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Clinical results after restorative proctocolectomy without diverting ileostomy for ulcerative colitis
Hiroki Ikeuchi1, Yasutsugu Shoji, Masato Kusunoki
1Second Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cyo, Nisinomiya, 663-8501 Hyogo, Japan. ikeuci2s@hyo-med.ac.jp
Background And Aims:
This study evaluated the postoperative complications and clinical results of restorative proctocolectomy without diverting ileostomy for ulcerative colitis.
Patients And Methods:
One hundred selected patients had a hand-sewn ileal J-pouch anal anastomosis with mucosectomy using an ultrasonically activated scalpel.
Results:
Three patients with pouch-related complications who needed diverting ileostomy. Five patients showed intestinal obstruction; two of the five needed relaparotomy and division of adhesions. The median number of bowel movements per 24 h was 6.5 (2-13) at 3 months and 5 (3-10) at 12 months. The corresponding nightly frequencies were 0 (0-5) at 3 months and 0 (0-3) at 12 months. After 3 months 82% of patients had no soiling during the daytime, and 45% were fully continent day and night. After 3 months 89% had recovered the ability to distinguish flatus from feces.
Conclusion:
Ileal pouch anal anastomosis can be performed safely without diverting ileostomy using an ultrasonically activated scalpel. The postoperative functional result was stabilized 3 months after the operation.