Experience with restorative proctocolectomy in 201 patients.

Two hundred and one patients underwent restorative proctocolectomy between January 1985 and January 1993. The underlying disease was ulcerative colitis in 191 and familial adenomatous polyposis in ten patients. All patients had a J pouch and, except for 22 patients, total mucosectomy was performed. The procedure was technically successful in 200 cases (99.5%). There was no postoperative mortality, but two patients died soon afterwards due to unrelated causes (suicide, upper gastrointestinal bleeding). Early postoperative complications were observed in 33% of patients and 21% required reoperations, most often because of haemorrhage or pelvic sepsis. Late morbidity rate was 29% including reoperations in 31 patients (17%) and conversion to permanent ileostomy in five cases (2.5%). The most common late problems were anal sinus, stricture or fistula (11%) and episodic or chronic pouchitis (20%). The functional result was evaluated in 150 patients followed up for one year. the mean bowel frequency was 5.6 times in 24 hours, 19% of patients had minor anal soiling and 11% required a protective pad. It is concluded that restorative proctocolectomy has become the first choice for most patients with ulcerative colitis and familial adenomatous polyposis.