late postoperative complications such as anastomotic stenosis, obstruction, pelvic sepsis, pouchitis, postoperative bleeding, wound infection, pouch failure, anastomotic leakage, and fistula formation were examined. Question forms were created to evaluate the functional outcomes regarding the number of defecations per day including day and night, fecal incontinence, use of pads, presence of urinary and sexual dysfunction, use of antidiarrheal medication, and the history of post-operative pregnancy. Cleveland Global Quality of Life (CGQL) scoring was administered in order to evaluate the quality of life. The forms were filled out by reaching the patients on the phone or via e-mail.\u003c/p\u003e "},{"header":"Results","content":" \u003cp\u003eIPAA was performed to a total of 26 patients in our clinic. All surgeries were performed as open surgeries. In the preoperative evaluations of the patients, upper GI endoscopy, colonoscopy, pathological analysis, upper abdominal tomography, pelvic MRI, gynecological examinations, and genetic studies were performed as a routine. It was found that 2 of the patients died during their follow-up due to the reasons independent of the operation. One of these two patients had been operated due to FAP and the other one had been operated for a colon tumor with a diagnosis of UC. In one of the patients that we had operated for ulcerative colitis, abdominoperineal resection was performed due to anastomotic recurrence. In a patient we had operated for FAP, ileostomy closure was not performed due to the development of pouch fistula. Therefore, these four patients were excluded from the study. Of the 22 patients, 14 were female and 8 were male. At the time of the surgery, the mean age was 40.7\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2 and the mean body mass index was 26.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u0026nbsp;kg/m\u003csup\u003e2\u003c/sup\u003e. Ten of the patients had UC and 12 had FAP (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Postoperative pathology results indicated adenocarcinoma in 2 patients with ulcerative colitis and 4 patients with FAP. A 2-stage surgical procedure (ileostomy closure after IPAA) was performed to 19 patients, a 3-stage surgical procedure (complete colectomy\u0026thinsp;+\u0026thinsp;RP complementary to ileostomy, followed by ileostomy closure) was performed on 3 patients. All three-stage surgeries were performed on patients with a diagnosis of UC. After proctocolectomy with total mesorectal excision in all patients, the J pouch of 12-13cm was formed with a stapler, and IPAA was performed with the 25\u0026nbsp;mm circular stapler. The mean duration of ileostomy closure after the procedure was 4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7 months. While the mean duration of ileostomy closure in patients with UC was 5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.65 months, it was 3.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86 in patients with FAP. The mean postoperative follow-up period of the patients was 43 (7-115) months. Before ileostomy closure, the pouch was evaluated using endoscopic and imaging methods.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Characteristics According to Diagnoses\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;22\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFAP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, year, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40,7\u0026thinsp;\u0026plusmn;\u0026thinsp;14,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44,8\u0026thinsp;\u0026plusmn;\u0026thinsp;16,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37,3\u0026thinsp;\u0026plusmn;\u0026thinsp;11,6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (F / M)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14/8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6/4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8/4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.746\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26,4\u0026thinsp;\u0026plusmn;\u0026thinsp;4,3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26,9\u0026thinsp;\u0026plusmn;\u0026thinsp;4,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25,9\u0026thinsp;\u0026plusmn;\u0026thinsp;4,3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.611\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIleostomy closure time, month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46,7\u0026thinsp;\u0026plusmn;\u0026thinsp;96,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery Type (two / three stage)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,2\u0026thinsp;\u0026plusmn;\u0026thinsp;2,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7/3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.043\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up time, month, median (min-max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19/3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (10\u0026ndash;86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.5 (7-115)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.878\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the early postoperative period (\u0026lt;\u0026thinsp;3 months), 4 patients had ileus (18.2%), 5 patients had wound infections (22.7%), 3 patients had a pelvic abscess (13.6%), and other complications such as DVT, urinary tract infection and pneumonia developed in 5 patients (22.7%). In the late postoperative period (\u0026gt;\u0026thinsp;3 months), 2 patients had pouchitis (9.1%), 2 patients had anastomotic stenosis (9.1%), and 2 patients had pouch dysfunction (9.1%).