Quality of Life After Total Proctocolectomy With Ileostomy or IPAA: A Systematic Review.

Abstract

The standard surgical treatment for ulcerative colitis involves either a total proctocolectomy and end ileostomy or an IPAA. Both treatments result in similar control of disease but differ in terms of patient experience and daily functioning. The aim of this systematic review was to determine whether one surgical approach was superior with regard to health-related quality of life. An electronic literature search of PubMed, MEDLINE, EMBASE, and the Cochrane Database of Collected Reviews was performed for dates from 1978 to 2014. The search included the following terms: "inflammatory bowel disease," "colitis," "colectomy," and "ileal pouch-anal anastomosis." Studies were included if they reported on a comparison of total proctocolectomy and end ileostomy with an IPAA and evaluated some aspect of quality of life. All of the studies were systematically reviewed. No meta-analysis was performed secondary to significant heterogeneity across studies in different health-related quality-of-life measures. End points were a mixture of global, generic, and disease-specific measures of quality of life. Thirteen studies reporting a total of 1604 patients who underwent total proctocolectomy with ileostomy (N = 820) or IPAA (N = 783) were included for review. Neither procedure was found to be clearly superior with regard to health-related quality of life. The conclusions of this review were limited by small study sample size, significant between-study heterogeneity, observational designs, and limited follow-up. Despite being limited by poor study quality, both total proctocolectomy with ileostomy and IPAA appear equivalent in terms of overall health-related quality of life. Most patients are satisfied with their choice regardless of procedure. Most of the improvement in quality of life after surgery is related to the control of disease-related symptoms. These findings indicate that both IPAA and permanent ileostomy should be discussed in detail with patients preoperatively to help them make an informed decision.