Impact of diverting ileostomy on functional outcome and quality of life after restorative proctocolectomy and ileal pouch anal anastomosis

Abstract

Aim: Diverting ileostomy (DS) after restorative proctocolectomy (RPC) can be omitted in selected patients. Its omission could improve functional outcomes and quality of life (QoL), as has been demonstrated in patients after proctectomy. The aim of this study was to report the impact of diverting ileostomy on functional outcomes and QoL after ileal pouch-anal anastomosis (IPAA). Methods: This was a retrospective study including all patients operated (2015–2020) for RPC with IPAA. Functional outcome was evaluated by validated scores (LARS, Wexner, Öresland, pouch functional score [PFS] and the ileoanal pouch syndrome severity [IPSS] score). Global health-related QoL was evaluated with the SF-36. We also analysed demographic characteristics, morbidity, correlation between functional outcomes and QoL. Results: Among 179 eligible patients, 150 responded (84%): S− (no stoma = 78; 52%) and S+ (had stoma = 72; 48%). Overall morbidity and anastomotic leak rates were 46% and 9.3%, respectively without difference between the groups. Medians for the functional scores were comparable between the S− and S+ group, respectively: 18 [12.5–31] versus 18 [11–31], p = 0.48 for LARS; 9 [7–11] versus 9 [7–12], p = 0.23 for Wexner's score; 6 [3–13] versus 8 [5–11], p = 0.22 for Öresland's score, 6 [3–13] versus 6.8 [4–12], p = 0.174 for PFS score, and 40 [35–45] versus 46 [42–51], p = 0.045 for IPSS score. The SF-36 summary score was comparable between the two groups without any difference in eight specific health dimensions. After propensity score matching, results were still comparable between the two groups for all scores. Linear regression found a significant correlation between all QoL domains and all functional scores (p < 0.001). Conclusion: DS for IPAA does not alter either functional outcomes or QoL and can be omitted in selected patients.