\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe effect of the final diagnosis on the complications (\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of complications by diagnosis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFAP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePouchits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(8,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnastomotic stricture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(8,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePouch fistula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnastomotic leak\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIleus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(8,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePelvic abscess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.041\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePouch dysfunction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(8,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(16,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(8,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOne of the patients with pouchitis had been diagnosed with UC and the other with FAP (10% versus 8.3%, p\u0026thinsp;=\u0026thinsp;0.892). Anastomotic stenosis was observed in one patient (10% versus 8.3%, p\u0026thinsp;=\u0026thinsp;0.892). Crohn's disease developed in 1 patient during follow-up. The patient was excluded from the study since the ileostomy closure had not yet been performed due to the development of pelvic abscess and pouch-vaginal fistula. 3 patients with UC and 1 patient with FAP had ileus (30% versus 8.3%, p\u0026thinsp;=\u0026thinsp;0.293). A pelvic abscess was observed in 3 patients with UC; however, it was not observed in patients with FAP (30% versus 0, p\u0026thinsp;=\u0026thinsp;0.041). Pouch dysfunction was observed in one patient (10% versus 8.3%, p\u0026thinsp;=\u0026thinsp;0.892). Wound infection was observed in 3 patients with UC and 2 patients with FAP (30% versus 16.6%, p\u0026thinsp;=\u0026thinsp;0.221). In 4 patients with UC, complications such as DVT, urinary infection, and pneumonia were observed, whereas one patient with FAP had a urinary infection (40% versus 8.3%, p\u0026thinsp;=\u0026thinsp;0.078).\u003c/p\u003e \n\u003ch2\u003eFunctional Outcomes And Quality Of Life (table\u0026nbsp;)\u003c/h2\u003e\n \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuality of life and functional results of patients according to diagnosis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;22\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFAP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCQOL,mean\u0026thinsp;+\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,78\u0026thinsp;\u0026plusmn;\u0026thinsp;0,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,71\u0026thinsp;\u0026plusmn;\u0026thinsp;0,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,85\u0026thinsp;\u0026plusmn;\u0026thinsp;0,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDefecation number daytime, mean\u0026thinsp;+\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,31\u0026thinsp;\u0026plusmn;\u0026thinsp;2,37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,6\u0026thinsp;\u0026plusmn;\u0026thinsp;1,26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,91\u0026thinsp;+\u0026thinsp;2,93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.203\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDefecation number at night, mean\u0026thinsp;+\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,04\u0026thinsp;\u0026plusmn;\u0026thinsp;0,89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,2\u0026thinsp;+\u0026thinsp;0,78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,91\u0026thinsp;+\u0026thinsp;0,99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.475\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncontinence, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (27,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (16,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePad usage, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (18,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (8,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.190\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary dysfunction, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (8,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.350\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual dysfunction, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (41,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.392\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntidiarretic drug use, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (9,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (8,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.262\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere was fecal incontinence in 6 (27.3%) of the patients. It was found that 4 (18.2%) of them used pads during the day. The patients were observed to require defecation with an average of (4.31\u0026thinsp;\u0026plusmn;\u0026thinsp;2.37) times during the day and (1.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89) times at night. Half of the patients (50%) had complaints of sexual dysfunction. Two patients (9.1%) were using antidiarrheal drugs. It was found that 1 patient (4.5%) got pregnant twice after the operation and gave birth by cesarean section.\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe effects of their final diagnosis on functional outcomes and quality of life\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAccording to the results of the questionnaire that was administered by reaching all patients, the quality of life score was found to be significantly better in patients with FAP patients (0.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13) compared to the patients with UC (0.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11). There was no significant difference between the groups in terms of other results.