Twenty cases of restorative proctocolectomy for ulcerative colitis of Asian patients: analysis of operative safety and functional outcomes in single institution experience

Abstract

Dear Editor, Since the first reports on restorative proctocolectomy, the procedure pioneered by Park and Nicholls in 1978, ileal pouch-anal anastomosis (IPAA) has become the gold standard for patients who require total proctocolectomy (TP) for ulcerative colitis. Although a high evacuation frequency with anal incontinence was recorded in the initial functional tests, the overall results improved gradually during the first 3–6 months, with further improvement over the next couple of years. Despite the high level of patient satisfaction with IPAA for postoperative fecal incontinence and stool consistency, the operation carries a high potential for complications; various pouch-related and unrelated complications have been reported postoperatively. Moreover, the young age of most of the IPAA patients warrants monitoring of the long-term complication rate and stability of function over time. In Korea, the incidence of ulcerative colitis has been steadily increasing since mid 1980s and so does the number of patients needing total proctocolectomy. Of the patients (n=24) who underwent TP for ulcerative colitis in our department between January 1996 and December 2005, 20 patients who underwent restorative proctocolectomy for ulcerative colitis were included in this study. We reviewed the medical records of the 20 patients and assessed their defecation, urinary, and sexual functions using a questionnaire. The procedures we performed were total proctocolectomy. The anastomosis method after TP was either hand-sewn IPAA with diverting ileostomy (n=17) or double-stapled IPAA without ileostomy, which remained 2 cm rectal mucosa from the dentate line (n=3). The mean age of the patients was 41.9 years (range, 24–63 years). The patients were 7 men and 13 women with an average disease duration of 47.70 months. The indications for surgery were medical intractability (n=18) and toxic megacolon (n=2). The mean duration for fecal diversion was 3.7 months, and the mean follow-up after the ileostomy take down was 59.1 months. Seven cases (35%) of postoperative complications developed, which included intestinal obstructions (n=3), pouchitis (n=2), pouch and stoma bleeding (n=1), and intractable fecal incontinence (n=1). The frequency of bowel movements was 10.1 times per day in the 3 months after ileostomy closure (period 1). It decreased to 8.1 times per day from 4 months to 1 year after ileostomy closure (period 2) and decreased further to 6.5 times per day 1 year more after ileostomy closure (period 3). Day and night fecal incontinence was seen in 4/20 and 17/20, respectively, during the period 1; 2/20 and 11/20 during the period 2; and 0/20 and 5/20 during the period 3. Consistency of the stool, expressed as the ratio of semisolid to loose stool, was 0:20 during the period 1, 10:10 during the period 2, and 14:6 Int J Colorectal Dis (2008) 23:131–132 DOI 10.1007/s00384-007-0278-y