Review article: restorative proctocolectomy, indications, management of complications and follow-up--a guide for gastroenterologists.
BACKGROUND
Restorative proctocolectomy with ileal pouch-anal anastomosis is the procedure of choice for the majority of patients with ulcerative colitis who require surgery. Over 2500 patients in the UK have undergone restorative proctocolectomy. It is now increasingly being performed in district general hospitals as well as in specialist inflammatory bowel disease units. Gastroenterologists are increasingly involved in the management of patients following restorative proctocolectomy.


OBJECTIVE
To provide gastroenterologists with a clear understanding of the investigation and evidence-based management of complications and the aftercare required in patients who have undergone restorative proctocolectomy.


RESULTS
Following restorative proctocolectomy, most patients have an excellent long-term functional outcome. Pouchitis, pelvic sepsis and poor function are the most common causes of failure. The development of cancer is rare; nevertheless, long-term follow-up is required.


CONCLUSIONS
The investigation and management of patients who develop complications require a multidisciplinary team approach to optimize the outcome. Protocols are suggested for investigation and management of patients with complications and for long-term cancer surveillance.
McLaughlin
S D
SD
Department of Biosurgery and Surgical Technology, Imperial College London, London, UK. simon.mclaughlin@nhs.net
Clark
S K
SK
Tekkis
P P
PP
Ciclitira
P J
PJ
Nicholls
R J
RJ
D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects; D003672:Defecation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D019449:Pouchitis / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation; D011379:Prognosis; D016896:Treatment Outcome