Restorative Proctocolectomy with Ileal Reservoir and Ileoanal Anastomosis for Ulcerative Colitis and Familial Polyposis

Abstract

Our experience with the technique of restorative proctocolectomy utilizing a rectal mucosectomy, total colectomy, and ileal reservoir with ileoanal anastomosis in 56 patients with ulcerative colitis or familial polyposis is presented. 3 patients (5 %) had their pouch excised and represent failures of the operation. The current functional results are very encouraging but the potential for morbidity is high. The proper role of this procedure in the management of patients with ulcerative colitis or polyposis is currently being defined. In selected patients who are relatively fit, stable, and reliable and cognizant of the nature of this procedure and its alternatives, the ileoanal reservoir pull-through procedure is a reasonable option.

Outcome of restorative proctocolectomy when the diagnosis is suggestive of Crohn's disease.

“…[28][29][30][31][32] The results of restorative proctocolectomy have generally been unfavourable if Crohn's disease is diagnosed as there is a high incidence of complications and the failure rate is unacceptable. Despite a relatively short term median follow up (5 7 years) only three of 10 patients (30%) with definite Crohn's colitis have so far had their pouch excised, admittedly all were for fistulas, while the remaining seven have satisfactory function despite episodes of recurrent pouchitis in three.…”

Restorative proctocolectomy for distal proctocolitis

“…Pouchitis [ 16] has a reported incidence of 8–50% following pouch formation [ 17–19]. This study showed a slightly higher incidence of pouchitis (44%) in patients with `distal' disease compared with those with `more extensive' disease (33%; NS), which we think is curious since pouchitis is usually more common in patients with a history of extensive disease [ 7, 20].…”

Familial Adenomatous Polyposis: Surgical Approaches

“…Similarly, excellent long-term results have been re ported from other internationally recognized centers with ileoanal anastomosis coupled with either an 'S'-shaped reservoir [21] or a 'W' pouch [22] without dem onstrating superiority over the easier to construct 'J' ileal pouch.…”