[(Procto)colectomy with permanent ileostomy versus restorative proctocolectomy in ulcerative colitis; the past as...

In the University Hospital of Utrecht, in order to assess the value of 'restorative' proctocolectomy, the early and late complications after 'classical' (procto)colectomy with establishment of a permanent ileal stoma were evaluated retrospectively over the period 1969-1988. The inclusion criteria were: having undergone a (procto)colectomy with establishment of an ileal stoma because of pathologico-anatomically confirmed ulcerative colitis, with follow-up in the clinic mentioned. Data on the preoperative period, on the operation and on the early and late complications were collected of 101 patients. Immediately postoperative complications were encountered in 50% of the patients. Mortality was 2% in the group as a whole and 5% after emergency surgery. Late complications occurred in 62% of the patients, and in 45% of the patients they necessitated one or several reoperations. Sources of late complications included: the rectal stump left in situ, the perineal wound area, the stoma and the formation of abdominal adhesions. Classical (procto)colectomy with establishment of a permanent ileal stoma entails a large proportion of early and late postoperative complications. It is asserted that the complications at present observed after restorative proctocolectomy must not prompt a return to classical proctocolectomy as the standard surgical treatment of ulcerative colitis.