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”.