CHANGING REFERRAL PATTERNS FOR SURGICAL-TREATMENT OF ULCERATIVE-COLITIS

Objective: To determine whether referral patterns for surgical treatme nt among patients with chronic ulcerative colitis have changed in rece nt years, especially in view of the introduction of a new operation, t he ileal pouch-anal anastomosis (IPAA). Material and Methods: Between January 1976 and December 1986, 981 patients underwent proctocolectomy at Mayo Clinic Rochester. Brooke ileostomy (N = 300), colectomy with ileorectal anastomosis (N = 33), proctocolectomy with Rock pouch (N = 180), or ileal pouch-anal anastomosis (IPAA) (N 468) was performed. Th e indications for surgical intervention mere categorized as emergent o r elective, the latter including intractability, cancer, and cancer pr ophylaxis. For analysis, the duration from diagnosis of disease to ope ration, indications for surgical treatment, and types of operation wer e subdivided into pre-IPAA era (before 1981) and post-IPAA era (from 1 981 onward) for the entire group and for distant versus local patients . Results: More continence-preserving operations were done in 1981 and thereafter (76%) than before 1981 (46%). In the later segment of the study period in comparison with before 1981, fewer operations were don e for emergent reasons (4% versus 8%) and a greater percentage of oper ations were done for elective indications, especially intractability ( 74% versus 61%). With the advent of IPAA in 1981, patients underwent o peration sooner after the diagnosis was made (7.4 years versus 8.6 yea rs before 1981). A smaller proportion of patients underwent operation for cancer prophylaxis during 1981 through 1986 (19%), however, than b efore 1981 (28%). Conclusion: Referral patterns for surgical treatment of patients with ulcerative colitis have changed in recent years-pati ents are being referred for operation sooner, before complications dev elop that necessitate emergent procedures. Although the changed referr al pattern may be due to the availability of IPAA, other factors may a lso have a role.