proctocolectomy for ulcerative colitis

Between 1976 and 1985, 110 patients had restorative proctocolectomy or proctectomy for ulcerative colitis and 103 were foilowed up until death or February 1992. There was one postoperative and one late death related to surgery. The cumulative probability of pouch failure was 12% at five years: half of the failures occurred within one year. The commonest reasons were perianal/pelvic sepsis and probable Crohn's disease. The cumulative probability of readmission, excluding that for ileostomy closure, was 68% at five years. There were 152 operations carried out during readmissions. These included 44 laparotomies. Function was assessed in 80 patients at a mean of 99*3 months after ileostomy closure. For 66 patients with spontaneous evacuation, average minimum diurnal frequency was 3-8, maximum 4'9, with 35 evacuating at night. One patient experienced major continence problems, 30 had minor leaks, and 49 were completely continent. Postoperatively, five patients gave birth to nine babies, four had renal stones, two myasthenia gravis, and two severe anaemia: seven had pre or postoperative thyroid dysfimction. (Gut 1994; 35: 1070-1075) St Mark's Hospital, City Road, London P Setti-Carraro J K Ritchie K H Wilkinson R J Nicholls P R Hawley Correspondence to: Mr R J Nicholls, St Mark's Hospital, City Road, London EC1V 2PS. Accepted for publication 7 January 1994 The first restorative proctocolectomy in this hospital was carried out by Parks in 1976. Since that time it has become the most commonly used surgical procedure for ulcerative colitis as well as for selected patients with familial adenomatous polyposis and, more recently, some patients with functional bowel disease. With an experience of the operation of more than 15 years, it was felt appropriate to review the longterm outcome in patients with ulcerative colitis. To allow for lengthy follow up, the study has been confined to patients operated on before the end of 1985. It was hoped that a minimum follow up of six years would permit an assessment of function in the long term and show any possible delayed adverse effects of the operation. Patients and methods Between July 1976 and December 1985, 1 10 patients were treated at this hospital for ulcerative colitis by restorative proctocolectomy or proctectomy. Review of the case notes was supplemented by personal examination of 66 patients by one clinician (PSC). Five patients were contacted by letter or telephone and for nine information was sought from the referring surgeon using a standardised proforma. Patients were followed up until death or February 1992, apart from seven (6-3%) who could not be traced at that time. Fifty six patients had all their surgery performed at this hospital: 40 had a restorative proctocolectomy and 16 a restorative proctectomy. Fifty four patients were referred: 42 had been treated by a colectomy and ileostomy, four by a partial colectomy, and eight by colectomy and ileorectal anastomosis, which had proved unsuccessful (7) or in whom high grade dysplasia had developed in the rectum (1). A temporary ileostomy was constructed in 104 cases. The indications for surgery in the 40 patients treated by a restorative proctocolectomy were chronic symptoms in 22, severe relapsing disease in seven, dysplasia in eight, and known or suspected carcinoma in two. One patient (the first in the series) had the operation as an urgent procedure after failure of medical treatment for acute colitis. Of the 16 patients undergoing a restorative proctectomy in this hospital, an original colectomy and ileostomy was carried out urgently in 10 and electively in four. In two patients, an ileorectal anastomosis was converted to a pouch for diarrhoea in one and high grade rectal dysplasia in the other. There were 59 men and 51 women in the series with a mean age at operation of 31-6 years (median 30, range 14-60).