[Single-stage proctocolectomy and ileo-anal anastomosis: benefits and risk factors]

A collective experience of restorative proctocolectomy with "J" pouch over seven and a half years is presented comparing 63 patients with covering ileostomy and 122 patients with no ileostomy. There was no postoperative mortality in either group, and permanent failure resulted in four (6.3%) and one (0.8%) of patients with and without covering ileostomy, respectively. Total number of postoperative complications was slightly more in the ileostomy group (38 vs. 30%), and significant ileostomy related complications or anastomosis leakage were more common in patients with covering ileostomy (24%) than anastomosis leakage needing later covering ileostomy in the no ileostomy group (14%). There was a median saving of 12 hospital days and 30 sick-leave days in favor of no ileostomy. Severe active ulcerative colitis and male sex (indicating technically difficult anastomosis) emerged as significant risk factors of anastomosis leakage in the no ileostomy group, while steroid use as such seemed not to be a special risk. It was concluded that one stage restorative proctocolectomy suits well for most patients in good general condition when a technically sound anastomosis without tension can be done.