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Title
The Clinical Results of a Total Proctocolectomy with an Ileal Pouch-Anal Anastomosis: 12 Cases
Author
Gyoung Chun Lee, Seung Hyun Lee, Byung Kwon Ahn, Sung Uhn Baek
Place of duty
Publicationinfo
Journal of Korean Soc Coloproctol 2003 | Vol.19 No.1 | 6 ~ 12, 7 pages
Keyword
ÀüÁ÷°áÀåÀýÁ¦¼ú; JÇü ȸÀ島-Ç×¹® ¹®ÇÕ¼ú; ¼ú ÈÄ ÇÕº´Áõ; ±â´ÉÀû Æò°¡; Total proctocolectomy; Ileal pouch anal anastomosis; Postoperative complication; Functional outcomes;
Abstract
Purpose:
A restorative proctocolectomy has been accepted as the operation of choice for ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess the postoperative complications and functional outcomes
following a total proctocolectomy with a J ileal pouch-anal anastomosis.
Methods:
The medical records of 12 patients who had undergone a total proctocolectomy, with a J ileal pouch-anal anastomosis, between January 1997 and June 2002, were retrospectively reviewed according to sex, age, underlying disease and
postoperative complications. We evaluated the functional outcomes using medical record reviews and patients and telephone interviews.
Results:
Total proctocolectomy, with a J ileal pouch-anal anastomosis, were done for ulcerative colitis (n=2) and familial adenomatous polyposis (n=10). A diverting ileostomy was performed in 8 patients. Postoperative complications occurred
in 7
patients (58%), intestinal obstructions in 4 and complications related with anastomosis in 3, i.e. J ileal pouch leakage (n=2) and ileal pouch-vaginal fistula (n=1). Re-operations, due to postoperative complications, were performed in 4 patients,
i.e.
small bowel segmental resection (n=1), adhesiolysis (n=1), diverting ileostomy (n=1) and ileal pouch resection & reconstruction (n=1). The daily median defecation frequencies were 7.7 (range 4¡20) a month after the operation, 5.4 (3¡12) at 2¡3
months, 4.5 (3¡7) at 6 months and 4.1 (3¡5) at 12 months, following the operation. Two patients had gas incontinence, 1 had fluid incontinence, 4 had night soiling and 3 needed pads, but these incontinences, the need for anti-diarrhea medication
and
the use of pads, all improved within 6 months of the operation. Fluid incontinence and the use of pads improved within 3 months of the operation, gas incontinence and night soiling improved within 6 months of the operation. The mean length of
follow-up
was 30.6 months.
Conclusions:
The postoperative complication rate was 58%. Thirty-three percent of patients had fecal incontinence, but all these improved within 6 months. The long-term functional outcomes, after a total proctocolectomy with J ileal
pouch-anal
anastomosis, were satisfactory, and the postoperative complications acceptable. The postoperative complication rates were no different between the protective diverting ileostomy and non-ileostomy groups.
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ÀüÁ÷°áÀåÀýÁ¦¼ú; JÇü ȸÀ島-Ç×¹® ¹®ÇÕ¼ú; ¼ú ÈÄ ÇÕº´Áõ; ±â´ÉÀû Æò°¡; Total proctocolectomy; Ileal pouch anal anastomosis; Postoperative complication; Functional outcomes;