Surgical options in ulcerative colitis.
The length of ileum used rather than pouch configuration per se is related to eventual functional outcome: A pouch constructed from 15- to 20-cm limbs is ideal. One-stage procedures appear feasible in those patients who are not malnourished or taking steroids and in whom a tension-free anastomosis may be achieved. Because most of our patients do not satisfy these criteria, single-stage IPAA is rarely used at the Mayo Clinic. The decision to excise the ATZ should relate to the risk of developing subsequent neoplasia. All patients with FAP should have a mucosectomy performed. Patients with CUC who do not have a mucosectomy should have life-long surveillance. Indeed, an argument can be made that all patients should undergo surveillance after IPAA. The decision to staple the anastomosis impacts little on eventual functional outcome but does preserve the ATZ with the attendant risk of recurrent disease, polyps, and neoplasia. When cancer is a presenting feature, the decision to perform IPAA should be based on the stage of the tumor and the subsequent need for radiation therapy. Patients with early-stage tumors not requiring adjuvant radiation therapy attain long-term function comparable to that of patients who have had an IPAA for benign disease.
Farouk
R
R
Mayo Graduate School of Medicine, Rochester, Minnesota, USA.
Pemberton
J H
JH
D000714:Anastomosis, Surgical; D003093:Colitis, Ulcerative / Q000150:complications / Q000601:surgery*; D003110:Colonic Neoplasms / Q000150:complications; D006801:Humans; D007081:Ileostomy; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative / Q000379:methods*; D017792:Surgical Stapling