Restorative proctocolectomy (total proctocolectomy and ileal J pouch anal anastomosis) has been accepted as the operation of choice in the setting of chronic ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess operative safety and functional outcome after restorative proctocolectomy. A total of sixteen patients underwent surgery between January 1996 and December 1999. Hand sewn anastomosis with diverting ileostomy was performed in 9 patients and double stapled anastomosis in 7 patients. The underlying disease was ulcerative colitis in 9 cases and familial adenomatous polyposis in 7. Postoperative complications developed in 8 cases (50%), and intestinal obstruction was found in 4 cases (2 cases were operated upon). Anastomosis related complications were stenosis (n=2), leak (n=1) and perianal abscess (n=1). All patients were followed up at the outpatient clinic using questionnaires, with a mean follow up period of 19.9 months. The frequency of bowel movement was 8.2 per day in hand sewn anastomosis (HS), and 12 per day in double stapled anastomosis (DS) 3 months after surgery (period 1). This frequency decreased to 5.5 per day in HS, and 4.6 per day in DS after one year (period 2). Day and night continence was shown in 12/15, and 5/15, respectively in period 1, but improved to 10/11, and 10/11, respectively in period 2. Night time incontinence was noted in 10 of 15 patients in period 1 (seepage 3/15, soiling 7/15). The need to take anti-diarrheal medication, and to use a pad was noted in 2/15, and 10/15, respectively in period 1, but no patient took antidiarrheal medication or wore a protective pad in period 2. Postoperative urinary function was satisfactory in 13/14 patients. Postoperative sexual function was analyzed in a total of 8 patients, who showed good erection (5/5), ejaculation (5/5) and satisfactory sexual life (5/5). In females, 3 patients showed a satisfactory sexual life. In conclusion, restorative proctocolectomy for chronic ulcerative colitis and familial adenomatous polyposis can be performed safely with excellent functional outcomes, including bowel movement, urinary and sexual functions one year after surgery.
Adenomatous Polyposis Coli/surgery ; Adult ; Colitis, Ulcerative/surgery ; Defecation ; Ejaculation ; Female ; Human ; Male ; Patient Satisfaction ; Penile Erection ; Proctocolectomy, Restorative*/adverse effects ; Safety ; Sex Behavior ; Treatment Outcome

BACKGROUNDThe incidence of chronic ulcerative colitis (CUC) in China is remarkably increasing, while little information on surgical treatment has been reported. This study aimed to completely describe and analyze the clinical outcome of restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) for CUC in China.

METHODSNinety-five consecutive patients, who suffered CUC and had surgical indications, were carefully selected. All patients underwent IPAA. Data on patient characteristics, surgical indications, surgical details, postoperative complications, functional outcome, and quality of life were collected.

RESULTSThe mean patient age at the time of the operation was 32 years. Twenty-nine (31%) patients underwent an emergency operation, and 66 (69%) underwent elective procedures. Four patients with severe dysplasia underwent operations, but no carcinoma was histologically confirmed. A two-stage operation was performed in 87 (92%) patients, and a hand-sewn technique was applied in 88 (93%) patients. Sixteen patients (17.0%) experienced early complications, and there was a significant difference between the emergency surgery group and the elective group (31.0% vs. 10.6%, respectively; P < 0.01). Five (5.3%) patients developed pouchitis as a late complication. The mean stool frequency after the operation was 4.6 (2-11) during the first 24 hours and 1.5 (0-4) overnight. According to the Kirwan grading scale, 87 (91.8%) patients showed satisfactory anal continence function. The quality of life improved significantly from a preoperative mean value of 0.28-0.61 before ileostomy closure to 0.78 after ileostomy closure (P < 0.01) according to the Cleveland Global Quality of Life index.

CONCLUSIONSIPAA is an effective and safe surgical procedure for patients with CUC in China. However, some characteristics, such as the low incidence of pouchitis, require further study.

Adolescent ; Adult ; Anastomosis, Surgical ; adverse effects ; methods ; China ; Colitis, Ulcerative ; surgery ; Colonic Pouches ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Proctocolectomy, Restorative ; Young Adult