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One-stage restorative proctocolectomy without temporary ileostomy for ulcerative colitis: a note of caution
M E Williamson1, W G Lewis, P M Sagar
1Academic Unit of Surgery and Centre for Digestive Diseases, The General Infirmary at Leeds, United Kingdom.
Diseases of the Colon and Rectum
|September 18, 1997
Summary
Omitting a temporary defunctioning ileostomy during restorative proctocolectomy for ulcerative colitis increases the risk of life-threatening complications. This one-stage procedure without an ileostomy is not recommended for routine use.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Colorectal Surgery
Background:
- Restorative proctocolectomy is a common surgical procedure for ulcerative colitis.
- The use of a temporary defunctioning ileostomy is a debated topic in this procedure.
Purpose of the Study:
- To evaluate the safety of omitting a temporary defunctioning ileostomy in patients undergoing restorative proctocolectomy for ulcerative colitis.
Main Methods:
- A comparative study of 100 patients with ulcerative colitis undergoing restorative proctocolectomy and pouch-anal anastomosis.
- 50 patients had a defunctioning ileostomy, while 50 underwent a one-stage procedure without ileostomy.
Main Results:
- No operative mortality was observed in either group.
- Patients without a defunctioning ileostomy had a higher incidence of life-threatening complications, including pelvic sepsis and need for reoperation (P < 0.01).
- While pelvic sepsis occurred in both groups, reoperation was significantly more common in the no-ileostomy group.
Conclusions:
- One-stage restorative proctocolectomy without a defunctioning ileostomy is associated with an increased risk to life.
- The routine omission of a defunctioning ileostomy in this patient population cannot be recommended.
- Careful patient selection and consideration of risk factors are crucial when deciding on ileostomy use.