Restorative proctocolectomy is the preferred elective surgical procedure for ulcerative colitis. The outcome is good in most patients but failures, which require either the removal of the pouch or indefinite ileostomy, do occur in some patients
The reasons and rates of failure shortly after surgey are well documented, but there is little information on long-term failure.
Dr Hagit Tulchinsky and colleagues in London, UK, reviewed a series of over 600 paients who underwent restorative proctocolectomy for inflammatory bowel disease between 1976-1997.
Dr Tulchinsky’s group examined the reasons for both early and late failures of restorative protocolectomy. Early failures were defined as occurring within the year after surgery and late failures were those which occurred over a year after surgery.
In total, failures occurred in 61 (9.7%) of the 634 patients. 25% of these failures were early failures and 75% were late failures.
The most common causes of late failure were pelvic sepsis (54%) and poor function (35%). Pouchitis accounted for 11% of late failures.
A final diagnosis of Crohn's disease, female gender, postoperative pelvic sepsis and a one-stage procedure were significantly associated with failure
|A final diagnosis of Crohn's disease, female gender, postoperative pelvic sepsis and a one-stage procedure were significantly associated with failure.|
|Annals of Surgery|
Dr Tulchinsky suggests that, in future, failures of restorative protocolectomy be reported based on the duration of follow up.