OUTCOME OF 200 RESTORATIVE PROCTOCOLECTOMY OPERATIONS - THE JOHN-RADCLIFFE-HOSPITAL EXPERIENCE

Background Restorative proctocolectomy is now the operation of choice for the definitive management of ulcerative colitis and familial adeno matous polyposis (FAP). Methods A total of 200 patients (117 male, 53 female) underwent restorative proctocolectomy over a 12-year period, I nformation in a dedicated prospective database was supplemented by cha rt review. Some 177 had ulcerative colitis, 13 had indeterminate colit is and seven had FAP, Pouch designs were two-loop J (n = 142), four-lo op W (n = 45) and three-loop S (n = 13). The majority (73.5 per cent) had a stapled ileoanal anastomosis and 139 patients had a defunctionin g ileostomy. Results There were no deaths. Early morbidity (less than 30 days after operation) included 76 complications in 71 patients (35. 5 per cent), of which 35 were related to the pouch itself. Lung-term f ollow-up data were available for 196 patients at a median of 27 months , Sixteen pouches (8.0 per cent) have been excised. Mean daytime frequ ency was 4.5 (range 1-15). Of 175 patients with colitis, 42 (24.0 per cent) had one or more episodes of pouchitis. Conclusion Continuous imp rovements in operative technique have simplified the procedure, and fu nctional results, although variable, have generally been acceptable.