Evolution of the pelvic pouch procedure at one institution: the first 100 cases.
BACKGROUND
Total extirpation of the colon with pelvic pouch formation, and the avoidance of a permanent stoma, continues to pose a challenge for better results, both technically and functionally. The aims of this study were to investigate the first 100 pelvic ileal-pouch procedures, assessing changes in surgical technique, their relationship to morbidity and long-term outcome, and compare this to the few large international series.


METHODS
Between 1984 and 1997, 100 patients had a pelvic J-shaped ileal-pouch formed, 58 two-stage and 42 three-stage procedures. Fifty had a hand-sewn pouch-anal anastomosis and 50 a double-stapled anastomosis. Seventy-three were for ulcerative colitis, five for indeterminate colitis, 20 for familial adenomatous polyposis (FAP), one for multiple primary colorectal cancers, and one for constipation.


RESULTS
After a median follow-up of 68 months, 97% of patients still have a functioning pouch. There were two postoperative deaths (one after-pouch formation and one after-stoma closure). Morbidity occurred in 52 patients, including three patients with pouch leaks and three pouch-anal anastomosis leaks (6% leak rate), 27% with a small bowel obstruction (2% early, 20% late, 5% both), a 19% anal stricture rate, and a 9% pouchitis rate. Three pouches have been removed (all for Crohn's disease). Median number of bowel movements per day was six, with 85% of patients reporting a good quality of life. Patients following a double-stapled procedure have less anal seepage and improved continence over those with a hand-sewn ileal pouch-anal anastomosis.


CONCLUSIONS
Despite high morbidity rates, pelvic pouch formation provides satisfactory long-term results for patients requiring total proctocolectomy, with functional results and morbidity rates comparable to larger overseas series.
Young
C J
CJ
The Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Solomon
M J
MJ
Eyers
A A
AA
West
R H
RH
Martin
H C
HC
Glenn
D C
DC
Morgan
B P
BP
Roberts
R
R
D011125:Adenomatous Polyposis Coli / Q000235:genetics / Q000534:rehabilitation / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016737:Proctocolectomy, Restorative / Q000379:methods / Q000534:rehabilitation / Q000706:statistics & numerical data*; D011788:Quality of Life; D013537:Sutures