Quality of Life After Total Proctocolectomy With Ileostomy or IPAA
Bibliographic record
Abstract
BACKGROUND: 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. OBJECTIVE: The aim of this systematic review was to determine whether one surgical approach was superior with regard to health-related quality of life. DATA SOURCES: 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." STUDY SELECTION: 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. INTERVENTION(S): 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. MAIN OUTCOME MEASURES: End points were a mixture of global, generic, and disease-specific measures of quality of life. RESULTS: 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. LIMITATIONS: The conclusions of this review were limited by small study sample size, significant between-study heterogeneity, observational designs, and limited follow-up. CONCLUSIONS: 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.025 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.007 | 0.007 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".