title: One-stage restorative proctocolectomy without temporary ileostomy for ulcerative colitis: a note of caution.
abstract: OBJECTIVE
  This study was designed to determine the safety of omitting a temporary defunctioning ileostomy in restorative proctocolectomy for ulcerative colitis.
  
  
  METHODS
  One hundred consecutive patients with ulcerative colitis were treated electively by restorative proctocolectomy and pouch-anal anastomosis, without mucosal stripping; 50 had a defunctioning ileostomy added, and 50 underwent a one-stage procedure without ileostomy.
  
  
  RESULTS
  There was no operative mortality. The incidence of postoperative complications was similar in the two groups of patients. Life-threatening complications, however, were more common among patients who did not have a defunctioning ileostomy, of whom 11 developed pelvic sepsis and 7 required reoperation. Among patients with an ileostomy, seven developed pelvic sepsis but none required reoperation (P < 0.02). Emergency reoperations were required in 11 patients without an ileostomy but in only 1 patient with an ileostomy (P < 0.01).
  
  
  CONCLUSIONS
  One-stage restorative proctocolectomy without a defunctioning ileostomy is associated with increased risk to life. Its routine use cannot be recommended.
authors.affiliation: Academic Unit of Surgery and Centre for Digestive Diseases, The General Infirmary at Leeds, United Kingdom.
authors.forename: M E
authors.initials: ME
authors.lastname: Williamson
authors.forename: W G
authors.initials: WG
authors.lastname: Lewis
authors.forename: P M
authors.initials: PM
authors.lastname: Sagar
authors.forename: P J
authors.initials: PJ
authors.lastname: Holdsworth
authors.forename: D
authors.initials: D
authors.lastname: Johnston
mesh_terms: D000293:Adolescent; D000328:Adult; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D006801:Humans; D007081:Ileostomy; D007415:Intestinal Obstruction; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative / Q000379:methods; D012086:Reoperation; D018805:Sepsis; D014624:Vaginal Fistula