Clinical and functional outcome after restorative proctocolectomy

Br J Surg. 1991 Sep;78(9):1039-44. doi: 10.1002/bjs.1800780905.


Restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has been carried out on 88 patients since 1982. Three different pouch designs (J, S and W) were used. Ten pouches had to be removed. Detailed analysis was performed on 61 patients (J = 23, S = 15, W = 23) whose pouches had been functioning for at least 6 months. There was no significant difference in surgical complications before or after ileostomy closure between pouch designs but the hospital stay was greater after construction of an S pouch (P less than 0.05). There were no significant differences in stool frequency, degree of continence or urgency between the three types. Twelve patients with J pouches required antidiarrhoeal medication compared with only one with S and five with W pouches. Only seven patients with S pouches could defaecate spontaneously compared with 22 with W pouches and all patients with J pouches (P less than 0.001). Twenty-five of 29 patients who had preservation of the anal transition zone had perfect continence compared with 23 of 32 with a mucosal proctectomy (P = n.s.). Pouchitis occurred in 13 patients, all of whom had ulcerative colitis. In a subgroup of 23 patients, pouch evacuation was assessed scintigraphically. There was no difference in pouch capacity or total volume evacuated, but spontaneous evacuation was better in J and W pouches compared with S pouches.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anal Canal / diagnostic imaging
  • Anal Canal / physiopathology*
  • Anastomosis, Surgical
  • Colonic Diseases / surgery
  • Defecation
  • Female
  • Humans
  • Ileitis / diagnostic imaging
  • Ileitis / etiology
  • Ileitis / physiopathology
  • Ileum / diagnostic imaging
  • Ileum / physiopathology*
  • Male
  • Middle Aged
  • Postoperative Complications / physiopathology*
  • Proctocolectomy, Restorative* / methods
  • Radionuclide Imaging
  • Reoperation