AN AUDIT OF RESTORATIVE PROCTOCOLECTOMY

A total of 168 restorative proctocolectomies have been performed witho ut mortality during the past nine years. Morbidity from pelvic sepsis (12%), ileoanal stricture (15%), and pouch related fistulas (16%) have become less with increasing experience of the operation. Pouch excisi on, which occurred in 30% of the first 50 patients was undertaken in o nly 4% in the last 68 patients. Despite this, intestinal obstruction ( 18%) continues to complicate the operation. We have abandoned restorat ive proctocolectomy after failed ileorectal anastomosis in patients wi th slow transit constipation as half have now requested pouch excision because of poor results. Failure to identify Crohn's disease continue s to influence the outcome: in 10 patients now known to have Crohn's d isease six developed post operative fistulas, three have required pouc h excision. Sexual impairment has occurred in three male patients (4%) . Ten women had children after operation, eight uncomplicated vaginal deliveries occurred without impaired continence. Seven of nine patient s over 60 years of age have had a successful outcome. Our data also in dicate that the operation may be justified in distal disease if urgenc y is socially inconvenient. Frequency of defecation is usually less th an three per 24 hours in patients with familial adenomatous polyposis but remains variable in those with ulcerative colitis.