title: Indications for operation in ulcerative colitis in the era of the pouch and before.
abstract: OBJECTIVE
  To find out if the change in the operation of choice for ulcerative colitis from proctocolectomy with conventional ileostomy to restorative proctocolectomy which occurred during the 1980s had any influence on the indications for operation.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  University hospital, Finland.
  
  
  METHODS
  430 consecutive patients who underwent operations for ulcerative colitis: 154 patients during 1976-85, when conventional proctocolectomy was the first choice, and 276 patients in 1986-94, when restorative proctocolectomy was the operation of choice.
  
  
  METHODS
  Comparison of the main surgical indications between the two periods.
  
  
  METHODS
  The indication for the first operation for three groups of patients: acute colitis, chronic colitis, and carcinoma (or at risk of cancer).
  
  
  RESULTS
  The annual number of patients operated on roughly doubled even though the duration of colitis became longer and the age of patients older. The percentage of patients with "acute colitis" decreased from 29% (45/154) to 20% (55/276) (p = 0.032) and that of "chronic colitis" increased from 52% (80/154) to 65% (179/276) (p = 0.01) during the study period, while patients operated on for risk of carcinoma decreased slightly (19%, 29/154, compared with 15%, (42/276) p = 0.35).
  
  
  CONCLUSIONS
  The adoption of restorative proctocolectomy has not caused any significant changes in indications for operation in ulcerative colitis. On the contrary, the medical control is better than before, but dealing with the risk of cancer remains difficult.
authors.affiliation: Second Department of Surgery, Helsinki University Central Hospital, Finland.
authors.forename: K A
authors.initials: KA
authors.lastname: Mikkola
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000150:complications / Q000473:pathology / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000150:complications / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies; D016896:Treatment Outcome