\u003c/p\u003e "},{"header":"Discussion","content":" \u003cp\u003eThe colon and rectum are completely resected with RP and IPAA, ensuring the intestinal continuity of the patients and defecation via the anus (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Park et al. first described this procedure in 1978 as the anastomosis of the S-shaped pouch manually to the dentate line level after mucosectomy was performed in the remaining rectum (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Over the years, J, W, and K-shaped pouch designs have also been defined. Since the 1980s, J pouch and stapler anastomosis have become the most common techniques with the development of surgical stapler technology. It has a simple design, the construction with the linear stapler is easier compared to the other techniques, and the application time is shorter (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). IPAA procedure has various complications such as the postoperative anastomotic leak, stricture, fistula, pelvic abscess, obstruction, and pouchitis. In addition, there are consequences that negatively affect daily life activities, social life, and quality of life, such as an increase in the number of defecations during the day and at night, the urgent need to urinate, excessive weight loss, fecal and gas incontinence problems, which are defined as the functional outcomes of this surgery after the procedure.\u003c/p\u003e \u003cp\u003eIn the present study, we evaluated the postoperative functional outcomes, complications, approaches to complications, and quality of life in patients, who underwent IPAA in our clinic. The results of this procedure have been discussed since the day Park et al. presented their IPAA results in 1978. According to the previous studies, morbidity rates after IPAA varied between 30\u0026ndash;60% (\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The surgical technique is constantly changing and improving to reduce these morbidity rates. We used total mesorectal excision and J pouch stapler anastomosis technique in all our patients. In many studies, the J pouch has been reported as the most common pouch type due to its ease of application and good long-term functional outcomes (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The studies comparing stapled anastomosis with hand-sewn anastomosis concluded that the functional outcomes were observed to be better. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Considering the functional outcomes of the patients, we avoided mucosectomy in patients with no suspicion of dysplasia and neoplasia in the anal canal (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe most common complications we encountered in our study were wound infection, pouchitis, anastomotic stenosis, pelvic abscess, and pouch dysfunction. Fazio et al. demonstrated that such complications affected functional outcomes and the quality of life (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Tiainen \u0026amp; Matikainen (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) mentioned that pouchitis was the most common complication after IPAA. Similar to our study, certain studies reported that small bowel obstruction was one of the most common complications of restorative proctocolectomy and is encountered in 12\u0026ndash;17% of all patients (\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). When we compared the patients with UC and FAP, the development of ileus and pelvic abscess in patients with UC was significantly higher compared to the patients with FAP. In a study, Fazio et al. reported the increase of many complications in patients with UC (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eKıran et al. mentioned that the protective ileostomy would not prevent pelvic sepsis; (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) and some other studies indicated that protective ileostomy did not prevent anastomotic leaks (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). However, we performed protective ileostomy in all patients and closed the ileostomies after controlling with endoscopy and pouch radiography in an average of 4.2 months. When we identified problems such as pouch fistula and pouchitis on endoscopy and pouch radiography, we postponed the ileostomy closure process and started treatment, where necessary.\u003c/p\u003e \u003cp\u003eWe performed the 2-stage RP surgery in all patients diagnosed with FAP and the patients with UC, who underwent elective surgery. 3-stage surgery is recommended for patients with acute severe colitis, who received steroid therapy or anti-TNF therapy for a long time (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). We performed the 3-stage surgery to 3 patients diagnosed with UC.\u003c/p\u003e \u003cp\u003ePatients, who undergo IPAA, are expected to have defecations 4\u0026ndash;6 times during the day and 0\u0026ndash;1 times at night, with complete continence (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). In our study, it was observed that the number of day and night defecations were compatible with the literature, 27.3% of the patients, 2 of whom used pads, had fecal incontinence; and these results were found to be acceptable (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Half of the patients stated that they suffered from sexual dysfunction; and one of our patients got pregnant after the operation.\u003c/p\u003e \u003cp\u003eWe saw that our patients were satisfied with the IPAA operation and the quality of life score was similar to the study conducted by \u0026Ouml;zdemir et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhen we compared the patients with UC and FAP, it was seen that the results of patients with FAP were better in terms of complications, functional outcomes, and quality of life score. It is believed that the patients with UC required emergency surgery, which was caused by the preoperative treatments received by the patients and malnutrition during the preoperative period.\u003c/p\u003e \u003cp\u003eIt was observed that the IPAA procedure had a certain complication rate as well as functional outcomes and results affecting the quality of life; however, these were at an acceptable level when compared to the preoperative period. In a study by Lichtenstein et al., 10 clinical studies investigating the quality of life after IPAA were examined. The quality of life was found to have increased in 8 of the studies, remained the same in one of the studies, and was worse than the general population in the other study.