Restorative proctocolectomy and indeterminate colitis

One hundred seventy-five patients underwent restorative proctocolectomy between November 1984 and December 1992. The pathologic results were reviewed by two pathologists, one being a gastrointestinal pathologist. One hundred fifty-eight patients had a confirmed diagnosis of ulcerative colitis, and 16 patients were diagnosed with indeterminate colitis. In addition, one patient was diagnosed with familial adenomatous polyposis. Eight of the 158 patients with ulcerative colitis required removal of their pouches, and 3 of the 16 patients with indeterminate colitis required pouch removal. By this definition, the success rate for restorative proctocolectomy in patients with ulcerative colitis was 95% and the success rate for restorative proctocolectomy in patients with indeterminate colitis was 81%. Of the 16 patients with indeterminate colitis, 8 have satisfactory pouch function and 5 have some ongoing problems. We recommend this pathology-review approach to more clearly define which patients have indeterminate colitis and, therefore, to more accurately present to the patient the likelihood of success or failure of restorative proctocolectomy with this diagnosis.