SURGERY FOR ULCERATIVE-COLITIS IN THE ERA OF THE POUCH - THE ST-MARKS-HOSPITAL EXPERIENCE

The choice of operation for ulcerative colitis among 422 patients havi ng all their surgery at one hospital between 1976 (the year of the fir st restorative proctocolectomy) and 1990, was reviewed. The 15 year pe riod was divided into three quinquennia (1976-80, 1981-85, 1986-90). E lective surgery was performed in 316 patients with one operative death . The proportions of conventional proctocolectomy, colectomy with ileo rectal anastomosis, and restorative proctocolectomy for the three quin quennia were 36/60, 17/60; 4/60; 29/111, 30/111, 35/111; 30/145, 17/14 5, 75/145. Of 106 urgent operations with three postoperative deaths, 1 2 had a conventional proctocolectomy and 86 a colectomy with ileostomy and preservation of the rectum. Of 85 survivors of the latter there w ere two late deaths and in 13 no further surgery had been done at the time of this assessment. In the remaining 70 having subsequent surgery the proportion of conventional proctocolectomy, colectomy with ileore ctal anastomosis, and restorative proctocolectomy for the three quinqu ennia respectively were 19/27, 4/27, 14/27; 11/21, 2/21, 8/21; 5/22, 4 /22, 13/22. Of the 76 patients having colectomy with ileorectal anasto mosis 12 (16%) no longer had a functioning rectum at the end of 1990. Of the 153 patients having an ileoanal pouch procedure, 11 (7%) no lon ger had, a functioning anus. The study showed an increase in the numbe rs of patients having elective surgery for ulcerative colitis during t he three quinquennia. It also showed a rise of restorative over conven tional proctocolectomy with diminution in elective colectomy with ileo rectal anastomosis in the last five year period.