Restorative proctocolectomy for distal ulcerative colitis

Background-Chronic distal colitis may cause troublesome symptoms and alter quality of life. When medical treatment fails to control symptoms, patients and doctors are often reluctant to consider surgical resection because of the relatively small portion of the large bowel affected by the disease. Aim-To assess the outcome of restorative proctocolectomy (RP) in patients w ith distal colitis who required surgery for chronic debilitating symptoms a nd failed medical management. Patients/Methods-From 1986 to 1996, of 263 patients receiving RP for ulcera tive colitis, 27 (16 men) were operated on for distal ulcerative colitis li mited to the rectum and sigmoid colon. Bowel function and quality of life w ere compared before and one year after RP. Results-The mean (SD) duration of ulcerative colitis was 11 (6) years. RP w as performed at a mean age of 46 (10) years. All the pouches were J-shaped, and a diverting loop ileostomy was always performed. Mean (SD) hospital st ay was 25 (10) days. Seven complications occurred in six patients. Previous ly unknown severe dysplasia was discovered on the colectomy specimen in two patients. After RP there was a significant decrease in mean (SD) daytime s tool frequency (8.2 (4) v 4.7 (2), p < 0.05), night-time stool frequency (2 (2) v 1 (1), p = 0.05), and the number of patients with urgency to defecat e (26/27 v 1/27, p < 0.001). Sex life was improved in eight patients, socia l life in 26, and professional life in eight. Twenty six patients were sati sfied with the results, and 25 wished that they had received surgery earlie r in the course of their disease. Conclusion-RP can improve bowel function and quality of life in patients wi th disabling chronic symptoms of distal ulcerative colitis.