One-stage restorative proctocolectomy without temporary ileostomy for ulcerative colitis: a note of caution.
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.
Williamson
M E
ME
Academic Unit of Surgery and Centre for Digestive Diseases, The General Infirmary at Leeds, United Kingdom.
Lewis
W G
WG
Sagar
P M
PM
Holdsworth
P J
PJ
Johnston
D
D
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