THE IMPACT OF THE DEVELOPMENT OF RESTORATIVE PROCTOCOLECTOMY ON THE MANAGEMENT OF INFLAMMATORY BOWEL-DISEASE IN THE NORTH OF SCOTLAND

In the North of Scotland, 40 out of 196 patients who had surgery for c olitis between 1986 and 1992 underwent restorative proctocolectomy. Th e problems of the development of experience in a new technique were re duced by cooperation between two consultant surgeons from centres 100 miles apart who performed the first 30 operations together. Over 7 yea rs, the standard operative technique evolved from perimuscular dissect ion of the rectum with formation of an S pouch and hand sutured endo-a nal anastomosis to perimesenteric rectal dissection with a stapled J p ouch and double stapled anastomosis. There was no mortality and no pel vic sepsis requiring urgent re-operation. One pouch has been removed s ubsequently because of Crohn's disease. One patient required revisiona l surgery for severe stricture of the ileo-anal anastomosis. At 1 year post operatively, 35 out of 40 patients were highly satisfied with th e result of surgery. The proportion of patients undergoing restorative proctocolectomy rather than panproctocolectomy for ulcerative colitis has risen from 15 to 52%. The number of total colectomies performed a s initial procedures for colitis has increased. The age of patients wh o have restorative proctocolectomy has widened to include teenagers as well as a few patients over 50 pears of age.