Abstract
PURPOSE: This study was designed to determine the safety of omitting a temporary defunctioning ileostomy in restorative proctocolectomy for ulcerative colitis. METHOD: One hundred consecutive patients with ulcerative colitis were treated electively by restorative proctocolectomy and pouch-anal anastomosis, without mucosal stripping; 50 had a defunctioning ileostomy added, and 50 underwent a one-stage procedure without ileostomy. RESULTS: There was no operative mortality. The incidence of postoperative complications was similar in the two groups of patients. Lifethreatening complications, however, were more common among patients who did not have a defunctioning ileostomy, of whom 11 developed pelvic sepsis and 7 required reoperation. Among patients with an ileostomy, seven developed pelvic sepsis but none required reoperation (P <0.02). Emergency reoperations were required in 11 patients without an ileostomy but in only 1 patient with an ileostomy (P <0.01). CONCLUSION: One-stage restorative proctocolectomy without a defunctioning ileostomy is associated with increased risk to life. Its routine use cannot be recommended.
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Read at the meeting of The American Society of Colon and Rectal Surgeons, Orlando, Florida, May 8 to 13, 1994.
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Williamson, M.E.R., Lewis, W.G., Sagar, P.M. et al. One-stage restorative proctocolectomy without temporary ileostomy for ulcerative colitis. Dis Colon Rectum 40, 1019–1022 (1997). https://doi.org/10.1007/BF02050922
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DOI: https://doi.org/10.1007/BF02050922