A prospective study of the quality of life after pelvic pouch operation.

BACKGROUND: For surgeons familiar with pelvic pouch operation, it is disappointing that the patients, although very satisfied to have a pouch instead of an ileostomy, often have difficulty in specifying exactly how their quality of life really has improved. The present study is an attempt to examine this situation.

STUDY DESIGN: In 48 patients with ulcerative colitis undergoing pelvic pouch operation, quality of life (QOL) was studied prospectively when the patients had an ileostomy, and at follow-up evaluation at least one year after restitution of anal defecation. The surgeons' evaluation of functional outcome was compared with those of three independent evaluators (the patient, a psychiatrist, and a psychologist). The Psychosocial Adjustment to Illness Scale, the Well-being Profile, the Global Assessment of Function Scale, and surgical evaluation scales were used.

RESULTS: As assessed by surgeons using the surgical evaluation scales, functional outcome correlated significantly with most of the assessments of QOL done by the three independent evaluators (the patient, a psychiatrist, and a psychologist). Quality of life did not improve with increasing time, either with an ileostomy or with a functioning pelvic pouch. On most evaluations, there was no further significant improvement in QOL after restitution of anal defecation.

CONCLUSIONS: The findings suggest that QOL is already satisfactory after "cure" of the disease, and restitution of normal defecation does not yield much further improvement.