title: Clinical and functional results after restorative proctocolectomy.
abstract: Of 84 patients who underwent restorative proctocolectomy with an ileoanal reservoir in 21 Italian departments of surgery, 51 had ulcerative colitis, 32 familial polyposis and 1 intractable constipation. Follow-up information is available for all 58 patients who had their ileostomy closed, the length of follow-up ranging between 2 and 78 months. There were no operative deaths. A failure rate (i.e. excision of the pouch) of 3 per cent was observed. Sepsis was the most common postoperative complication, and was most often related to ileoanal anastomosis dehiscence (15 per cent), followed by small-bowel obstruction requiring laparotomy (10 per cent). Clinical 'pouchitis' occurred in 14 per cent of patients after ileostomy closure. The average frequency of defaecation was four motions per 24 h; evacuation was spontaneous in all patients and only 5 per cent complained of troublesome faecal soiling while 34 per cent had occasional incontinence to flatus and mucus. Patients with a short or absent rectal cuff had a lower rate of incontinence (30 versus 48 per cent, difference not statistically significant) without any increase in the frequency of genito-urinary disorders. None of the two most used reservoirs, the J (n = 40) and S pouch (n = 17) showed significant superiority in terms of bowel frequency and continence. Incontinence was more likely in patients whose ileostomy closure had been delayed for more than one year.
authors.affiliation: Istituto di Clinica Chirurgica, Università Cattolica, Policlinico A., Gemelli, Roma, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Pescatori
authors.forename: C
authors.initials: C
authors.lastname: Mattana
authors.forename: M
authors.initials: M
authors.lastname: Castagneto
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000601:surgery; D003672:Defecation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012007:Rectum / Q000601:surgery*