Multivariate analysis of factors influencing the results of restorative proctocolectomy.
Univariate and multivariate analysis has been used to assess the influence of 14 variables on the results of 65 consecutive ileoanal pouch procedures over 5 years. There were 9 failures requiring intubation, ileosomy or pouch excision. There was a significant association between failure and pelvic sepsis (p less than 0.05; n = 8), endoanal mucosectomy (p less than 0.05; n = 7), preservation of a long rectal cuff (p less than 0.05; n = 5) and lack of experience with the operation (p less than 0.05; n = 8). Of 49 patients with preoperative evidence of ulcerative colitis, 3 are now known to have Crohn's disease. The only factor having a significant adverse influence on complications was endoanal mucosectomy (p less than 0.01). Functional outcome was significantly impaired in patients who developed pelvic sepsis (p less than 0.001), a post-operative fistula (p less than 0.05) and who had an endoanal mucosectomy (p less than 0.05). Success with ileo-anal pouch reconstruction increases with experience. Avoidance of sepsis is associated with a lower failure rate, improved functional results and reduced hospital stay. Preliminary colectomy is also advised to exclude Crohn's disease if the diagnosis is in question.
Keighley
M R
MR
Winslet
M C
MC
Flinn
R
R
Kmiot
W
W
D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D003082:Colectomy / Q000379:methods*; D003093:Colitis, Ulcerative / Q000601:surgery*; D003111:Colonic Polyps / Q000601:surgery*; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012007:Rectum / Q000601:surgery*