CLINICAL OUTCOME AND BOWEL FUNCTION FOLLOWING TOTAL ABDOMINAL COLECTOMY AND ILEORECTAL ANASTOMOSIS IN THE ORIENTAL POPULATION

Total abdominal colectomy with ileorectal anastomosis is a commonly pe rformed surgical procedure. The postoperative outcome of these patient s, however, has not been studied in detail in the Asian population. AI M. The purpose of this study was to analyze the functional outcome of patients following total abdominal colectomy and ileorectal anastomosi s. METHOD: All patients subjected to a total abdominal colectomy with ileorectal anastomosis during a six-year period from February 1989 to October 1995 were reviewed. RESULTS: Sixty-six patients (male:female, 40:26) with a mean age of 55.2 (range, 20-88) years underwent total ab dominal colectomy with ileorectal anastomosis. Median followup after s urgery was 26 (range, 4-78) months. Indications for surgery were synch ronous or metachronous tumors (18), complicated pancolonic diverticula r disease (15), obstructed tumors with impending perforation (13), fam ilial adenomatous polyposis (7), slow-transit constipation (6), and ot hers (7). Mean operative time was 137 +/- 48 minutes. Mean postoperati ve hospitalization was 13.3 +/- 11.9 days. Time to first bowel movemen t and commencement of solid diet were 4.7 +/- 1.8 and 7.2 +/- 2.4 days , respectively. Four patients had prolonged postoperative ileus. Avera ge stool frequencies per day were 5.5 at one week, 4.3 at one month, 3 .9 at six months, 3.2 at one year, and 2.9 at two years postoperativel y. Thirty-three patients (50 percent) required antidiarrheal treatment for a transient period, but none required long-term therapy. Ninety-s even percent of all patients rated the functional outcome as good to e xcellent, and 3 percent said it was fair. There was two perioperative mortalities. Five cases required re-laparotomy, three for anastomotic complications and two for hemoperitoneum. Five patients had recurrent admissions for adhesion colic, which resolved with nonsurgical therapy . Ten patients succumbed on follow-up, six to tumor recurrence, two to unrelated cancers (stomach and bladder), and three to medical conditi ons. CONCLUSION: The functional outcome of ileorectal anastomosis is g enerally rated as good to excellent by patients. Acceptable bowel func tion and control is regained within six months of the operation and le vels off at one year after surgery, and no patient requires long-term antidiarrheal medication.