Restorative proctocolectomy: Operative safety and functional outcomes

Restorative proctocolectomy (total proctocolectomy and ileal J pouch anal a nastomosis) has been accepted as the operation of choice in the setting of chronic ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess operative safety and functional outcome after r estorative proctocolectomy. A total of sixteen patients underwent surgery b etween January 1996 and December 1999. Hand sewn anastomosis with diverting ileostomy was performed in 9 patients and double stapled anastomosis in 7 patients. The underlying disease was ulcerative colitis in 9 cases and Fami lial adenomatous polyposis in 7. Postoperative complications developed in 8 cases (50%), and intestinal obstruction was found in 4 cases (2 cases were operated upon). Anastomosis related complications were stenosis (n = 2), l eak (n = 1) and perianal abscess (n = 1). All patients were followed up at the outpatient clinic using questionnaires, with a mean follow up period of 19.9 months. The frequency of bowel movement was 8.2 per day in hand sewn anastomosis (HS), and 12 per day in double stapled anastomosis (DS) 3 month s after surgery (period 1). This frequency decreased to 5.5 per day in HS, and 4.6 per day in DS after one year (period 2). Day and night continence w as shown in 12/15, and 5/15, respectively in period 1, but improved to 10/1 1, and 10/11, respectively in period 2. Night time incontinence was noted i n 10 of 15 patients in period 1 (seepage 3/15, soiling 7/15). The need to r ake anti-diarrheal medication, and to use a pad was not-ed in 2/15, and 10/ 15, respectively in period 1, but no patient took antidiarrheal medication or wore a protective pad in period 2. Postoperative urinary function was sa tisfactory in 13/14 patients. postoperative sexual function was analyzed in a total of 8 patients, who showed good erection (5/5), ejaculation (5/5) a nd satisfactory sexual life (5/5). In females, 3 patients showed a satisfac tory sexual life. In conclusion, restorative proctocolectomy for chronic ul cerative colitis and familial adenomatous polyposis can be performed safely with excellent functional outcomes, including bowel movement, urinary and sexual functions one year after surgery.