Restorative proctocolectomy with ileal pouch-anal anastomosis for refractory or fulminant ulcerative colitis: Functional outcomes

Background: Ulcerative colitis is a chronic inflammatory disease of the colon and rectum. During the course of their disease, about 30% of patients with ulcerative colitis (UC) will undergo proctocolectomy with ileal pouch-anal anastomosis (IPAA). Restorative proctocolectomy with IPAA is considered the procedure of choice for patients with UC requiring surgery.
Patients and methods: A prospective series of 20 patients from January 2004 till June 2008, presented with refractory or fulminant ulcerative colitis underwent restorative proctocolectomy with construction of J-pouch ileoanal anastomosis at Ain Shams University Hospitals and Ain Shams Specialized Hospital. The patients were 14 females (70%) and 6 males (30%) with an average age of 35.52±8.21 years (range: 24-48) years. Two-stage procedure was done in good risk patients while in high risk patients the three-stage procedure was adopted. The average follow up time was 34.21±15.32 months (range: 12-60) months. All patients were studied one month after closure of ileostomy with evacuation pouchography to assess the function and efficiency of evacuation of the pouch. In our study, the primary aim was to assess the postoperative complications as well as the functional outcome following restorative proctocolectomy with J- pouch ileoanal anastomosis for ulcerative colitis.
Results: The average postoperative hospital stay was 23.52±8.56 days (range: 10-32) days. Only 2 patients (10%) had the three-stage procedure, while 18 patients (90%) had the two-stage procedure. The average follow up time was 34.21±15.32 months (range: 12-60) months. No intra or postoperative mortalities. Nine patients (45%) had morbidities and all were managed conservatively. Six patients (30%) developed variable degrees of wound infection and one patient (5%) had minor anastomotic leak. Minor incontinence was recorded in 7 patients (35%) and it was significantly improved in 5 of them during the first 12-18 months after closure of ileostomy. Anastomotic stricture developed in two patients (10%), managed by repeated sessions of dilatation. Skin excoriation surrounding Ileostomy were found in four patients (20%).Two patients (10%) suffered from adhesive intestinal obstruction after closure of ileostomy. Recurrent pouchitis developed in six patients (30%) and was controlled by metronidazole. The efficiency of the pouch evacuation was highly dependent on each of the pouch anal angles during rest and during  straining.  The  final  functional  outcome  was  satisfactory  in  all  patients