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Omission of temporary diversion in restorative proctocolectomy--is it safe?
Omission of temporary diversion in restorative proctocolectomy--is it safe?
- Source :
-
Diseases of the colon and rectum [Dis Colon Rectum] 1993 Nov; Vol. 36 (11), pp. 1007-14. - Publication Year :
- 1993
-
Abstract
- Purpose: The aim of our study was to evaluate the safety and functional outcome of restorative proctocolectomy (RP) without diversion.<br />Methods: Fifty patients underwent RP without diversion for ulcerative colitis (82 percent), familial adenomatous polyposis (12 percent), and indeterminate colitis (6 percent). The perioperative course and functional outcome of these patients were compared with another group of 50 patients undergoing RP with diverting ileostomy during the same time period (1989-1991) and closely matched for age, gender, surgeon, diagnosis, extent and duration (median, 10 years) of colitis, prior colectomy (approximately 22 percent), steroid use (40 percent), type of pouch, distance of ileal pouch-anal anastomosis from the dentate line (median, 1.5 cm), and the duration of follow-up (median, 12 months). All patients had a stapled ileal pouch-anal anastomosis without mucosectomy and a smooth conduct of the operation.<br />Results: There was no operative mortality. Anastomotic leaks and pelvic abscess were more common in patients without ileostomy (7/50 or 14 percent vs. 2/50 or 4 percent); 8 of these 9 patients were taking > or = 20 mg of prednisone/day. Septic complications requiring relaparotomy (6 percent vs. 0 percent), prolonged ileus, and fever of unknown origin (10 percent vs. 4 percent) were also more common in patients without ileostomy. Despite similar functional results at 6 weeks and at 12 months after initial pouch function, patients without ileostomy had a poorer quality of life index (5 vs. 8; 10 being best) in the early period (0-6 weeks) of pouch function.<br />Conclusion: In equally favorable cases, RP without diversion is not as safe as RP with diversion, especially in patients taking > or = 20 mg of prednisone/day.
- Subjects :
- Adolescent
Adult
Aged
Child
Colitis surgery
Combined Modality Therapy
Female
Follow-Up Studies
Humans
Length of Stay
Male
Middle Aged
Postoperative Complications epidemiology
Prednisone therapeutic use
Premedication
Reoperation
Retrospective Studies
Time Factors
Treatment Outcome
Adenomatous Polyposis Coli surgery
Colitis, Ulcerative surgery
Ileostomy adverse effects
Postoperative Complications surgery
Proctocolectomy, Restorative
Subjects
Details
- Language :
- English
- ISSN :
- 0012-3706
- Volume :
- 36
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Diseases of the colon and rectum
- Publication Type :
- Academic Journal
- Accession number :
- 8223051
- Full Text :
- https://doi.org/10.1007/BF02047291