[Organisation and early outcome of restorative proctocolectomy and ileal pouch-anal anastomosis].
BACKGROUND
Restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has become the operation of choice for patients with ulcerative colitis and familial polyposis. However, the procedure is complex with a long learning curve, and carries a risk of both early and late complications. The purpose of this study was to evaluate the early outcomes (within 30 days after surgery) and organisation of IPAA surgery in Denmark between January 2001 and December 2005.


METHODS
IPAA patients >18 years old were drawn from the Danish National Patient Registry from 2001 through 2005. Hospital stay and the primary operation were recorded as well as re-operations and readmissions within the first 30 postoperative days. Mortality was recorded from the National Civic Register.


RESULTS
385 patients underwent IPAA surgery during the study period (77/year) in six centres. One centre performed 31% of the operations. The mean postoperative hospital stay (primary - and readmission within 30 days) was 13.5 days. 24% were readmitted within 30 days and 8% were re-operated. The mortality rate was 0.3%.


CONCLUSIONS
Based upon the limited number of operations, the high risk of early readmissions and re-operations, the well-known steep learning curve and the potential improvement with the technically demanding laparoscopic technique, a reorganisation of the procedure to fewer centres is suggested.
Ljungmann
Ken
K
Arhus Universitetshospital, Arhus Sygehus, Kirurgisk Gastroenterologisk Afdeling P.
Bendixen
Anette
A
Laurberg
Søren
S
Kehlet
Henrik
H
D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000328:Adult; D000714:Anastomosis, Surgical; D002983:Clinical Competence; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects / Q000592:standards; D003107:Colorectal Surgery / Q000458:organization & administration / Q000592:standards; D003718:Denmark; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods / Q000592:standards; D012042:Registries; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome