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Restorative proctocolectomy without diverting ileostomy

S R Gorfine1, I M Gelernt, J J Bauer

  • 1Mount Sinai School of Medicine, New York, New York.

Diseases of the Colon and Rectum
|February 1, 1995
PubMed
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Restorative proctocolectomy (RPC) without temporary ileostomy is safe and effective for selected patients with chronic ulcerative colitis (CUC) and familial adenomatous polyposis (FAP). Omitting the ileostomy leads to fewer intestinal obstructions and shorter hospital stays.

Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Colorectal Surgery

Background:

  • Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is a popular surgical option for chronic ulcerative colitis (CUC) and familial adenomatous polyposis (FAP).
  • Traditionally, a temporary loop ileostomy is employed to protect the ileal pouch anastomosis from potential complications.
  • This study investigates the outcomes of RPC with mucosectomy, comparing procedures with and without a temporary ileostomy.

Purpose of the Study:

  • To compare the functional outcomes and complication rates of restorative proctocolectomy (RPC) with mucosectomy, with and without a temporary ileostomy.
  • To evaluate the safety and efficacy of omitting temporary ileostomy in selected patients undergoing RPC for CUC and FAP.

Main Methods:

  • One hundred forty-three consecutive patients with CUC or FAP underwent RPC with mucosectomy and an ileal 'J' reservoir.

Related Experiment Videos

  • A proximal loop ileostomy was performed in 69 patients; it was omitted in 74 patients based on specific clinical criteria (no immunosuppressants, low prednisone dose, tension-free anastomosis, excellent blood supply).
  • Outcomes including septic complications, anastomotic leakage, functional results (bowel movements, continence), and hospital stay were compared between the two groups.

    • Main Results:

    • No perioperative deaths occurred. Pelvic abscess rates were similar in both groups (1/69 with ileostomy vs. 1/74 without).
    • IPAA suture line dehiscence rates were not significantly different between the ileostomy (6%) and no-ileostomy (8%) groups.
    • Patients without an ileostomy experienced significantly fewer hospitalizations for partial intestinal obstruction (4% vs. 19%), required less enterolysis (1% vs. 10%), and had shorter overall hospital stays (17 vs. 24 days).

    Conclusions:

    • RPC with mucosectomy and without a temporary ileostomy is a suitable procedure for carefully selected patients with FAP and CUC.
    • Omitting the ileostomy does not compromise septic complication rates or functional outcomes and may lead to fewer complications like intestinal obstruction.
    • RPC without ileostomy results in significantly fewer episodes of intestinal obstruction, reduced need for re-exploration, and shorter total hospitalizations.