Clinical and functional outcome after restorative proctocolectomy.

Journal article

Restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has been carried out on 88 patients since 1982. Three different pouch designs (J, S and W) were used. Ten pouches had to be removed. Detailed analysis was performed on 61 patients (J = 23, S = 15, W = 23) whose pouches had been functioning for at least 6 months. There was no significant difference in surgical complications before or after ileostomy closure between pouch designs but the hospital stay was greater after construction of an S pouch (P less than 0.05). There were no significant differences in stool frequency, degree of continence or urgency between the three types. Twelve patients with J pouches required antidiarrhoeal medication compared with only one with S and five with W pouches. Only seven patients with S pouches could defaecate spontaneously compared with 22 with W pouches and all patients with J pouches (P less than 0.001). Twenty-five of 29 patients who had preservation of the anal transition zone had perfect continence compared with 23 of 32 with a mucosal proctectomy (P = n.s.). Pouchitis occurred in 13 patients, all of whom had ulcerative colitis. In a subgroup of 23 patients, pouch evacuation was assessed scintigraphically. There was no difference in pouch capacity or total volume evacuated, but spontaneous evacuation was better in J and W pouches compared with S pouches.

Authors: de Silva, H; de Angelis, C; Soper, N; Kettlewell, MG; Mortensen, N

• Publication status: Published
• Journal: British journal of surgery
• Volume: 78
• Issue: 9
• Pages: 1039-1044
• Publication date: 1991-09-01
• DOI: 10.1002/bjs.1800780905
• EISSN: 1365-2168
• ISSN: 0007-1323
• Language: English
• Keywords: Anastomosis, Surgical; Postoperative Complications; Ileum; Ileitis; Proctocolectomy, Restorative; Colonic Diseases; Adult; Anal Canal; Humans; Middle Aged; Reoperation; Female; Male; Defecation