ONE-STAGE RESTORATIVE PROCTOCOLECTOMY WITHOUT TEMPORARY ILEOSTOMY FORULCERATIVE-COLITIS - A NOTE OF CAUTION

PURPOSE: This study was designed to determine the safety of omitting a temporary defunctioning ileostomy in restorative proctocolectomy for ulcerative colitis. METHOD: One hundred consecutive patients With ulce rative colitis were treated electively by restorative proctocolectomy and pouch-anal anastomosis, without mucosal stripping; 50 had a defunc tioning ileostomy added, and 50 underwent a one-stage procedure withou t ileostomy. RESULTS: There was no operative mortality. The incidence of postoperative complications was similar in the two groups of patien ts. Life-threatening complications, however, were more common among pa tients who did not have a defunctioning ileostomy, of whom Il develope d pelvic sepsis and 7 required reoperation. Among patients with an ile ostomy, seven developed pelvic sepsis but none required reoperation (P < 0.02). Emergency reoperations were required in 11 patients without an ileostomy but in only 1 patient with an ileostomy (P < 0.01). CONCL USION: One-stage restorative proctocolectomy without a defunctioning i leostomy is associated with increased risk to life. Its routine use ca nnot be recommended.