Restorative proctocolectomy for distal proctocolitis

Restorative proctocolectomy (RP) is usually the surgical treatment of choice for severe ulcerative colitis, but patients with distal disease (rectosigmoid only) are frequently denied operation on the grounds that they are not systemically ill. Nevertheless, they may continue to have high frequency, low volume diarrhoea with severe urgency and bleeding, despite medical therapy.

To report the outcome of RP in `distal disease' compared with `more extensive' disease.

The results of all patients having RP for ulcerative colitis between February 1983 and February 1997 were reviewed. We excluded patients later found to have Crohn's disease.

RP was used for 34 with `distal' disease compared with 134 with `more extensive' disease. Pre-operative steroids were used in 9% of the `distal' group compared with 34% in the `more extensive' group. Anastomotic leaks and pelvic sepsis occurred in 3% and 9%, respectively, in the `distal' group compared with 13% and 17% in the `more extensive' group, but these differences were not statistically significant. Pre-operative steroids significantly influenced anastomotic leaks 22% vs 5% (P = 0.006). Pouch-related fistulas occurred in 12% of the `distal' group compared with 15% in the remainder. Pouchitis occurred in 44% of the `distal' group: 44% compared with 33% in the remainder. Pouch failure occurred in 3% in `distal' compared with 15% in those with `more extensive' disease.

These results imply that RP has a role in the treatment of intractable `distal' colitis, that morbidity is low and urgency is usually eliminated.