This shows fecal incontinence over a ten-year period of time, and importantly, in the same 300 patients. In other words, patients surveyed - same group - at 1,5 and 10 years. Not different patients at different years. So daytime perfect fecal incontinence is shown here at about 75%. Imperfect, meaning once or twice a week - or perhaps slightly more frequently - shown here at about 5%. Frequent fecal incontinence is very low. The night time success rate is lower than the daytime, for obvious reasons. This reaches about a 55%-60% chance of having perfect fecal control at night.
The mortality - for this usually, completely elective procedure - is very low. Morbidity is also not bad. Pelvic sepsis being a particularly difficult problem in 5% of patients. Wound infections are good at Mayo in general, but in this group it’s about 3%. Small bowel obstructions occur with a frequency no higher than the literature frequency of Brooke ileostomy.
The problem of pouchitis. About 40%-50% of our patients will experience an episode of pouchitis in the postoperative period. What does that mean? Well, let’s take a flow diagram of pouchitis in our patients. So of 100 patients after ileoanal anastomosis, 50 will never have the problem. So let’s go to the 50 that do. Twenty-five of the 50 will have one episode leaving 25 with more than one episode. Of that 25 patients, only four will have something called chronic, unremitting, long term problems with pouchitis, of whom three of the four will be managed. We can talk about the management perhaps later. And one will fail. So about half will have one episode. Among all the others with a rate of 15% have chronic pouchitis or 4% of all patients after ileoanal anastomosis, and most of those are managed medically. Among the patients that failed this operation, only 4% - if you have 100 patients who failed the operation - only four will fail because of pouchitis. They mainly fail for septic problems, mechanical problems with the operation. Perhaps something akin to Crohn’s disease occurring in the pouch or in the anal canal. But again, here’s that four patients with pouchitis as a cause of failure. So there’s no doubt that there are implications for patients with pouchitis, if there is increased incontinence, there are systemic manifestations of the disease at times, there is a need to take canadian medications and a whole host of different things have come along, and there are some workplace and social inconveniences. But there is no permanent increase in stool frequency in these patients and there is little chance of outright failure.
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