Restorative Proctocolectomy for Ulcerative Colitis in 1985-2009.

Abstract

BACKGROUND AND AIMS:

Restorative proctocolectomy is the most common operation in patients with ulcerative colitis. The aim was to evaluate long-term changes in our operative treatment and early and late complications related to restorative proctocolectomy.

MATERIAL AND METHODS:

The study comprised 352 (149 females) patients over 18 years of age with ulcerative colitis who underwent restorative proctocolectomy in 1985-2009 median follow-up time of 5 years.

RESULTS:

The indication for surgery was active chronic colitis in 168 (47.7%), acute colitis in 159 (45.2%), and cancer or dysplasia in 25 (7.1%) patients. Ileal pouch-anal anastomosis was performed using hand-sewn anastomosis with mucosectomy in 283 patients and stapled anastomosis in 69. A shift from hand-sewn to stapler ileal pouch-anal anastomosis took place in 2005. Covering ileostomy was carried out in 133 (37.8%) patients. There were 82 (23.3%) J-pouch-related complications. The operative mortality was 0.3%. There were significantly fewer leakages and early re-operations when covering ileostomy was used than when it was omitted: 6.0% versus 16.4% (p = 0.004), 4.5% versus 11.9% (p = 0.02), respectively. There were more strictures in hand-sewn than in stapled ileal pouch-anal anastomoses (17.6% vs. 0%, p = 0.001). Pouchitis occurred at least once in 134 (38.1%) patients.

CONCLUSION:

The ileal pouch-anal anastomosis technique used in restorative proctocolectomy had changed over the past years from hand-sewn to stapled anastomosis. Covering ileostomy seemed to protect against major complications. Pouchitis was the most common late complication.

• Authors: I Helavirta, H Huhtala, M Hyöty, P Collin, P Aitola
• Journal: Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society (Scand J Surg) Vol. 105 Issue 2 Pg. 73-7 (Jun 2016) ISSN: 1799-7267 [Electronic] England
• PMID: 26063652 (Publication Type: Evaluation Study, Journal Article)
• Copyright: © The Finnish Surgical Society 2015.

Topics

• Acute Disease
• Adolescent
• Adult
• Aged
• Chronic Disease
• Colitis, Ulcerative (surgery)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Postoperative Complications (epidemiology)
• Proctocolectomy, Restorative (methods)
• Retrospective Studies
• Treatment Outcome
• Young Adult