Abstract
A temporary ileostomy has been employed routinely by most medical centers to defunction the ileal reservoir after restorative proctocolectomy. The aim of this study was to compare the clinical outcome in patients who underwent restorative proctocolectomy with and without the use of a temporary, defunctioning ileostomy. A consecutive series of 58 patients was studied. Each patient underwent restorative proctocolectomy with quadruplicated ileal reservoir and stapled pouch-anal anastomosis, without mucosectomy; 28 had a temporary, defunctioning ileostomy and 30 did not. The decision for or against an ileostomy was taken at the end of the operation. The two groups of patients were similar in age and sex distribution. There was no postoperative mortality. There were no significant differences in the incidence of pelvic sepsis, anastomotic stricture, and intestinal obstruction in patients without an ileostomy compared with patients with an ileostomy. The total length of stay in hospital after the operation was significantly reduced in the group of patients without an ileostomy (P <0.01). The avoidance of a temporary ileostomy did not lead to an increase in postoperative complications and was associated with a shorter length of stay in hospital after restorative proctocolectomy.
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References
Scott NA, Dozois RR, Beart RW, 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.
Feinberg SM, McLeod RS, Cohen Z. Complications of loop ileostomy. Am J Surg 1987;153:102–7.
Johnston D, Williams NS, Neal DE, Axon AT. The value of preserving the anal sphincter in operations for ulcerative colitis and polyposis: a review of 22 mucosal proctectomies. Br J Surg 1981;68:874–8.
Nasmyth DG, Johnston D, Godwin PG, Dixon MF, Smith A, Williams NS. Factors influencing bowel function after ileal pouch-anal anastomosis. Br J Surg 1986;73:469–73.
Johnston D, Holdsworth PJ, Nasmyth DG,et al. 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 1987;74:940–4.
Fazio VW. Loop ileostomy and loop-end ileostomy. In: Dudley H, Carter DC, Russell RCG, eds. Atlas of general surgery. 2nd ed. London: Butterworths 1986:448–56.
Sagar PM, Holdsworth PJ, Johnston D. Correlation between laboratory findings and clinical outcome after restorative proctocolectomy for ulcerative colitis: serial studies in 20 patients with end-to-end pouch-anal anastomosis. Br J Surg 1991;78:67–70.
Thow GB. Single-stage colectomy and mucosal proctectomy with stapled antiperistaltic ileoanal reservoir. In: Dozois RR, ed. Alternatives to conventional ileostomy. Chicago: Year Book Medical Publishers, 1985:420–32.
Holdsworth PJ, Johnston D. Anal sensation after restorative proctocolectomy for ulcerative colitis. Br J Surg 1988;75:993–6.
Everett WG, Pollard SG. Restorative proctocolectomy without temporary ileostomy. Br J Surg 1990;77:621–2.
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Read at the meeting of The American Society of Colon and Rectal Surgeons, Boston, Massachusetts, May 12 to 17, 1991.
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Sagar, P.M., Lewis, W., Holdsworth, P.J. et al. One-stage restorative proctocolectomy without temporary defunctioning ileostomy. Dis Colon Rectum 35, 582–588 (1992). https://doi.org/10.1007/BF02050540
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DOI: https://doi.org/10.1007/BF02050540