IngentaConnect Restorative proctocolectomy for distal proctocolitis

Abstract:

Background

Restorative proctocolectomy (RP) is usually the surgical treatment of choice for severe ulcerative colitis, but patients with distal disease (rectosigmoid only) are frequently denied operation on the grounds that they are not systemically ill. Nevertheless, they may continue to have high frequency, low volume diarrhoea with severe urgency and bleeding, despite medical therapy. Objective

To report the outcome of RP in `distal disease' compared with `more extensive' disease. Patients and methods

The results of all patients having RP for ulcerative colitis between February 1983 and February 1997 were reviewed. We excluded patients later found to have Crohn's disease. Results

RP was used for 34 with `distal' disease compared with 134 with `more extensive' disease. Pre-operative steroids were used in 9% of the `distal' group compared with 34% in the `more extensive' group. Anastomotic leaks and pelvic sepsis occurred in 3% and 9%, respectively, in the `distal' group compared with 13% and 17% in the `more extensive' group, but these differences were not statistically significant. Pre-operative steroids significantly influenced anastomotic leaks 22% vs 5% (P = 0.006). Pouch-related fistulas occurred in 12% of the `distal' group compared with 15% in the remainder. Pouchitis occurred in 44% of the `distal' group: 44% compared with 33% in the remainder. Pouch failure occurred in 3% in `distal' compared with 15% in those with `more extensive' disease. Conclusion

These results imply that RP has a role in the treatment of intractable `distal' colitis, that morbidity is low and urgency is usually eliminated.

Keywords: Colitis; pouch surgery; extent of disease; function; complications

Document Type: Original article

DOI: 10.1046/j.1463-1318.1999.00026.x

Affiliations: 1: University Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK

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