Colectomy with ileorectal anastomosis preserves female fertility in ulcerative colitis.
ABSTRACT Restorative proctocolectomy with ileoanal anastomosis (IPAA) is the surgical standard for patients with ulcerative colitis (UC). Significant reduction in female fertility and fecundity after IPAA has been shown in recent studies. In selected cases, colectomy with ileorectal anastomosis (IRA) is another surgical option. The aim of this study was to evaluate fertility in women with UC who underwent IRA.
This study included all women with UC who underwent IRA between 1962 and 1999 and who were 40 years old or younger at the time of surgery, and older than 18 years of age at the time of the interview. Data were collected using a structured telephone interview concerning reproductive behavior and waiting times to pregnancy.
Among 40 eligible patients, 37 whose mean age at IRA was 28 years (range 11-39) answered the questionnaire. Twenty-two were unmarried, not wishful of pregnancy and/or already had children. Among 15 females wishing children after IRA, 10 (66%) became pregnant: one had therapeutic abortion, two had a miscarriage, four had 1 child, two had 2 children and one had 4 children. Five patients were sterile after IRA.
These preliminary results suggest that IRA for UC preserves female fertility. If confirmed in other series this information should be provided to young women with UC before deciding surgical option.
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ABSTRACT: Background Proctectomy for ulcerative colitis (UC) can be performed via intramesorectal (IME) or total mesorectal excision (TME). Methods We compared patient-reported bowel and sexual function among IME vs. TME UC patients (09/2000-03/2011) using MSKCC: Memorial Sloan-Kettering Cancer Center Bowel Function scale; FIQL: Fecal Incontinence Quality of Life; FISI: Fecal Incontinence Severity Index; FSFI: Female Sexual Function Instrument; and IIED: International Index of Erectile Dysfunction survey. Results 89 IME vs. TME patients (35±2 years, 57% male, 62% IME) had similar baseline characteristics, although IME patients had more open procedures (p≤0.03). IME patients reported better fecal continence (p=0.009) but similar fecal incontinence-related quality of life (p≥0.44). For sexual function, there were no differences for either women (FSFI; p≥0.20) or men (IIED; p≥0.22). Conclusions IME appears to be associated with better fecal continence but no difference in overall bowel or sexual function compared to TME in patients with UC.The American Journal of Surgery 10/2014; 208(4). DOI:10.1016/j.amjsurg.2014.05.012 · 2.41 Impact Factor
Diseases of the Colon & Rectum 01/2014; 57(1):5-22. DOI:10.1097/DCR.0000000000000030 · 3.20 Impact Factor
Journal of Crohn s and Colitis 10/2014; DOI:10.1016/j.crohns.2014.08.012 · 3.56 Impact Factor