EXPERIENCE WITH RESTORATIVE PROCTOCOLECTOMY IN 201 PATIENTS

Two hundred and one patients underwent restorative proctocolectomy bet ween January 1985 and January 1993. The underlying disease was ulcerat ive colitis in 191 and familial adenomatous polyposis in ten patients. All patients had a J pouch and, except for 22 patients, total mucosec tomy was performed. The procedure was technically successful in 200 ca ses (99.5 %). There was no postoperative morality, but two patients di ed soon afterwards due to unrelated causes (suicide, upper gastrointes tinal bleeding). Early postoperative complications were observed in 33 % of patients and 21 % required reoperations, most often because of h aemorrhage or pelvic sepsis. Late morbidity rate was 29 % including re operations in 31 patients (17 %) ar conversion to permanent ileostomy in five cases (2.5 %). The most common late problems were anal sinus, stricture fistula (11 %) and episodic or chronic pouchitis (20 %). The functional result was evaluated in 150 patients followed up for one y ear: the mean bowel frequency was 5.6 times in 24 hours, 19 % of patie nts had minor anal soiling and 11 % required a protective pad. It is c oncluded that restorative proctocolectomy has become the first choice for most patients with ulcerative colitis and familial adenomatous pol yposis.