Abstract
One hundred consecutive patients treated by restorative proctocolectomy with construction of an ileo-anal anastomosis and a J-shaped (n=90) or an S-shaped ileal reservoir were studied prospectively to evaluate postoperative complications and functional outcome and to search for factors that might influence results. There were no deaths. Postoperative complications requiring surgery were pelvic sepsis (3 patients), pouch-related fistula (2), peritonitis following ileostomy closure (3) and small bowel obstruction (6), with an overall relaparotomy rate of 14%. The cumulative risk of pouchitis was 30% at 2 years. The average stool frequency decreased gradually, stabilising at about five evacuations/24 h after 1 year. At that time 9% of patients still had ≥7 day-time evacuations and 40% had night evacuations (>1/week). These parameters did not improve further with time. Mucous soiling, a frequent problem initially, also diminished with time, occurring in 30% of patients at 1 year. At 2 years, however, this mucous leak occurred in only 20%, suggesting that improvement of continence can be expected to occur even beyond one year. Despite defects in function patient satisfaction was generally excellent. So far only three patients have preferred conversion to an ileostomy. To establish which factors might influence the functional results a specially designed scoring system, combining all functional variables, was used. It was shown that results deteriorated with increasing age and that elderly women tended to have a poorer result than elderly men. Sex, previous parity or postoperative complications appeared not to affect the functional outcome. Male sexual disturbances occurred in 8%. Three had erectile problems and one loss of ejaculation. Female sexual dysfunction was frequent; dyspareunia and/or leaks during intercourse occurred in about 30%. These results confirm that resorative proctocolectomy with construction of an ileal pouch-anal anastomosis can be performed safely with a reasonable complication rate. Although patient satisfaction is often high, the functional results are not perfect, however, and further trials are in progress in this unit to determine whether results can be improved by altering the techniques for fashioning the pouch.
Similar content being viewed by others
References
Nicholls RJ (1987) Restorative proctocolectomy with various types of reservoir. World J Surg 11:751–762
Taylor BA, Dozois RR (1987) The J ileal pouch-anal anastomosis. World J Surg 11:727–734
Vasilevsky CA, Rothenberger DA, Goldberg SM (1987) The S ileal pouch-anal anastomosis. World J Surg 11:742–750
Cohen Z, McLeod RS, Stern H, Grant D, Nordgren S (1985) The pelvic pouch and ileoanal anastomosis procedure. Surgical technique and initial results. Am J Surg 150:601–607
Becker JM, Raymond IL (1986) Ileal pouch-anal anastomosis. A single surgeon's experience with 100 consecutive patients. Ann Surg 204:375–383
Parks AG, Nicholls RJ, Belliveau P (1980) Proctocolectomy with ileal reservoir and anal anastomosis. Br J Surg 67:533–538
Johnston D, Williams NS, Neal DE, Axon ATR (1981) The value of preserving the anal sphincter in operations for ulcerative colitis and polyposis: a review of 22 mucosal proctectomies. Br J Surg 68:874–878
Utsunomiya J, Iwama T, Imajo M, Matsuo S, Sawai S, Yaegashi K, Hirayama R (1980) Total colectomy, mucosal proctectomy, and ileoanal anastomosis. Dis Colon Rectum 23:459–466
Pemberton JH, Kelly KA, Beart RW, Dozois RR, Wolf BG, Ilstrup DM (1987) Ileal pouch-anal anastomosis for chronic ulcerative colitis. Long term result. Ann Surg 206:504–513
Fonkalsrud EW (1984) Endorectal ileoanal anastomosis with isoperistaltic ileal reservoir after colectomy and mucosal proctectomy. Ann Surg 199:151–157
