Electronic Thesis and Dissertation Repository


Master of Science


Epidemiology and Biostatistics


Dr Richard Malthaner


Objectives: To develop a prototype decision aid used to assist ulcerative colitis patients when deciding between ileal pouch-anal anastomosis (IPAA) and ileostomy.

Methods: Three separate systematic reviews (quality of life studies, IPAA studies, ileostomy studies) were conducted to populate the decision aid with outcome probabilities. Meta-regression was used to select appropriate pooled outcomes.

Results: Of 3920 studies reviewed, 9 studies reported on quality of life, 67 on outcomes following IPAA, and 11 following ileostomy. No difference in quality of life was found between procedures. Among IPAA patients, pooled pouch failure rate was 5.5%, with pouchitis being the most common complication (22%). Among ileostomy patients, the pooled rate of ileostomy revision was 17.1%.

Conclusions: No surgical option is clearly superior and patients must weight specific risks and benefits in deciding between procedures. This newly developed decision aid may help patients decide which option is best for them.

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