Surgical treatment of ulcerative colitis in Stockholm county

The colectomy rate in patients with ulcerative colitis has increased during the last 30 years in Stockholm County due to increased incidence and a more liberal attitude to colectomy in acute cases. In an area of Stockholm's size, about 30 patients with UC will require colectomy every year and of these, 12 will be acute cases. The main factor affecting the colectomy rate was the extent of disease at diagnosis. The 25-year cumulative colectomy rate was 65% in patients with total colitis compared to 45% in all patients. The probability of undergoing a colectomy decreased as the duration of disease increased and after five years duration of disease the colectomy rate was about 1% per year. The choice of primary surgical procedure has changed during the study period and subtotal colectomy and ileostomy is now preferred as the surgical procedure of choice, both in acute and elective cases. The frequency of major complications was constant during the period of study but increased with the urgency of intervention, being 25% in elective cases and 46% in acute cases. The overall postoperative mortality fell from 13% during 1960 to 1964 to 2% during 1980-1984. In acute cases the mortality during the same time periods decreased from 36% to 3%. The long-term results of ileorectal anastomosis showed a substantial failure rate and the most common cause of failure was recurrent rectal disease. In patients who still had their ileorectal anastomosis at the time of follow-up the functional results were better than for the pelvic pouch. The ileorectal anastomosis is for some patients a definite solution and in others it avoids or delays an ileostomy and at the same time still permits a pelvic pouch at a later date. The need for secondary surgery after colectomy for UC is great. The cumulative probability of a fist small intestinal obstruction requiring surgery in 483 patients treated by colectomy was 23% after 15 years. The annual incidence was highest in patients treated by pelvic pouch and lowest in patients treated by IRA. The cumulative probability of a first ileostomy revision was 21% after 15 years. In patients with a Kock's pouch the cumulative probability of a first nipple revision was as high as 52% after two years. The need for secondary surgery was initially high in patients treated by pelvic pouch but the need has decreased during the latter years due to improved technique and increasing surgical experience.(ABSTRACT TRUNCATED AT 400 WORDS)