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Restorative compared with conventional proctocolectomy for the treatment of ulcerative colitis
K Mikkola1, P Luukkonen, H J Järvinen
1Second Department of Surgery, Helsinki University Central Hospital, Finland.
Objective:
To evaluate the clinical differences between conventional and restorative proctocolectomy in the treatment of ulcerative colitis.
Design:
Retrospective analysis.
Setting:
University hospital, Finland.
Subjects:
240 consecutive patients with ulcerative colitis who underwent elective proctocolectomy between 1976 and 1990.
Interventions:
Proctocolectomy and conventional ileostomy (n = 119) or restorative proctocolectomy (n = 121).
Main Outcome Measures:
Early and late surgical morbidity and recovery time.
Results:
There were no postoperative deaths after restorative proctocolectomy and one patient (1%) died after conventional proctocolectomy. Two other patients (2%) with ileostomies died of late complications. Delayed perineal would healing after conventional ileostomy (n = 45, 38%) and either early (n = 31, 26%) or late (n = 19, 16%) defects of the ileoanal anastomosis after restorative proctocolectomy caused most problems. Reoperations (early or late) were needed in 45 (38%) and 44 (36%) patients after Brooke ileostomy and restorative proctocolectomy, respectively. Major complications, however, were more common and the duration of sick leave was a month longer in the pouch group.
Conclusion:
Ulcerative colitis can safely be managed with either conventional or restorative proctocolectomy. In most cases the patient's preference should dictate the choice of procedure.