Different Result of Restorative Proctocolectomy between Polyposis Coli and Ulcerative Colitis-A Single Surgeon's Experience

Abstract

Purpose. Early operation is recommended for patients with adenomatous polyposis coli because cancer will develop in 100% of patients if untreated. Surgery is reserved for treating complications of ulcerative colitis (UC). This is a retrospective analysis of surgical results of restorative protocolectomy with ileal pouch anal anastomosis (IPAA), performed by a single surgeon (TCH) for patients with adenomatous polyposis coli and ulcerative colitis in a period of 27 years. Materials and Methods. A total of 44 patients with adenomatous polyposis coli and two patients with juvenile polyposis coli were operated from 1983 to 2010. Twenty-three patients were male, and 23 patients were female. Age ranged from 11 to 58 years old (an average age of 34.2 years old). Twenty-two cases of adenomatous polyposis coli received restorative proctocolectomy with IPAA. A total of 44 patients with ulcerative colitis were operated by the same surgeon. Twenty four were male and 20 were female. Age ranged from 16 to 74 years (an average age of 46.4 years old). Restorative proctocolectomy with IPAAwas performed for 25 patients. Results. In the patients with adenomatous polyposis coli, four patients were re-explored postoperatively for postoperative complications, a patient did not have the ileostomy closed, a patient died of metastatic cancer, and a patient died of non-cancer cause. 19 patients (86%) had good function of pouch. Complications of the patients with UC included intestinal obstruction in five patients (20%), wound infection in five patients (20%), rectovaginal fistula in three patients (12%), pelvic abscess in two patients (8%), pouch perforation in one patient (4%) and pouchitis in five patients (20%). Six patients had pouch removed for various complications. 16 patients (64%) had good function of pouch. Conclusion. Restorative proctocolectomy with IPAAis not a perfect operation, but could offer reasonable good quality of life among 86% of our patients with adenomatous polyposis coli. Only 64% of our patients with ulcerative colitis had good pouch function after restorative proctocolectomy with IPAA. Although IPAAmay offer fair to good quality of life, the price is high while such an operation was offered to the patients especially in patients with ulcerative colitis.