Pouch Durability and Functional Stability in the Long Term

IPAA is an operation with a high potential for complications leading to reservoir failure in 10-15% of cases 10 years after surgery [43, 45]. Data present in the literature show that the risk of losing the reservoir progresses with time, that 75% of these events happen well after 1 year following surgery [34] and that the main causes are pelvic sepsis/fistulisation, reservoir disfunction and CD [23,34,46]. Risk of los ing the reservoir is particularly high in patients developing postoperative septic complications, reaching values of 30% after 5 years and 40% after 10 years since surgery [32]. Fazio et al. [47] developed a predictive model to determine the risk of failure and allow patients an objective estimate of such an event in the light of an informed and well-thought-out choice among the various surgical options.

As for functional outcomes, despite the fact that short-term results are rather encouraging, there are concerns about continence stability in the long term, considering that the likely negative consequences of anastomotic complications adds to the physiological decline of the sphincterial function, which deteriorates with age [48]. If continence remains rather stable between 5 and 10 years since surgery [23], after 10-15 years since surgery, 18-32% of patients show a functional decay with an increase of incontinence episodes, usually intermittent and of a lower degree [49-51]. Noteworthy is the fact that the prevalence of incontinence in the long follow-up is no higher than that present before construction of the IPAA [49] and that patient quality of life remains excellent in all fields examined despite alteration of the intestinal function. This can also be contributed by patients' coping mechanisms to the new problems that arise [49, 51].

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