Abstract
The choice between proctocolectomy with end ileostomy or protocolectomy with ileal pouchanal anastomosis (IPAA) can be difficult for older patients with ulcerative colitis. Studies show that IPAA can be safely performed in older patients with well-managed comorbidities, adequate anal sphincter function and the ability to understand and manage their pouch function. Older patients with IPAA are at higher risk of dehydration than younger patients and may have more frequent stools and increased rates of incontinence but are generally satisfied with their pouch function and quality of life.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Shivashankar R, Tremaine WJ, Harmsen WS, Loftus EV. Incidence and prevalence of Crohn’s disease and ulcerative colitis in Olmsted county, Minnesota from 1970 through 2010. Clin Gastroenterol Hepatol. 2017;15:857–63.
Cohan JN, Bacchetti P, Varma MG. Impact of patient age on procedure type for ulcerative colitis: a national study. Dis Colon Rectum. 2015;58:769–74.
Bollegala N, Jackson TD, Nguyen GC. Increased postoperative mortality and complications among elderly patients with inflammatory bowel diseases: an analysis of the national surgical quality improvement program cohort. Clin Gastroenterol Hepatol. 2016;14:1274–81.
Pellino G, Sciaudone G, Candilio G, Camerlingo A, Marcellinaro R, Rocco F, De Fatico S, Canonico S, Selvaggi F. Complications and functional outcomes of restorative proctocolectomy for ulcerative colitis in the elderly. BMC Surg. 2013;13:S9.
Ho KS, Chang CC, Baig MK, Borjesson L, Nogueras JJ, Efron J, Weiss EG, Sands D, Vernava AM, Wexner SD. Ileal pouch anal anastomosis for ulcerative colitis is feasible for septuagenarians. Color Dis. 2005;8:235–8.
Pinto RA, Canedo J, Murad-Regadas S, Regadas SF, Weiss EG, Wexner SD. Ileal pouch–anal anastomosis in elderly patients: is there a difference in morbidity compared with younger patients? Color Dis. 2010;13:177–83.
Pellino G, Sciaudone G, Candilio G, De Fatico GS, Landino I, Canonico S, Selvaggi F. Restorative proctocolectomy with ileal pouch-anal anastomosis is safe and effective in selected very elderly patients suffering from ulcerative colitis. Int J Surg. 2014;12:S56–9.
Ananthakrishnan AN, McGinley EL, Binion DG. Inflammatory bowel disease in the elderly is associated with worse outcomes: a national study of hospitalizations. Inflamm Bowel Dis. 2009;15(2):182–9.
Chapman JR, Larson DW, Wolff BG, Dozois EJ, Cima RR, Pemberton JH, Crownhart BS, Larson DR. Ileal pouch-anal anastomosis, does age at the time of surgery affect outcome? Arch Surg. 2005;140:534–40.
Tan HT, Connolly AB, Morton D, Keighley MR. Results of restorative proctocolectomy in the elderly. Int J Color Dis. 1997;12:319–22.
Dayton MT, Larsen KR. Should older patients undergo ileal pouch-anal anastomosis? Am J Surg. 1996;172:444–8.
Delaney CP, Fazio VW, Remzi FH, Hammel J, Church JM, Hull TL, Senagore AJ, Strong SA, Lavery IC. Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch-anal anastomosis. Ann Surg. 2003;238:221–8.
Delaney CP, Dadvand B, Remzi FH, Church JM, Fazio VW. Functional outcome, quality of life, and complications after ileal pouch-anal anastomosis in selected septuagenarians. Dis Colon Rectum. 2002;45:890–4.
Ross H, Steele SR, Varma M, Dykes S, Cima R, Buie WD, Rafferty J. Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon Rectum. 2014;57:5–22.
Magro F, Gionchetti P, Eliakim R, et al. for the European Crohn’s and Colitis Organisation (ECCO). Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: Definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohns Colitis. 2017;11:649–70.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Kunitake, H., Bordeianou, L. (2019). Surgical Approach to the Older Ulcerative Colitis Patient. In: Hyman, N., Fleshner, P., Strong, S. (eds) Mastery of IBD Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-16755-4_31
Download citation
DOI: https://doi.org/10.1007/978-3-030-16755-4_31
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-16754-7
Online ISBN: 978-3-030-16755-4
eBook Packages: MedicineMedicine (R0)