[Early and long-term results following ileum-anal pouch anastomosis]

Between 1984 and 1989 21 patients underwent proctocolectomy and were reconstructed with ileal-pouch-anal anastomosis using a J-pouch. 18 patients had ulcerative colitis and 3 adenoma of the colon. In 16 of 21 patients the operation was performed in a three-stage way: (1.) total colectomy; (2.) proctomucosectomy, ileal-pouch-anal anastomosis and protective ileostomy; (3.) ileostomy closure. 5 patients had a two-stage operation (3 patients with adenoma of the colon, 2 patients with low or no steroid medication). Operative mortality was 0%. Complications were seen in 4 of 21 patients after colectomy (sepsis, pelvic abscess in 2 instances, ileus), in 4 of 21 patients after ileal-pouch-anal anastomosis (pouch-vaginal fistula, pelvic abscess, anastomotic stricture, ileus) and in 2 of 19 patients after closure of ileostomy (pouch-vaginal fistula). In 19 of 21 patients the ileostomy is closed. All of these patients are fully continent during the day and only 2 patients are slightly incontinent at night. The average stool evacuation is 4 to 5 during the day and once to twice at night. All patients are very satisfied with the result.