\u003c/p\u003e \u003cp\u003eThe insufficient number of patients and the retrospective nature of the study have been the limitations. However, the postoperative complication rates, functional outcomes, and quality of life of the patients were similar when compared with the literature. This procedure could be applied safely with low comorbidity and good functional outcomes in experienced health centers with high caseloads.\u003c/p\u003e "},{"header":"Abbreviations","content":" \u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eRP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRestorative Proctocolectomy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eIPAA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIleal Pouch-anal Anastomosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eUC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUlcerative Colitis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFAP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFamilial Adenomatous Polyposis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCGQL\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCleveland Global Quality of Life\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Committee Approval:\u003c/strong\u003e Gazi University, School of Medicine, 24074710-06, 10.02.2020\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr /\u003e Informed Consent: \u003c/strong\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e The data that support the findings of this study are available from the corresponding author on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest: \u003c/strong\u003eThe authors have no conflict of interest to declare\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial Disclosure: \u003c/strong\u003eThe authors declared that this study has received no financial support\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e Concept \u0026ndash; AY,OY; Design - AY; Supervision \u0026ndash; AY,OY; Resources - AY; Materials \u0026ndash; AY,OY; Data Collection and/or Processing \u0026ndash; HG,OK,SA; Analysis and/or Interpretation \u0026ndash; KD,HB; Literature Search - AY; Writing Manuscript - AY; Critical Review \u0026ndash; KD,OY\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOzdemir Y, Kiran RP, Erem HH, Aytac E, Gorgun E, Magnuson D, et al. Functional outcomes and complications after restorative proctocolectomy and ileal pouch anal anastomosis in the pediatric population. J Am Coll Surg. 2014;218(3):328\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGriffiths AM. Inflammatory bowel disease. Nutrition (Burbank, Los Angeles County, Calif). 1998;14(10):788\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGroden J, Thliveris A, Samowitz W, Carlson M, Gelbert L, Albertsen H, et al. Identification and characterization of the familial adenomatous polyposis coli gene. Cell. 1991;66(3):589\u0026ndash;600.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBussey H, editor Familial polyposis coli: family studies, histopathology, differential diagnosis, and results of treatment1975.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUtsunomiya J, Iwama T, Imajo M, Matsuo S, Sawai S, Yaegashi K, et al. Total colectomy, mucosal proctectomy, and ileoanal anastomosis. Dis Colon Rectum. 1980;23(7):459\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimillis C, Afxentiou T, Pellino G, Kontovounisios C, Rasheed S, Faiz O, et al. A systematic review and meta-analysis comparing adverse events and functional outcomes of different pouch designs after restorative proctocolectomy. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain Ireland. 2018;20(8):664\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlexander F. Complications of ileal pouch anal anastomosis. Semin Pediatr Surg. 2007;16(3):200\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEfron JE, Uriburu JP, Wexner SD, Pikarsky A, Hamel C, Weiss EG, et al. Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis in Obese Patients. Obes Surg. 2001;11(3):246\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKiran RP, Remzi FH, Fazio VW, Lavery IC, Church JM, Strong SA, et al. Complications and functional results after ileoanal pouch formation in obese patients. J Gastrointest Surg. 2008;12(4):668\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSup SU, Sik YC, Dong KD, Nam YS, Cheon KJ. Risk Factors of Pouch Failure after a Restorative Proctocolectomy. J Korean Soc Coloproctol. 2008;24(4):252\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026Oslash;resland T, Bemelman WA, Sampietro GM, Spinelli A, Windsor A, Ferrante M, et al. European evidence based consensus on surgery for ulcerative colitis. Journal of Crohn's colitis. 2015;9(1):4\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRemzi FH, Lavryk OA, Ashburn JH, Hull TL, Lavery IC, Dietz DW, et al. Restorative proctocolectomy: an example of how surgery evolves in response to paradigm shifts in care. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain Ireland. 2017;19(11):1003\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLovegrove RE, Heriot AG, Constantinides V, Tilney HS, Darzi AW, Fazio VW, et al. Meta-analysis of short-term and long-term outcomes of J, W and S ileal reservoirs for restorative proctocolectomy. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain Ireland. 2007;9(4):310\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLovegrove RE, Constantinides VA, Heriot AG, Athanasiou T, Darzi A, Remzi FH, et al. A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: a meta-analysis of 4183 patients. Annals of surgery. 2006;244(1):18\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChambers WM, Mc CMNJ. Should ileal pouch-anal anastomosis include mucosectomy? Colorectal disease: the. official journal of the Association of Coloproctology of Great Britain Ireland. 2007;9(5):384\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFazio VW, Ziv Y, Church JM, Oakley JR, Lavery IC, Milsom JW, et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Annals of surgery. 