Evolution of the pelvic pouch procedure at one institution: The first 100 cases

Background: Total extirpation of the colon with pelvic pouch formation, and the avoidance of a permanent stoma, continues to pose a challenge for bett er results, both technically and functionally. The aims of this study were to investigate the first 100 pelvic ileal-pouch procedures, assessing chang es in surgical technique, their relationship to morbidity and long-term out come, and compare this to the few large international series. Methods: Between 1984 and 1997, 100 patients had a pelvic J-shaped ileal-po uch formed, 58 two-stage and 42 three-stage procedures. Fifty had a hand-se wn pouch-anal anastomosis and 50 a double-stapled anastomosis. Seventy-thre e were for ulcerative colitis, five for indeterminate colitis, 20 for famil ial adenomatous polyposis (FAP), one for multiple primary colorectal cancer s, and one for constipation. Results: After a median follow-up of 68 months, 97% of patients still have a functioning pouch. There were two postoperative deaths (one after-pouch f ormation and one after-stoma closure). Morbidity occurred in 52 patients, i ncluding three patients with pouch leaks and three pouch-anal anastomosis l eaks (6% leak rate), 27% with a small bowel obstruction (2% early, 20% late , 5% both), a 19% anal stricture rate, and a 9% pouchitis rate. Three pouch es have been removed (all for Crohn's disease). Median number of bowel move ments per day was six, with 85% of patients reporting a good quality of lif e. Patients following a double-stapled procedure have less anal seepage and improved continence over those with a hand-sewn ileal pouch-anal anastomos is. Conclusions: Despite high morbidity rates, pelvic pouch formation provides satisfactory long-term results for patients requiring total proctocolectomy , with functional results and morbidity rates comparable to larger overseas series.