Death and complications after total colectomy for inflammatory bowel disease

Deaths and complications related to proctocolectomy in inflammatory bowel disease remain a serious problem for the general surgeon. Review of experience at a general hospital over a 25-year period disclosed that although there was substantial morbidity and 12.5% mortality there was a notable improvement over the last 10 years of the study. This was due mainly to a more aggressive surgical approach, meticulous preparation of the bowel for elective procedures, more physiologic monitoring peroperatively, careful replacement of fluid losses and intensive care postoperatively. Many patients with septic and nonseptic complications required reoperation. Intestinal occlusion by adhesions and ileostomy dysfunction are the most common nonseptic complications. One-stage proctocolectomy is a good choice for elective surgery but should be used with caution in emergency situations.