Restorative proctocolectomy: Ochsner Clinic experience.
BACKGROUND
Restorative proctocolectomy, a standard operation for ulcerative colitis and familial adenomatous polyposis has significant complications, even in experienced hands.


METHODS
We studied surgical outcome by retrospectively reviewing cases of restorative proctocolectomy done at Ochsner Foundation Hospital from 1982 to 1995. Demographic and clinical data from two periods (1982 to 1989 and 1989 to 1995) were compared to determine factors associated with improved outcome.


RESULTS
We performed 145 ileal pouch-anal procedures. In 56 patients, 104 complications occurred. The more recent group had a greater incidence of inflammatory bowel disease, steroid use, and staged operations; reduced operative times and hospital stays; more general but fewer pouch-related complications. Pouch failures were similar for both groups.


CONCLUSIONS
Perioperative outcome appeared to be associated with technical experience, improved perioperative care, exclusion of patients with Crohn's disease,judicious surgical reoperation for pouch complications, and use of a 3-stage procedure in malnourished patients or those with acute or toxic colitis.
Blumberg
D
D
Department of Colon and Rectal Surgery, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, LA 70121, USA.
Opelka
F G
FG
Hicks
T C
TC
Timmcke
A E
AE
Beck
D E
DE
D011125:Adenomatous Polyposis Coli / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000601:surgery; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology*; D016737:Proctocolectomy, Restorative / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome