BOWEL HABITS AND QUALITY OF LIFE IN ULCERATIVE COLITIS PATIENTS UNDERGOING J POUCH CONSTRUCTION: A RETROSPECTIVE ANALYSIS AT 6- AND 12-MONTHS POST-FUNCTIONALIZATION

Background: Total proctocolectomy with ileal pouch anal anastomosis (J pouch) is a preferred surgical intervention for ulcerative colitis patients with refractory disease or dysplasia. Many patients elect J pouch construction for hopes of the best quality of life. In the 1-2 years after J pouch construction, adaptation of the pouch and patient occurs. This study analyzed bowel function and quality of life (QoL) in J pouch patients at 6- and 12-months post-pouch functionalization.

Methods: A retrospective review of 105 patients was conducted, spanning from December 2008 to July 2018. All patients completed a questionnaire, including 8 questions focused on bowel habits and post-operative quality of life.

Results: Of 105 patients, 35% were women, and 65% were men. Surgical technique varied from laparoscopic (76%), robotic (11%), and open (13%). Additionally, 9% of patients had a hand-sewn anastomosis versus stapled. At 6 months, 32% of women and 6% of men used protective pads during the day, with only 10% and 3%, respectively, experiencing stool leakage. At night, 32% of women and 16% of men used pads, with 24% and 15%, respectively, experiencing leakage. 83% of patients used medications to control bowel movements, primarily loperamide. QoL improvements were reported by 85% compared to before the first operation, and 88% reported better QoL than with the ileostomy. 81% of women and 76% of men described their satisfaction with the operation and adjustment to the new lifestyle as excellent or good. In total, 90% of patients would recommend a J-pouch to other patients. At 12 months, overall daytime protective pad use decreased, with 22% of women and 9% of men reporting usage. Stool leakage during the day was reported by 10% of women and 6% of men. Nighttime pad use was 41% for women and 13% for men, with 22% and 10%, respectively, experiencing leakage. A consistent 80% of patients relied on medications, predominantly loperamide, for bowel movement control. The positive trend in QoL persisted, with 87% reporting improvement compared to preoperative status and 88% indicating better QoL than the ileostomy. 84% of women expressed contentment with the adjustment to the new lifestyle, while 75% of men reported the same. 91% of patients would recommend the J-pouch procedure to others.

Conclusions: This study explores the adaptation of patients post J-pouch construction for ulcerative colitis. Analysis at 6- and 12-months post-pouch functionalization reveals positive trends, with improved bowel function and quality of life. Decreased protective pad use suggests increased confidence in pouch functionality. Patient satisfaction remained high, with a significant percentage recommending the J-pouch procedure. These findings affirm the enduring efficacy and positive impact of J pouch construction for patients with medically refractory disease or dysplasia.