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[Restorative proctocolectomy for ulcerative colitis and familial polyposis]
D Sofer1, A Shnaper, G Goldman
1Dept. of Surgery C, Ichilov Hospital, Sourasky-Tel Aviv Medical Center.
Harefuah
|September 1, 1995
Summary
Proctocolectomy with ileal pouch anal anastomosis is effective for ulcerative colitis and familial polyposis. A single-stage surgery using the double stapling technique improves outcomes and preserves continence.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Colorectal Surgery
Context:
- 35 proctocolectomies with ileal pouch anal anastomosis (IPAA) were performed between 1987-1994.
- Indications included ulcerative colitis (29 patients) and familial polyposis (6 patients).
- Mean ages at operation were 35 for ulcerative colitis and 25 for familial polyposis.
Purpose:
- To evaluate the outcomes and complications of IPAA.
- To identify surgical techniques and staging that optimize functional results and continence.
Summary:
- The most common complication was small bowel obstruction (25%), with 50% requiring re-operation. Pouchitis occurred in 17% and was managed with antibiotics.
- No mortality was observed. Spontaneous evacuation averaged 5 bowel movements daily.
- Continence was well-preserved with the double stapling technique, whereas rectal mucosal stripping led to mild impairment in 30%.
Impact:
- Recommends single-stage IPAA with the double stapling technique to reduce complications and preserve continence.
- Suggests staged operations for severely ill patients or those requiring rectal mucosal stripping.
- Highlights the importance of surgical technique in achieving optimal functional outcomes after IPAA for inflammatory bowel disease and polyposis.