What Can an Aging Pouch Tell Us? Outcomes of Ileoanal Pouches Over 20 Years Old

BACKGROUND: Little is known about the long-term functional outcomes of restorative proctocolectomy. OBJECTIVE: The aim of this study was to examine ileoanal pouch outcomes 20 and 30 years postoperatively. DESIGN: This is a retrospective case series. SETTING: This study was conducted at a tertiary care referral center. PATIENTS: Patients who underwent restorative proctocolectomy between 1980 and 1994 were identified. Those with >= 20 years of in-person follow-up were included. MAIN OUTCOMES MEASURES: Pouch function, pouchitis, anal stricture, and pouch failure rates were analyzed. RESULTS: A total of 203 patients had >= 20 years of follow-up. Of those, 71 had >= 30 years of follow-up. Initial diagnoses included ulcerative colitis (83%), indeterminate colitis (9%), familial adenomatous polyposis (4%), and Crohn's disease (3%). Twenty-one percent of those with ulcerative or indeterminate colitis later transitioned to Crohn's disease. Mean daily stool frequency was 7 (IQR 6-8), 38% experienced seepage, 31% had anal stenosis, 47% experienced pouchitis, and 18% had pouch failure. Over time, stool frequency increased in 41% of patients, stayed the same in 43%, and decreased in 16%. Patients older than 50 years at the time of construction had more daily bowel movements (median 8 vs 6; p = 0.02) and more seepage (77% vs 35%; p = 0.005) than those younger than 50 years. Patients with Crohn's disease had higher stool frequency (median 8 vs 6; p < 0.001) and higher rates of anal stenosis (44% vs 26%; p = 0.02), pouchitis (70% vs 40%; p < 0.001), and pouch failure (38% vs 12%; p < 0.001) compared to non-Crohn's patients. Patients with >= 30 years of follow-up had similar function as those with 20-30 years of follow-up. LIMITATIONS: This was a retrospective, single-institution study. Only 35% of pouches created during the study period had >20 years of follow-up. CONCLUSIONS: Most patients maintain reasonably good function and retain their pouches after 20 years. Over time, stool frequency and seepage increase. Older age and Crohn's disease are associated with worse outcomes.