Moskowitz RL, Shepherd NA, Nicholls RJ (1986) An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir. Int J Colorectal Dis 1:167–174
Pezim ME, Nicholls RJ (1985) Quality of life after restorative proctocolectomy with pelvic ileal reservoir. Br J Surg 72:31–33
Fasth S, Scaglia M, Nordgren S, Öresland T, Hultén L (1986) Restoration of intestinal continuity (pelvic pouch) after previous proctocolectomy with distal mucosal proctectomy. Int J Colorect Dis 1:256–258
Thow CB (1984) Single stage colectomy and mucosal proctectomy with stapled antiperistalting ileoanal reservoir. In: Dozois RR (ed) Alternatives to the conventional ileostomy. Year Book Medical Publishers, Chicago, pp 420–432
Fasth S, Hultén L (1984) Loop ileostomy: A superior diverting stoma in colorectal surgery. World J Surg 8:401–407
Lycke G, Hultén L, Jensen J, Öresland T (1987) The value of radiography of pelvic pouches prior to the closure of the protective loop ileostomy. Abstract. European Congress of Radiology. Lisboa, June 1987
Lindqvist K, Nilsell K, Liljeqvist L (1987) Cuff abscesses and ileoanal anastomotic separations in pelvic pouch surgery. An analysis of possible etiologic factors. Dis Colon Rectum 30:355–359
Thomas D, Raymond JL, Becker JM (1987) Management of the temporary loop ileostomy following colectomy, mucosal proctectomy and ileal pouch-anal anastomosis. J Enterostomal Ther 14:194–196
Metcalf AM, Dozois RR, Beart RW, Kelly KA, Wolf BG (1986) Temporary ileostomy for ileal pouch-anal anastomosis. Function and complications. Dis Colon Rectum 29:300–303
Aylett SO (1963) Ulcerative colitis treated by total colectomy and ileorectal anastomosis: a ten-year review. Proc R Soc Med 56:183–190
Watts J McK, de Dombal FT, Goligher JC (1966) The early results of surgery for ulcerative colitis. Br J Surg 53:1005–1014
Hultén L (1985) The continent ileostomy (Kock's pouch) versus the restorative proctocolectomy (pelvic-pouch). World J Surg 9:952–959
McHugh SM, Diamant NE, McLeod R, Cohen Z (1987) S-pouches vs. J-pouches. A comparison of functional outcomes. Dis Colon Rectum 30:671–677
Fleshman JW, Cohen Z, McLeod RS, Stern H, Blair J (1988) The ileal reservoir and ileoanal anastomosis procedure. Dis Colon Rectum 31:10–16
Snooks SJ, Swash M, Henry MM, Setchell M (1986) Risk factors in childbirth causing damage to the pelvic floor innervation. Int J Colorect Dis 1:20–24
Fasth S, Filipsson S, Hellberg R, Hultén L, Lindhagen J, Nordgren S (1978) Sexual dysfunction following proctocolectomy. Ann Chir Gynaecol 67:8–12
Metcalf AM, Dozois RR, Kelly KA (1986) Sexual function in women after proctocolectomy. Ann Surg 204:624–627
Keighley MRB (1987) Abdominal mucosectomy reduces the incidence of soiling and sphincter damage after restorative proctocolectomy and J-pouch. Dis Colon Rectum 30:386–390
Johnston D, Holdsworth PJ, Nasmyth DG, Neal DE, Primrose JN, Womack N, Axon ATR (1987) Preservation of the entire anal canal in conservative proctocolectomy for ulcerative colitis: A pilot study comparing end-to-end ileo-anal anastomosis without mucosal resection with mucosal proctectomy and endo-anal anastomosis. Br J Surg 74:940–944
Nicholls RJ, Pezim ME (1985) Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatosis polyposis: a comparison of three reservoir designs. Br J Surg 72:470–474
Hultén L, Fasth S, Nordgren S, Öresland T (1988) Kock's pouch converted to a pelvic pouch — a case report. Dis Colon Rectum 31:467–469
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Öresland, T., Fasth, S., Nordgren, S. et al. The clinical and functional outcome after restorative proctocolectomy. Int J Colorect Dis 4, 50–56 (1989). https://doi.org/10.1007/BF01648551
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01648551