Clinical and functional outcome after restorative proctocolectomy.
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.
Department of Gastroenterology, John Radcliffe Hospital, Oxford, UK.
H J
HJ
de Silva
C P
CP
de Angelis
N
N
Soper
M G
MG
Kettlewell
N J
NJ
Mortensen
D P
DP
Jewell
D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology*; D000714:Anastomosis, Surgical; D003108:Colonic Diseases / Q000601:surgery; D003672:Defecation; D005260:Female; D006801:Humans; D007079:Ileitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D007082:Ileum / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D016737:Proctocolectomy, Restorative / Q000379:methods; D011877:Radionuclide Imaging; D012086:Reoperation