An analysis of 50 cases of restorative proctocolectomy

Restorative proctocolectomy with ileal pouch-anal anastomosis is clearly the operation of choice for ulcerative colitis and polyposis coli. Not so clear is the best way to perform this operation. The technique used at the University of Pittsburgh is described. Utilising a meticulous mucosectomy with the patient in a prone jack-knife position, the ileal pouch-anal anastomosis was successfully performed in a series of 50 consecutive patients which included six with orthotopic liver graft, nine with a prior Hartmann procedure, ten with fulminant colitis and six with cancer. All patients were fully continent of stools, and except for one, had a good functional result. Complications were minor and included pelvic sepsis (n = 2), ileostomy-related complications (n = 6) and pouchitis (n = 7).