RESTORATIVE COMPARED WITH CONVENTIONAL PROCTOCOLECTOMY FOR THE TREATMENT OF ULCERATIVE-COLITIS

Objective: To evaluate the clinical differences between conventional a nd restorative proctocolectomy in the treatment of ulcerative colitis. Design: Retrospective analysis. Setting: University hospital, Finland . Subjects: 240 consecutive patients with ulcerative colitis who under went elective proctocolectomy between 1976 and 1990. Interventions: Pr octocolectomy and conventional ileostomy (n = 119) or restorative proc tocolectomy (n = 121). Main outcome measures: Early and late surgical morbidity and recovery time. Results: There were no postoperative deat hs after restorative proctocolectomy and one patient (1%) died after c onventional proctocolectomy. Two other patients (2%) with ileostomies died of late complications. Delayed perineal wound healing after conve ntional ileostomy (n = 45, 38%) and either early (n = 31, 26%) or late (n = 19, 16%) defects of the ileoanal anastomosis after restorative p roctocolectomy caused most problems. Reoperations (early or late) were needed in 45 (38%) and 44 (36%) patients after Brooke ileostomy and r estorative proctocolectomy, respectively. Major complications, however , were more common and the duration of sick leave was a month longer i n the pouch group. Conclusion: Ulcerative colitis can safely be manage d with either conventional or restorative proctocolectomy. In most cas es the patient's preference should dictate the choice of procedure.