1995;222(2):120\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFazio VW, O'Riordain MG, Lavery IC, Church JM, Lau P, Strong SA, et al. Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Annals of surgery. 1999;230(4):575\u0026ndash;84. discussion 84 \u0026ndash; 6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTiainen J, Matikainen M. Health-related quality of life after ileal J-pouch-anal anastomosis for ulcerative colitis: long-term results. Scand J Gastroenterol. 1999;34(6):601\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDolejs S, Kennedy G, Heise CP. Small bowel obstruction following restorative proctocolectomy: affected by a laparoscopic approach? J Surg Res. 2011;170(2):202\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFichera A, Silvestri MT, Hurst RD, Rubin MA, Michelassi F. Laparoscopic restorative proctocolectomy with ileal pouch anal anastomosis: a comparative observational study on long-term functional results. J Gastrointest Surg. 2009;13(3):526\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePandey S, Luther G, Umanskiy K, Malhotra G, Rubin MA, Hurst RD, et al. Minimally invasive pouch surgery for ulcerative colitis: is there a benefit in staging? Dis Colon Rectum. 2011;54(3):306\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFazio VW, Kiran RP, Remzi FH, Coffey JC, Heneghan HM, Kirat HT, et al. Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Annals of surgery. 2013;257(4):679\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKiran RP, da Luz Moreira A, Remzi FH, Church JM, Lavery I, Hammel J, et al. Factors associated with septic complications after restorative proctocolectomy. Annals of surgery. 2010;251(3):436\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePlatell C, Barwood N, Makin G. Clinical utility of a de-functioning loop ileostomy. ANZ J Surg. 2005;75(3):147\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWong NY, Eu KW. A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study. Dis Colon Rectum. 2005;48(11):2076\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMagro F, Gionchetti P, Eliakim R, Ardizzone S, Armuzzi A, Barreiro-de Acosta M, et al. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders. Journal of Crohn's colitis. 2017;11(6):649\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePakarinen MP, Natunen J, Ashorn M, Koivusalo A, Turunen P, Rintala RJ, et al. Long-term outcomes of restorative proctocolectomy in children with ulcerative colitis. Pediatrics. 2009;123(5):1377\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWewer V, Hesselfeldt P, Qvist N, Husby S, Paerregaard A. J-pouch ileoanal anastomosis in children and adolescents with ulcerative colitis: functional outcome, satisfaction and impact on social life. J Pediatr Gastroenterol Nutr. 2005;40(2):189\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcIntyre PB, Pemberton JH, Beart RW Jr, Devine RM, Nivatvongs S. Double-stapled vs. handsewn ileal pouch-anal anastomosis in patients with chronic ulcerative colitis. Dis Colon Rectum. 1994;37(5):430\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Restorative Proctocolectomy, Ileal Pouch-Anal Anastomosis, Ulcerative Colitis, Familial Adenomatous Polyposis, Results ","lastPublishedDoi":"10.21203/rs.3.rs-154490/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-154490/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eOur aim is to evaluate the patients who underwent IPAA in our clinic, in terms of their characteristics, early and late complications, the results, and the problems that may emerge after the IPAA such as the quality of life. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Twenty-two of the 26 patients, who underwent IPAA were included in the study. Evaluations were made on the demographic characteristics of the patients, surgical indications, the type of operation, pathological diagnosis, early and late postoperative complications, and functional outcomes. Cleveland Global Quality of Life scoring was administered in order to evaluate the quality of life.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Ten of the patients had UC and 12 had FAP. Nineteen of the patients underwent a two-stage surgical procedure. In postoperative period, ileus occurred in 4 patients (18.2%), 5 had wound infections (22.7%), 3 had a pelvic abscess (13.6%), and other complications developed in 5 patients (22.7%). Two patients had pouchitis (9.1%), 2 had anastomotic stenosis (9.1%), and 2 had pouch dysfunction (9.1%). There was incontinence with fluid in 6 (27.3%) patients. Four patients (18.2%) used pads during the day, requiring defecation with an average of (4.31±2.37) times during the day and (1.04±0.89) times at night. Half of them (50%) had complaints of sexual dysfunction. The life quality score was observed to be significantly better in patients with FAP (0.85±0.13) compared to patients with UC patients (0.71±0.11).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis procedure could be applied safely with low comorbidity and good functional outcomes in experienced health centers with high caseloads.\u003c/p\u003e","manuscriptTitle":"Functional and Clinical Results of Patients Who Underwent an Ileal Pouch Anal AnastomosisFunctional and Clinical Results of Patients Who Underwent an Ileal Pouch Anal Anastomosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-01-29 19:48:26","doi":"10.21203/rs.3.rs-154490/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"eb7f34b3-90b7-4991-a2eb-c2918723f63c","owner":[],"postedDate":"January 29th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":2116989,"name":"Gastroenterology \u0026 Hepatology"}],"tags":[],"updatedAt":"2021-01-29T19:48:26+00:00","versionOfRecord":[],"versionCreatedAt":"2021-01-29 19:48:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-154490","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-154490","identity":"rs-154490","version":["v1"]},"buildId":"ApUGefWb6u5IBVtyqm6d5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}