Defecation states in patients with or without soiling at 5 years or more after colectomy, mucosal proctectomy and ileal J pouch-anal anastomosis for ulcerative colitis

BACKGROUND/AIMS: There are no reports about the relationship between soiling and other defecation states in patients with ulcerative colitis (UC) after ileal J pouch-anal anastomosis (IPAA). To assess the defecation states in patients with or without soiling at 5 years or more after IPAA for UC, we studied clinical findings in such patients. METHODOLOGY: Subjects with UC who had undergone IPAA a 5-cm short cuff, anal canal mucosa including anal transitional zone (AZT) stripped from the level of dentate line (DL)] with ileostomy closure at least 60 to 132 months (mean; 103.6 months) previously, and who had no pre- or postoperative complications were recruited. They were 43 patients (28 men and 15 women aged 15 to 59 years, average 39.2 years) divided into 2 groups; group A n=28; patients without soiling (18 men and 10 women aged 15 to 49 years, average 37.5 years) and group B n=15; patients with soiling (10 men and 5 women aged 24 to 59 years, average 42.1 years). Postoperative interviews concerning the defecation states (mean daily stool frequency, nocturnal stool frequency, ability to discriminate flatus from feces, feeling of stool remaining, consistence of stools, soiling, incontinence, and urgency) were conducted with patients after IPAA. RESULTS: No cases in group A showed soiling. All cases in group B had some soiling, 6 cases; rare soiling (at diarrhea), 4 cases; occasional soiling (1 time per 2 or 3 days), 4 cases; frequent soiling (patients must use pad due to daily soiling, 2 cases had incontinence). There was a significant difference between groups A and B (P < 0.001). All cases in group A showed less than 6 times per day and all cases of group B showed 7 or more times per day. There was a significant difference between groups A and B (P < 0.001). High nocturnal stool frequency was significantly more common in patients of group B than group A (P < 0.001). All cases in group A and 12 cases in group B could significantly discriminate flatus from feces (P < 0.05). Feeling of stool remaining was significantly more common in patients of group B than group A (P < 0.001). The stool consistency of group A was significantly harder than that of group B (P < 0.001). No cases in group A reported incontinence. Two cases in group B had incontinence. Urgency in group B was noted more than in group A. Regarding patient satisfaction (Peck's criteria), all cases in group B and no cases in group A reported "excellent". Ten cases in group B were "good". Three cases in group B were "fair". Two cases in group B showed failure. Patient satisfaction of group A was significantly higher than that of group B (P < 0.01). CONCLUSIONS: According to these interviews, no importance of preserving the AZT was recognized. The patients without soiling showed better defecation states than patients with soiling. The patients with soiling showed poor defecation status following