Abstract
Sixty-nine patients were operated upon in a three-stage procedure. Early complications occurred in 29 percent after colectomy-ileostomy, in 25 percent after proctomucosectomy with ileoanal anastomosis and loop ileostomy, and in 9 percent after closure of loop ileostomy. Only three of these were considered serious. Seventy-one percent of the patients were readmitted into the hospital between the three operations or after the last one. Total hospital stay was 49 days (median); the range was 20 to 345 days. Reconstruction of the reservoir was performed in four patients owing to defecation problems, with satisfying functional results in two patients, while two emptied by catheter. There was no postoperative mortality or pelvic sepsis, and no pouches were excised. Ileostomy was re-established in two patients. At histopathologic reevaluation of colectomy specimens, the diagnosis was changed from ulcerative colitis to Crohn's disease in three patients and to indeterminate colitis in five. Median follow-up was 4.3 years. Continent anal defecation without ileostomy was achieved in 67 patients (97 percent), with 4.1 bowel movements per day and 0.6 per night. Perfect continence was achieved in 55 percent in the daytime and in 43 percent at night. The low rate of reservoirthreatening complications is attributed to the three-stage procedure and the technical details in the surgical procedures.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Parks AG, Nicholls RJ, Belliveau P. Proctocolectomy with ileal reservoir and anal anastomosis. Br J Surg 1980;67:533–8.
Lee EC, Dowling BL. Perimuscular excision of the rectum for Crohn's disease and ulcerative colitis. A conservation technique. Br J Surg 1972;59:29–32.
Martin LW, Torres AM, Fischer JE, Alexander F. The critical level for preservation of continence in the ileoanal anastomosis. J Pediatr Surg 1985;20:664–7.
Price AB. Overlap in the spectrum of nonspecific inflammatory bowel disease—“colitis indeterminate”. J Clin Pathol 1978;31:567–77.
Pezim ME, Pemberton JH, Beart RW Jr,et al. Outcome of “indeterminant” colitis following ileal pouch-anal anastomosis. Dis Colon Rectum 1989;32:653–8.
Hawley PR. Ileorectal anastomosis. Br J Surg 1985;72:75–6.
Dozois RR, Goldberg SM, Rothenberger DA,et al. Symposium. Restorative proctocolectomy with ileal reservoir. Int J Colorectal Dis 1986;1:2–19.
Pemberton JH, Kelly KA, Beart RW, Dozois RR, Wolff BG, Ilstrup DM. Ileal pouch-anal anastomosis for chronic ulcerative colitis. Ann Surg 1987;206:504–13.
Fleshman JW, Cohen Z, McLeod RS, Stern H, Blair J. The ileal reservoir and ileoanal anastomosis procedure: factors affecting technical and functional outcome. Dis Colon Rectum 1988;31:10–6.
Nicholls RJ, Holt SD, Lubowski DZ. Restorative proctocolectomy with ileal reservoir: comparison of twostagevs. three-stage procedures and analysis of factors that might affect outcome. Dis Colon Rectum 1989;32:323–6.
Becker JM, Raymond JL. Ileal pouch-anal anastomosis: a single surgeon's experience with 100 consecutive cases. Ann Surg 1986;204:375–83.
Öresland T, Fasth S, Nordgren S, Hultén L. The clinical and functional outcome after restorative proctocolectomy: a prospective study in 100 patients. Int J Colorectal Dis 1989;4:50–6.
Skarsgard ED, Atkinson KG, Bell GA, Pezim ME, Seal AM, Sharp FR. Function and quality of life results after ileal pouch surgery for chronic ulcerative colitis and familial polyposis. Am J Surg 1989;157:467–71.
Keighley MR, Winslet MC, Flinn R, Kmiot W. Multivariate analysis of factors influencing the results of restorative proctocolectomy. Z Gastroenterol [Verh] 1989;24:252–5.
Emblem R, Bergan A, Flatmark A. Mucosal proctectomy with straight ileoanal anastomosis: a comparison of two methods. Scand J Gastroenterol 1988;23:1165–72.
Luukkonen P, Järvinen H. Restorative proctocolectomy for ulcerative colitis. Ann Chir Gynaecol 1988;77:9–14.
Schoetz DJ Jr, Coller JA, Veidenheimer MC. Can the pouch be saved? Dis Colon Rectum 1988;31:671–5.
Wexner SD, Jensen L, Rothenberger DA, Wong WD, Goldberg SM. Long-term functional analysis of the ileoanal reservoir. Dis Colon Rectum 1989;32:275–81.
Francois Y, Dozois RR, Kelly KA,et al. Small intestinal obstruction complicating ileal pouch-anal anastomosis. Ann Surg 1989;209:46–50.
Scott NA, Dozois RR, Beart RW Jr, Pemberton JH, Wolff BG, Ilstrup DM. Postoperative intra-abdominal and pelvic sepsis complicating ileal pouch-anal anastomosis. Int J Colorectal Dis 1988;3:149–52.
Dozois RR, Kelly KA, Welling DR,et al. Ileal pouchanal anastomosis: comparison of results in familial adenomatous polyposis and chronic ulcerative colitis. Ann Surg 1989;210:268–73.
Svenberg T, Poppen B, Vesterberg K. Hartmann closure of rectum after abdominal colectomy for ulcerative colitis and familial polyposis coli. Coloproctology 1989;2:266–8.
Author information
Authors and Affiliations
Additional information
This work was supported by grants from The Medical Research Council of the Swedish Life Insurance Companies and grants from the Karolinska Institutet.
About this article
Cite this article
Poppen, B., Svenberg, T., Bark, T. et al. Colectomy-proctomucosectomy with S-pouch: Operative procedures, complications, and functional outcome in 69 consecutive patients. Dis Colon Rectum 35, 40–47 (1992). https://doi.org/10.1007/BF02053337
Issue Date:
DOI: https://doi.org/10.1007/BF02053337