[Aspects of the complications after restorative proctocolectomy in the treatment of ulcerative colitis. Review of the literature and personal experience].
OBJECTIVE
Analysis of complications and causes of failure after stapled restorative proctocolectomy with ileal J pouchanal anastomosis in patients with ulcerative colitis is presented.


METHODS
The procedure was performed in 28 patients, 19 males (68%) and 9 females (32%); diverting ileostomy was always performed.


RESULTS
There was no perioperative mortality. The overall morbidity rate was 31%. Six patients (21%) had pelvic abscess, 2 (7%) pelvic hematoma, 4 patients (14%) presented ileo-anal anastomotic stricture, 1 patient (3.6%) had pouch-vaginal fistula, three patients (11%) presented intestinal obstruction and 7 (25%) pouchitis. Reoperation was necessary in patients with small bowel obstruction and with pouch-vaginal fistula. Septic complications and pouchitis were resolved with medical treatment. Stenosis of the anastomosis required anal dilation. No patient underwent pouch excision for pouch failure.


CONCLUSIONS
The main significant complications of ileal pouch-anal anastomosis for ulcerative colitis were pelvic sepsis, intestinal obstruction and pouchitis. Our results suggest that the use of stapling technique is safer and has fewer early septic complications and sepsis-related pouch removals. Success in ileo-anal construction increases with experience. The selection of patients with exclusion of Crohn disease, a correct surgical timing, a carefully technique, a delayed ileostomy closure and a low pre and postoperative regimen of steroids are important factors of success.
Colombo
P L
PL
Istituto di Chirurgia Generale e dei Trapianti d'Organo Università degli Studi di Pavia Istituto di Chirurgia Generale Gastroenterologica e Mammaria, Cattedra di Chirurgia dell'Apparato Digerente IRCCS Policlinico San Matteo, Pavia.
Tinozzi
F P
FP
Abelli
M
M
Laera
M R
MR
Testone
G
G
Moglia
P
P
Albertario
S
S
Morone
G
G
Bianchi
C
C
Tinozzi
S
S
D000328:Adult; D003093:Colitis, Ulcerative / Q000601:surgery*; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D019449:Pouchitis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D011859:Radiography; D012086:Reoperation