[Ileal pouch anal-anastomosis without protective ileostomy]

Ileo-anal anastomosis (IAA) for ulcerative colitis (UC) or familial adenomatous polyposis (FAP) is usually associated with a defunctioning ileostomy, which may in itself cause morbidity. We report the results of a series of patients undergoing IAA without ileostomy.

Between 1993 and 1998, 84 patients underwent IAA without ileostomy: 51 for FAP, 30 for UC, 2 for non familial colonic polyposis and 1 for indeterminate colitis. Patients taking > 30 mg steroids daily were excluded. The decision not to fashion an ileostomy was taken if there were no perioperative difficulties.

One patient died from a pulmonary embolus. Early and late complications were seen in 25 (30%) and 23 patients (27%) respectively, necessitating reoperation in 13, including three temporary ileostomies and one pouch excision for Crohn's disease. Functional results were analysed in 81 patients. Median follow-up was 22 months, the mean number of stools per day was 3.8 +/- 1. Daytime and night time continence was normal in 77 (95%) and 73 patients (90%) respectively. In 66 patients (94%) there was no urgency and in 61 (75%) no need for constipating agents.

For a selected group of patients undergoing an IAA, a defunctioning ileostomy may be avoided. Morbidity and functional results are equivalent to those obtained with a defunctioning ileostomy