A comparison of adverse events and functional outcomes after restorative proctocolectomy for familial adenomatous polyposis and ulcerative colitis.
OBJECTIVE
Restorative proctocolectomy is the procedure of choice for patients undergoing proctocolectomy for familial adenomatous polyposis or ulcerative colitis. This meta-analysis was designed to identify differences in adverse events and functional outcomes between these two groups.


METHODS
Studies published between 1986 and 2003 that compared outcomes between patients with familial adenomatous polyposis and ulcerative colitis were included. Meta-analytical techniques using random effect models were used to compare short-term and long-term adverse events as well as functional outcomes between the groups.


RESULTS
Nineteen studies comprising 5,199 patients (familial adenomatous polyposis, 782; ulcerative colitis, 4,417) were analyzed. There were no significant differences in immediate postoperative adverse events between the two groups. Pouch-related fistulation was significantly increased in the ulcerative colitis group (10.5 percent vs. familial adenomatous polyposis 4.8 percent; odds ratio 2.31; P < 0.001). There was no significant difference in pouch failure between the two groups (ulcerative colitis 5.8 percent vs. familial adenomatous polyposis 4.5 percent; odds ratio 1.22; P = 0.43). The incidence of pouchitis was significantly greater in the ulcerative colitis group (30.1 vs. 5.5 percent; odds ratio 6.44; P < 0.001). Patients with familial adenomatous polyposis had a significant advantage in stool frequency with one less motion per 24 hours (95 percent confidence interval, 0.21-1.76; P = 0.01).


CONCLUSIONS
In contrast to studies reporting similar outcomes for patients undergoing restorative proctocolectomy for familial adenomatous polyposis or ulcerative colitis, the present meta-analysis suggested that patients with ulcerative colitis are at greater risk of pouch-related fistulation and pouchitis. Although there was an increase in the 24-hour stool frequency in the ulcerative colitis group, this may be accounted for by the younger age at surgery in the familial adenomatous polyposis group.
Lovegrove
Richard E
RE
Imperial College London, Department of Biosurgery and Surgical Technology, St. Mary's Hospital, Praed Street, London, United Kingdom.
Tilney
Henry S
HS
Heriot
Alexander G
AG
von Roon
Alexander C
AC
Athanasiou
Thanos
T
Church
James
J
Fazio
Victor W
VW
Tekkis
Paris P
PP
D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D003093:Colitis, Ulcerative / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications; D019449:Pouchitis / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*