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Background
Heal pouch-anal anastomosis (IPAA) is a technically demanding, lengthy procedure with
substantial associated morbidity. Some have suggested that this procedure should not
be performed in older patients. This study was conducted to evaluate whether older
patients have a poorer functional outcome and higher complication rate than younger
patients who undergo IPAA.
Methods
The 455 patients who have undergone IPAA at this institution were stratified according
to age (<55 versus>55) to compare functional outcome and complication rates. The data
were prospectively collected. The groups included 32 patients >55 (7%) and 423 patients
<55. Comparisons were made with regard to stool frequency, incontinence rates, post-IPAA
complications, postileostomy closure complications, and results 12 months postileostomy
closure.
Results
Preoperative anal sphincter resting and squeeze pressures were significantly lower
in the >55 group. Most complication rates were similar after IPAA except dehydration
rates, which were higher in the older patients than the younger ones (27% versus 11%,
respectively). Pre-ileostomy closure anal sphincter resting and squeeze pressures
were not significantly lower in patients older than 55. Twenty-four hour daytime and
nighttime stool frequencies were significantly higher in the >55 group, as were daytime
and nighttime stool incontinence.
Conclusion
Although functional outcome is poorer and some complications are higher in the >55
group, the procedure can be safely performed with acceptable results and is greatly
preferred by this population over permanent ileostomy.
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Article info
Footnotes
**Presented at the 48th Annual Meeting of the Southwestern Surgical Congress, Scottsdale, Arizona, April 28–May 1, 1996.
Identification
Copyright
© 1996 Excerpta Medica, Inc. All rights reserved. Published by Elsevier Inc.
