1 May 2002Article
CLINICAL AND FUNCTIONAL RESULTS AFTERSTAPLED RESTORATIVE PROCTOCOLECTOMYWITH ILEAL J POUCH FOR ULCERATIVE COLITIS
P. Colombo 1F. Tinozzi 2M. Abelli 2G. Pini 3M. Benedetti 2P. Moglia G. Morone 2S. Albertario 1P. Forti 2M. Laera 2C. Bianchi 2S. Tinozzi 2
Affiliations
Article Info
1 Istituto di Chirurgia Generale Gastroenterologica e Mammaria; Cattedra di Chirurgia dell’Apparato Digerente IRCCS Policlinico San Matteo - Pavia
2 Istituto di Chirurgia Generale e dei Trapianti d’Organo Università degli Studi di Pavia
3 Cattedra di Chirurgia dell’Apparato Digerente IRCCS Policlinico San Matteo - Pavia
Ann. Ital. Chir., 2002, 73(3), 287-298;
Published: 1 May 2002
Copyright © 2002 Annali Italiani di Chirurgia
This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
Purpose: Restorative proctocolectomy is the procedure of choice in the treatment of ulcerative colitis. The operation is successful in removing all diseased mucosa while preserving a normal bowel function and a good quality of life for the patient. In this article are presented the clinical and functional results obtained in 28 patients, 19 males (68%) and 9 females (32%) after stapled restorative proctocolectomy with ileal J pouch-anal anastomosis. Results: There were no perioperative deaths. The overall morbidity rate was 31%. Six patients (21%) presented pelvic abscess; 2 (7%) pelvic hematoma, 4 patients (14%) ileo-anal anastomotic stricture, 1 patient (3,6%) pouchvagina fistula, three patients (11%) intestinal obstruction and 7 (25%) pouchitis. All patients were able to evacuate their pouches spontaneously. The mean bowel movements were 6-9/24 hours at the first postoperative month and 3-5/24 hours at the sixth month. Infrequent nocturnal seepage occurred in 6 patients (21%). Stool consistency returned to normal within 3-6 months. The mean pouch capacity was 210 cc. The mean resting pressure was diminished in 11 patients (39%), the men and maximal squeeze pressures were improved in 9 (32%); the ileo-rectal-anal inhibitory reflex was normal in 5 patients (18%), not defined in 12 (43%). Impotence or impaired bladder function was not present. Conclusion: The use of staplers in the surgical technique of restorative proctocolectomy with J shaped ileo-anal pouch is associated with low morbidity and better long-term results. The procedure requires a good selection of patients, a correct surgical timing, a very carefully technique and a low pre and postoperative treatment with steroids.
Keywords
- Restorative proctocolectomy
- ileo-anal J pouch
- ulcerative colitis