Restorative compared with conventional proctocolectomy for the treatment of ulcerative colitis.

OBJECTIVE

To evaluate the clinical differences between conventional and restorative proctocolectomy in the treatment of ulcerative colitis.

DESIGN

Retrospective analysis.

SETTING

University hospital, Finland.

SUBJECTS

240 consecutive patients with ulcerative colitis who underwent elective proctocolectomy between 1976 and 1990.

INTERVENTIONS

Proctocolectomy and conventional ileostomy (n = 119) or restorative proctocolectomy (n = 121).

MAIN OUTCOME MEASURES

Early and late surgical morbidity and recovery time.

RESULTS

There were no postoperative deaths after restorative proctocolectomy and one patient (1%) died after conventional proctocolectomy. Two other patients (2%) with ileostomies died of late complications. Delayed perineal would healing after conventional ileostomy (n = 45, 38%) and either early (n = 31, 26%) or late (n = 19, 16%) defects of the ileoanal anastomosis after restorative proctocolectomy caused most problems. Reoperations (early or late) were needed in 45 (38%) and 44 (36%) patients after Brooke ileostomy and restorative proctocolectomy, respectively. Major complications, however, were more common and the duration of sick leave was a month longer in the pouch group.

CONCLUSION

Ulcerative colitis can safely be managed with either conventional or restorative proctocolectomy. In most cases the patient's preference should dictate the choice of procedure.