OMISSION OF TEMPORARY DIVERSION IN RESTORATIVE PROCTOCOLECTOMY - IS IT SAFE

PURPOSE: The aim of our study was to evaluate the safety and functiona l outcome of restorative proctocolectomy (RP) without diversion. METHO DS: Fifty patients underwent RP without diversion for ulcerative colit is (82 percent), familial adenomatous polyposis (12 percent), and inde terminate colitis (6 percent). The perioperative course and functional outcome of these patients were compared with another group of 50 pati ents undergoing RP with diverting ileostomy during the same time perio d (1989-1991) and closely matched for age, gender, surgeon, diagnosis, extent and duration (median, 10 years) of colitis, prior colectomy (a pproximately 22 percent), steroid use (40 percent), type of pouch, dis tance of ileal pouch-anal anastomosis from the dentate line (median, 1 . 5 cm), and the duration of follow-up (median, 12 months). All patien ts had a stapled ileal pouch-anal anastomosis without mucosectomy and a smooth conduct of the operation. RESULTS: There was no operative mor tality. Anastomotic leaks and pelvic abscess were more common in patie nts without ileostomy (7/50 or 14 percent vs. 2/50 or 4 percent); 8 of these 9 patients were taking greater-than-or-equal-to 20 mg of predni sone/day. Septic complications requiring relaparotomy (6 percent vs. 0 percent), prolonged ileus, and fever of unknown origin (10 percent vs . 4 percent) were also more common in patients without ileostomy. Desp ite similar functional results at 6 weeks and at 12 months after initi al pouch function, patients without ileostomy had a poorer quality of life index (5 vs. 8; 10 being best) in the early period (0-6 weeks) of pouch function. CONCLUSION: In equally favorable cases, RP without di version is not as safe as RP with diversion, especially in patients ta king greater-than-or-equal-to 20 mg of prednisone/day.