[Ileal pouch anal-anastomosis without protective ileostomy].
OBJECTIVE
Ileo-anal anastomosis (IAA) for ulcerative colitis (UC) or familial adenomatous polyposis (FAP) is usually associated with a defunctioning ileostomy, which may in itself cause morbidity. We report the results of a series of patients undergoing IAA without ileostomy.


METHODS
Between 1993 and 1998, 84 patients underwent IAA without ileostomy: 51 for FAP, 30 for UC, 2 for non familial colonic polyposis and 1 for indeterminate colitis. Patients taking > 30 mg steroids daily were excluded. The decision not to fashion an ileostomy was taken if there were no perioperative difficulties.


RESULTS
One patient died from a pulmonary embolus. Early and late complications were seen in 25 (30%) and 23 patients (27%) respectively, necessitating reoperation in 13, including three temporary ileostomies and one pouch excision for Crohn's disease. Functional results were analysed in 81 patients. Median follow-up was 22 months, the mean number of stools per day was 3.8 +/- 1. Daytime and night time continence was normal in 77 (95%) and 73 patients (90%) respectively. In 66 patients (94%) there was no urgency and in 61 (75%) no need for constipating agents.


CONCLUSIONS
For a selected group of patients undergoing an IAA, a defunctioning ileostomy may be avoided. Morbidity and functional results are equivalent to those obtained with a defunctioning ileostomy
Gignoux
Benoît-Michel
BM
Centre de Chirurgie Digestive, Hôpital Saint-Antoine, Paris, France.
Dehni
Nidal
N
Parc
Rolland
R
Tiret
Emmanuel
E
D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D002648:Child; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D018579:Patient Selection; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000379:methods*; D012086:Reoperation; D016896:Treatment Outcome