Introduction

Restorative proctocolectomy (RPC) with ileal pouchanal anastomosis (IPAA) has become the surgical procedure of choice for patients with ulcerative colitis (UC) and familial adenomatous polyposis (FAP). This high level of satisfaction has led to the referral of patients who would not have otherwise considered a procedure requiring permanent ileostomy [1, 2].

In the past, total proctocolectomy with terminal ileostomy was the most radical and oncologically safest procedure. Alternatively, when the rectum contained only a few polyps, total colectomy with ileorectal anastomosis was the preferred treatment [3].

The advantage of obviating the need for a stoma while preserving sexual and voiding function was offset by the disadvantage of close and lifelong follow-up with the aim of removing new rectal polyps, or excising the rectum before cancer develops.

Nowadays, restorative proctocolectomy with the formation of (IPAA), which preserves the sphincters as well as sexual and bladder function while nevertheless completely removing colorectal mucosa, is the procedure of choice in the elective treatment of patients affected by (UC) [4].

Amelioration of the technique reduced procedure morbidity; nevertheless, some unsatisfactory functional results led several authors to consider the importance of quality of life [9,10].

Health-related quality of life (HRQL) is defined as the patient's' own appraisal of their current physical and mental health, social interactions, and general well- being . Knowledge of postoperative health status is important in decision- making about the type of operation necessary in patients with FAP and inflammatory bowel disease (IBD). Although long-term functional results, described by some authors, are excellent, there is a relevant incidence of complications related to the ileal pouch [11].

The difficulty of quantifying such dysfunction, and its impact on HRQL, make it necessary to use an investigative instrument that not only explores clini cal parameters of each patient but also his/ or her emotional and social function.

Several authors reported a. high level of satisfaction in patients submitted to colectomy in general [ [15,16] and in particular to RPC [10,12,16]. However, despite the dramatic improvement of patients' general condition, functional results are not always perfect. In fact, some patient complains of occasional episodes of soiling or urgency, elevated number of daily bowel movements, difficulties in pouch emptying or dietary restrictions. And even more, without such complications, patients with IPAA may refer to a conspicuous number of daily stool, and a certain degree of incontinence or urgency [16,18].

The difficulty quantifying such dysfunction, and its impact on HRQL make it necessary to use an investigative instrument, that not only explores clinical parameters, especially bowel function (BF) of each patient but also his/ or her emotional and social function.

Many studies provide evidence that there is a statistically significant association between HRQL levels and BF [10]

Of the numerous BF characteristics, five appear to be of greater importance with regard to certain HRQL domains [18, 19, 38]. The physical function domain is improved with the ability to pass flatus independent of stool, physical role and mental health domains are improved with decreased stool frequency, social function domain is improved with increased stool retention time while perception of general health is improved with less diaper usage and less sexual dysfunction [18, 20].

RPC is generally considered to achieve better functional results and therefore HRQL in patients with than in those with UC.

Patients with UC usually have a higher overall complication rate and more pouch-related septic complications. Functional results are similar for daytime and nighttime stool frequency and the median duration that defecation could take. The use of antidiarrhoeal medications does not differ between patient with RPC affected by FAP and UC. Even though pouchitis is more common in UC than FAP, many studies suggest that the functional outcome, quality of life and health and satisfaction with outcome is identical between the groups [19, 20].

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