IngentaConnect Outcomes of the rectal remnant following colectomy for ulcerative...

Authors: Brady, R. R. W.¹; Collie, M. H. S.²; Ho, G. T.³; Bartolo, D. C. C.²; Wilson, R. G.²; Dunlop, M. G.

Source: Colorectal Disease, Volume 10, Number 2, February 2008 , pp. 144-150(7)

Abstract:

Objective

Controversy surrounds the optimal surgical management of the distal rectal remnant during colectomy for ulcerative colitis (UC) and the potential benefit from the placement of a rectal catheter for remnant drainage. This study reviews the clinical outcomes of patients who have undergone colectomy for UC with intra-peritoneal closure of the rectal remnant. Method

Analysis of prospective data lodged on Lothian Surgical Audit databases from patients treated in a tertiary coloproctology unit over 11 years. Results

One hundred and fifty-nine patients were identified, the mean age was 41.9 years, 63% were men. Failure of maximal medical therapy necessitated surgery for 78.1% patients, while 12.6% had acute perforation and 11.9% had toxic megacolon. Complications included five (3.1%) stump dehiscences, eight (5.0%) intra-abdominal/pelvic collections, four (2.5%) significant wound infections, three (1.9%) small bowel obstructions and three (1.9%) deaths. Within the follow-up period, 62.3% patients had an ileo-pouch anal anastomosis (IPAA), 7.5% patients had a completion proctectomy, 10.1% patients within the series had a retained rectal remnant after 1 year follow up, the remaining patients had less than 1 year follow up. Conclusion

The intra-peritoneal rectal stump following colectomy for UC is associated with low rates of pelvic sepsis and a high proportion of patients successfully proceeding to IPAA.

Keywords: Ulcerative colitis; colectomy; rectum; outcomes; rectal catheter

Document Type: Research article

DOI: 10.1111/j.1463-1318.2007.01224.x

Affiliations: 1: Academic Coloproctology, University of Edinburgh, Western General Hospital, Edinburgh 2: Department of Colorectal Surgery, Western General Hospital, Edinburgh 3: Gastroenterology and Internal Medicine, Western General Hospital, Edinburgh, UK

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Outcomes of the rectal remnant following colectomy for ulcerative colitis