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 19 January 2018

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News

Removal of the pouch after failed restorative proctocolectomy

Pouch excision after failed restorative proctocolectomy is associated with high morbidity, find researchers in the June issue of Diseases of the Colon and Rectum.

News image

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Restorative proctocolectomy is the elective surgical procedure of choice for ulcerative colitis and familial adenomatous polyposis.

However, at 10 years 15% or more will have failed. These patients require indefinite defunctioning or excision of the pouch.

In this study, researchers from England assessed 996 patients who underwent a restorative proctocolectomy and 245 patients who were referred for potential salvage.

The team evaluated the 68 cases in which the pouch was excised (58 and 10 patients, respectively).
Overall morbidity rate was 62%.
Diseases of the Colon and Rectum

The research team found 1 postoperative death.

They calculated that the overall morbidity rate was 62%.

The team found that 54% of patients were readmitted on 67 occasions for a late complication. They calculated that the risk of readmission from the time of pouch excision was 38% at 1 year and 58% at 5 years.

Surgical treatment was required during 48 of these readmissions. The researchers determined that a persistent perineal sinus was the most common late complication.

The perineal wound was not healed at 6 months in 40% of cases, and at 12 months in 10%.

The team was unable to identify any factors associated with an unhealed perineal wound.

Dr Mehdi Karoui and colleagues concluded, “Pouch excision is associated with high morbidity”.

“Perineal wound-delayed healing is the commonest late complication and often requires further surgery”.

Dis Colon Rectum 2004; 47(6): 869-75
10 June 2004

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