Restorative Proctocolectomy for Ulcerative Colitis in 1985-2009.
BACKGROUND AND AIMS
Restorative proctocolectomy is the most common operation in patients with ulcerative colitis. The aim was to evaluate long-term changes in our operative treatment and early and late complications related to restorative proctocolectomy.


MATERIAL AND METHODS
The study comprised 352 (149 females) patients over 18 years of age with ulcerative colitis who underwent restorative proctocolectomy in 1985-2009 median follow-up time of 5 years.


RESULTS
The indication for surgery was active chronic colitis in 168 (47.7%), acute colitis in 159 (45.2%), and cancer or dysplasia in 25 (7.1%) patients. Ileal pouch-anal anastomosis was performed using hand-sewn anastomosis with mucosectomy in 283 patients and stapled anastomosis in 69. A shift from hand-sewn to stapler ileal pouch-anal anastomosis took place in 2005. Covering ileostomy was carried out in 133 (37.8%) patients. There were 82 (23.3%) J-pouch-related complications. The operative mortality was 0.3%. There were significantly fewer leakages and early re-operations when covering ileostomy was used than when it was omitted: 6.0% versus 16.4% (p = 0.004), 4.5% versus 11.9% (p = 0.02), respectively. There were more strictures in hand-sewn than in stapled ileal pouch-anal anastomoses (17.6% vs. 0%, p = 0.001). Pouchitis occurred at least once in 134 (38.1%) patients.


CONCLUSION
The ileal pouch-anal anastomosis technique used in restorative proctocolectomy had changed over the past years from hand-sewn to stapled anastomosis. Covering ileostomy seemed to protect against major complications. Pouchitis was the most common late complication.
['Helavirta|I|I|', 'Huhtala|H|H|', 'Hyöty|M|M|', 'Collin|P|P|', 'Aitola|P|P|']
D000208:Acute Disease D000293:Adolescent D000328:Adult D000368:Aged D002908:Chronic Disease D003093:Colitis, Ulcerative D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D011183:Postoperative Complications D016737:Proctocolectomy, Restorative D012189:Retrospective Studies D016896:Treatment Outcome D055815:Young Adult
restorative proctocolectomy Ulcerative colitis complication ileal pouch-anal anastomosis